Retrospective analysis of the endovascular and surgical treatment outcomes in 105 patients with cerebral arteriovenous malformation

Year 2024, Volume: 7 Issue: 3, 308 - 313, 27.05.2024

Tanin Oğur , Ahmet Deniz Belen , Ergün Dağlıoğlu , Özhan Merzuk Uçkun , Necati Üçler , Şahin Kırmızıgöz İnan Gezgin

https://doi.org/10.32322/jhsm.1465719

Abstract

Aims: We aimed to compare the short-term follow-up outcomes of treatment with liquid embolization agents in 105 patients with low- and medium-grade arteriovenous malformation (AVM) having supra- or infratentorial localization and its reliability and efficacy.
Methods: This retrospective study assessed patients diagnosed with grade I, II, III, IV, and V infratentorial AVM according to the Spetzler–Martin grading system who received endovascular treatment and underwent surgical resection. The pre-treatment, post-treatment, preoperative, postoperative, and follow-up data and the electronic radiograph findings, epicrisis reports, and clinical follow-up reports were recorded and examined.
Results: AVM was detected in 105 patients, who underwent 132 endovascular treatment sessions in total. Of the 105 patients, 47 were fed with a single venous system; 37 with two venous systems; and 21 with three or more venous systems. The mean follow-up duration was 28 months, and no patient presented with re-hemorrhage. Some of the complications associated with embolization were hemiparesis/hemiplegia, hemihypesthesia, hemorrhage and hematoma, vision disorders and alar defects, cranial nerve paralysis, and aphasia/dysphasia. Meanwhile, seven patients died after treatment.
Conclusion: AVM treatment generally includes usage of gamma knife, endovascular treatment, surgical resection, or the combination of such treatments. If surgical resection is performed, a complete and absolute outcome can be achieved. However, complete treatment can be rarely achieved with endovascular therapy alone. Higher morbidity and mortality rates were observed in patients with hemorrhage than in those without.

