Surgical outcomes after classifying Grade III arteriovenous malformations according to Lawton’s modified Spetzler–Martin grading system
Autor: | Seung Kon Huh, Keun Young Park, Kyu Chang Lee, Hong Jun Jeon, Jae Whan Lee, So Yeon Kim |
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Rok vydání: | 2014 |
Předmět: |
Adult
Intracranial Arteriovenous Malformations Male Microsurgery medicine.medical_specialty medicine.medical_treatment Treatment outcome Radiosurgery Severity of Illness Index Complete resection Neurosurgical Procedures Young Adult Surgical obliteration Modified Rankin Scale Humans Medicine business.industry Mortality rate General Medicine Middle Aged Incomplete Resection Surgery Surgical morbidity Treatment Outcome Female Neurology (clinical) business Craniotomy |
Zdroj: | Clinical Neurology and Neurosurgery. 124:72-80 |
ISSN: | 0303-8467 |
DOI: | 10.1016/j.clineuro.2014.06.017 |
Popis: | Objective We aimed to evaluate microsurgical outcomes after classifying Grade III arteriovenous malformations (AVMs) according to Lawton’s modified Spetzler–Martin grading system. Methods Of 131 patients with Grade III AVMs, 55 had undergone microsurgery between 1995 and 2010. The 55 AVMs were classified as follows: Grade III−/S1E1V1, Grade III/S2E0V1, Grade III+/S2E1V0, or Grade III*/S3E0V0. The surgical obliteration rate, morbidity rate, and functional outcomes for each subtype were compared before surgery and after follow-up. Additionally, factors related with morbidity were investigated from demographic and morphological characteristics. Results We observed 18 Grade III−, 16 Grade III, 20 Grade III+, and 1 Grade III* AVMs. Complete resection was achieved in 49 patients (obliteration rate, 89.1%). Incomplete resection rates were higher for Grade III (12.5%) and III+ (15.0%) AVMs than that for Grade III− (5.6%) AVMs. Seven patients (12.7%) presented postoperative deficits, of which 3 (5.4%) experienced disabilities. Patients with Grade III+ (25.0%) had higher morbidity rates than those with other subtypes. Modified Rankin scale scores at the last follow-up indicated unfavorable outcomes for Grades III (18.8%) and III+ (25.0%) AVMs. AVM size (≥3 cm) and non-hemorrhagic type were associated with the occurrence of postoperative deficits ( p Conclusion The modified classification of Grade III AVMs was useful to predict surgical morbidity and clinical outcomes. We recommend that microsurgery should be used to treat Grade III− AVMs, but should be considered carefully for the treatment of Grades III and III+. |
Databáze: | OpenAIRE |
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