The efficacy of surgical treatment of cerebral arteriovenous malformations in a single academic institution: a case series

Abstract

Aim: To report on patients who underwent surgical treatment of arteriovenous malformations (AVMs) at our institution.

Methods: This retrospective single-center case series enrolled the patients who underwent surgical treatment of pial AVM at the Department of Neurosurgery, University Hospital Brno, between 2005 and 2019. The data are summarized as descriptive statistics presenting basic characteristics in all the patients and in sex or age subgroups.

Results: Fifty patients were enrolled. The majority of AVMs were of Spetzler-Martin grade II (n=27; 54%), localized supratentorialy (n=43; 86%), and half of AVMs were ruptured. A total resection was performed in 48 patients (96%), and a good overall outcome was achieved in 44 patients (88%). Surgery-associated morbidity was 2%, and the mortality rate was 0% due to meticulous selection of patients for surgical treatment.

Conclusion: Microsurgery is an appropriate method of treatment for S-M grade I-III pial AVMs. Microsurgery may be used to treat the majority of small-nidus AVMs with a low mortality and morbidity, when precisely planned and performed by an expert vascular team. The meticulous selection of patients for surgical treatment is crucial.

Figure 1

An illustrative case of a typical patient who underwent surgical treatment of arteriovenous malformations (AVM). A 44-year-old man with a history of sudden severe headache and nausea was referred by his general practitioner to the regional hospital. Computed tomography (CT) and CT angiogram revealed right temporo-occipital intracerebral hematoma caused by the AVM, Spetzler Martin grade II (A). The patient was admitted to the neurosurgical ICU and was neurologically intact. Angiography confirmed temporo-occipital AVM, fed mainly by posterior cerebral artery (B) on the right and terminal branches of the middle cerebral artery (C). There was also very subtle filling of the AVM from the occipital artery. Because of stable and intact neurological condition, endovascular preoperative embolization of the AVM was performed two weeks after the bleeding with almost total occlusion of the AVM after the intervention. The following day, the AVM was removed microsurgically, through navigated craniotomy and excision. On the fourth postoperative day, angiography showed total removal of the AVM without any filling (D). The course of the inpatient stay was uneventful, and the patient remained neurologically intact.