Keywords

Arteriovenous malformation, Endovascular treatment, Surgery, Complication

References

• Osborn AG. Osborn’s Brain Imaging, Pathology, and Anatomy. Lippincott Williams & Wilkins: 2012.
• Deshaies EM. Handbook of Neuroendovascular Surgery. Thieme Medical Publishers: 2012.
• Colby GP, Coon AL, Huang J, Tamargo RJ. Historical perspective of treatments of cranial arteriovenous malformations and duralarteriovenous fistulas. Neurosurg Clin N Am. 2012;23(1):15-25. doi: 10.1016/j.nec.2011.10.001
• Jeon HJ, Park KY, Kim SY, Lee JW, Huh SK, Lee KC. Surgical outcomes after classifying Grade III arteriovenous malformations according to Lawton’s modified Spetzler-Martin grading system. Clin Neurol Neurosurg. 2014;124:72-80. doi: 10.1016/j.clineuro.2014.06.017
• Wu C, Ansari SA, Honarmand AR, et al. Evaluation of 4D vascular flow and tissue perfusion in cerebral arteriovenous malformations: influence of Spetzler-Martin grade, clinical presentation, and AVM risk factors. AJNR Am J Neuroradiol. 2015;36(6):1142-1149. doi: 10.3174/ajnr.A4259
• Steiger HJ, Fischer I, Rohn B, Turowski B, Etminan N, Hänggi D. Microsurgical resection of Spetzler-Martin grades 1 and 2 unruptured brain arteriovenous malformations results in lower long-term morbidity and loss of quality-adjusted life-years (QALY) than conservative management--results of a single group series. Acta Neurochir (Wien). 2015;157(8):1279-1287. doi: 10.1007/s00701-015-2474-9
• Lawton MT, Kim H, McCulloch CE, et al. A supplementary grading scale for selecting patients with brain arteriovenous malformations for surgery. Neurosurgery. 2010;66(4):702-713. doi: 10.1227/01.NEU.0000367555.16733
• Bradac O, Charvat F, Benes V. Treatment for brain arteriovenous malformation in the 1998-2011 period and review of the literature. Acta Neurochir (Wien). 2013;155(2):199-209. doi: 10.1007/s00701-012-1572-1
• Morgan MK, Rochford AM, Tsahtsarlis A, Little N, Faulder KC. Surgical risks associated with the management of Grade I and II brain arteriovenous malformations. Neurosurgery. 2004; 54(4):832-837.
• Nair AP, Kumar R, Mehrotra A, Srivastava AK, Sahu RN, Nair P. Clinical, radiological profile and outcome in pediatric Spetzler-Martin grades I-III arteriovenousmal formations. Childs Nerv Syst. 2012;28(4):593-598. doi: 10.1007/s00381-011-1668-6
• Pandey P, Marks MP, Harraher CD, et al. Multimodality management of Spetzler-Martin grade III arteriovenous malformations. J Neurosurg. 2012;116(6):1279-1288. doi: 10.3171/2012.3.JNS111575
• Zhao J, Yu T, Wang S, Zhao Y, Yang WY. Surgical treatment of giant intracranial arteriovenous malformations. Neurosurgery. 2010;67(5):1359-1370. doi: 10.1227/NEU.0b013e3181eda216
• Appelboom G, Hwang BY, Bruce SS, et al. Predicting outcome after arteriovenous malformation associated intracerebral hemorrhage with the original ICH score. World Neurosurg. 2012; 78(6):646-650. doi: 10.1016/j.wneu.2011.12.001
• Bir SC, Maiti TK, Konar S, Nanda A. Overall outcomes following early interventions for intracranial arteriovenous malformations with hematomas. J Clin Neurosci. 2016;23:95-100. doi: 10.1016/j.jocn.2015.05.041
• Pierot L, Kadziolka K, Litré F, Rousseaux P. Combined treatment of brain AVMs with use of Onyx embolization followed by radiosurgery. AJNR Am J Neuroradiol. 2013;34(7):1395-1400. doi: 10.3174/ajnr.A3409
• Potts MB, Zumofen DW, Raz E, Nelson PK, Riina HA. Curing arteriovenous malformations using embolization. Neurosurg Focus. 2014;37(3):E19. doi: 10.3171/2014.6.FOCUS14228
• Elsenousi A, Aletich VA, Alaraj A. Neurological outcomes and cure rates of embolization of brain arteriovenous malformations with n-butyl cyanoacrylate or Onyx: a meta-analysis. J Neurointerv Surg. 2014;8(3):265-272. doi: 10.1136/neurintsurg-2014-011427
• Westphal M, Cristante L, Grzyska U, et al. Treatment of cerebral arteriovenous malformations by neuroradiological intervention and surgical resection. Acta Neurochir (Wien). 1994;130(1-4):20-27.
• Xu F, Ni W, Liao Y, et al. Onyx embolization for the treatment of brain arteriovenous malformations. Acta Neurochir (Wien). 2011;153(4):869-878. doi: 10.1007/s00701-010-0848-6
• n-BCA Trail Investigators. N-butyl cyanoacrylate embolization of cerebral arteriovenous malformations: results of a prospective, randomized, multi-center trial. AJNR Am J Neuroradiol. 2002; 23(5):748-755.
• Hartmann A, Stapf C, Hofmeister C, et al. Determinants of neurological outcome after surgery for brain arteriovenous malformation. Stroke. 2000;31(10):2361-2364.
• Mohr JP, Parides MK, C Stapf, et al. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet. 2014;383(9917):614-621. doi: 10.1016/S0140-6736(13)62302-8
• Rodríguez-Hernández A, Kim H, Pourmohamad T, et al. University of California, San Francisco Arteriovenous Malformation Study Project: Cerebellar arteriovenous malformations: anatomic subtypes, surgical results, and increased predictive accuracy of the supplementary grading system. Neurosurgery. 2012;71(6):1111-1124. doi: 10.1227/NEU.0b013e318271c081