Objectives

Brain arteriovenous malformations (AVMs) represent high-flow vascular lesions made up of a complex network of feeding arteries and draining veins interposed by a nidus and without a capillary bed. The management of the AVMs represents a challenge, and the optimal treatment should be considered based on the particularities of each AVM. This paper aims to provide outcome data for the cohort of patients with AVMs that underwent surgical treatment.

Methods

A retrospective review of patients who presented with AVMs between 2001 and 2019 was conducted. Patients were included if they underwent surgery, preoperative and postoperative angiographic studies were available.

Results

91 patients were included. The SM grade was 1 in 16 cases (17,6%), 2 in 27 patients (29.7%), 3 in 29 patients (31,9%), 4 in 12 cases (13.2%) and grade 5 in 7 cases (7.7%). In 58 (63.7%) cases the AVMs were ruptured. Complete microsurgical resection was achieved in 82 cases (90.1%). Unruptured AVM (87.9% vs. 63.8% for ruptured AVMs; p = 0.015), low-grade AVM (86% vs. 60.4% for grade III–V AVMs; p = 0.006) and cortical location (79.5% vs. 30.8% for deep AVM; p < 0.0001) were the factors associated with a good outcome on mRS scale.

Conclusions

Microsurgical resection is the curative treatment for AVMs and offers a good functional outcome if selection criteria are met.

中文翻译：

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有症状的脑AVM的显微外科手术方法–单中心经验

目标

脑动静脉畸形（AVM）代表高流量血管病变，由病变血管和不穿毛细血管床插入的复杂的进食动脉和引流网络组成。AVM的管理是一个挑战，应根据每个AVM的特殊性考虑最佳治疗方法。本文旨在为接受手术治疗的AVM患者队列提供结果数据。

方法

对2001年至2019年期间出现AVM的患者进行了回顾性审查。如果患者接受了手术，则将其包括在内，可以进行术前和术后血管造影研究。

结果

包括91例患者。SM等级为16例中的1例（17.6％），27例中的2例（29.7％），29例中的3例（31,9％），12例中的4例（13.2％）和5例中的7例（ 7.7％）。在58例（63.7％）的病例中，AVM破裂了。82例（90.1％）完全显微手术切除。未破裂的AVM（破裂的AVM分别为87.9％和63.8％； p = 0.015），低等级的AVM（III-V级AVM分别为86％和60.4％； p = 0.006）和皮质位置（79.5％相比30.8％）对于深层AVM； p <0.0001）是与mRS量表良好结局相关的因素。

结论

显微手术切除是AVM的治疗方法，如果符合选择标准，则可提供良好的功能预后。