Microsurgical resection of brain arteriovenous malformations in the elderly: outcomes analysis and risk stratification

Abstract

As the population ages, the question of how to manage brain arteriovenous malformations in the elderly becomes increasingly relevant. Is resection a reasonable option for these patients? In this study, the authors examined the outcomes of surgical patients 60 years or older and found that favorable outcomes were achieved with careful patient selection. Preoperative grading scales were more predictive of outcomes in patients older than 65 years than in those 60-65 years of age.

Keywords: AVM = arteriovenous malformation; LFU = last follow-up; Lawton-Young grading system; SM = Spetzler-Martin; Spetzler-Martin grading system; arteriovenous malformation; elderly; mRS = modified Rankin Scale; microsurgical resection; supplemented Spetzler-Martin grading; vascular disorders.

FIG. 1.

Bar graph showing that the mRS scores in both patient age groups were comparable before surgery (p = 0.07) (A), with a significantly better mRS score at LFU for those 60–65 years (B). Both groups gained more favorable outcomes (mRS scores 0–2) after surgery (C). Favorable outcome (dichotomized as mRS scores 0–2 vs 3–6) was significantly higher in patients 60–65 years (D).

FIG. 2.

Dichotomized outcome (favorable [mRS scores 0–2] vs unfavorable [mRS scores 3–6]) based on SM grade (A and B) and supplemented SM grade (C and D) for patients 60–65 years (A and C) and those older than 65 years (B and D). Patients older than 65 years showed a significantly dependent outcome on SM grade (p = 0.041) and a borderline significantly dependent outcome on supplemented SM grade (p = 0.06).