Microsurgery for cerebral arteriovenous malformations: postoperative outcomes and predictors of complications in 264 cases

A total of 264 patients with cerebral arteriovenous malformation were treated with microsurgical resection between 1994 and 2010 at the Jefferson Hospital for Neuroscience. Initial hemorrhage, clinical presentation, Spetzler-Martin AVM grading system (SM), treatment modalities, clinical outcomes, and obliteration rates were reviewed.
Univariate analysis and multivariate analysis were used to determine predictors of operative complications.
Of the 264 patients treated with microsurgery, 120 (45%) patients initially presented with hemorrhage. There were 27 SM Grade I lesions (10.2%), 101 Grade II lesions (38.3%), 96 Grade III lesions (36.4%), 31 Grade IV lesions (11.7%), and 9 Grade V lesions (3.4%). Among these patients, 102 (38.6%) had undergone prior endovascular embolization. In all patients, resection resulted in complete obliteration of the AVM. Complications occurred in 19 (7.2%) patients and resulted in permanent neurological deficits in 5 (1.9%). In multivariate analysis, predictors of complications were increasing AVM size (OR 3.2, 95% CI 1.5-6.6; p = 0.001), increasing number of embolizations (OR 1.6, 95% CI 1.1-2.2; p = 0.01), and unruptured cerebral arteriovenous malformation (OR 2.7, 95% CI 1-7.2; p = 0.05).
Microsurgical resection of AVMs is highly efficient and can be undertaken with low rates of morbidity at high-volume neurovascular centers. Unruptured and larger AVMs were associated with higher complication rates 1).

1) Theofanis T, Chalouhi N, Dalyai R, Starke RM, Jabbour P, Rosenwasser RH, Tjoumakaris S. Microsurgery for cerebral arteriovenous malformations: postoperative outcomes and predictors of complications in 264 cases. Neurosurg Focus. 2014 Sep;37(3):E10. doi: 10.3171/2014.7.FOCUS14160. PubMed PMID: 25175429.

Top Read: Predictors of outcome after treatment of mild traumatic brain injury: a pilot study.

J Head Trauma Rehabil. 2014 Mar-Apr;29(2):109-16. doi: 10.1097/HTR.0b013e3182860506.

Predictors of outcome after treatment of mild traumatic brain injury: a pilot study.

Abstract

OBJECTIVE:

To determine factors affecting outcome of comprehensive outpatient rehabilitation of individuals who sustained a mild traumatic brain injury.

PARTICIPANTS:

From a 4-year series of referrals, 49 nonconsecutive participants met criteria for mild traumatic brain injury (ie, loss of consciousness <30 minutes, Glasgow Coma Scale score >12).

SETTING:

Outpatient, community-based postconcussion clinic at a rehabilitation hospital.

MAIN MEASURES:

Participants and therapy staff completed the Mayo-Portland Adaptability Inventory-Fourth Edition (MPAI-4) at the initiation and conclusion of treatment. Participants were also administered the Trail Making Test at the start of treatment.

RESULTS:

Participants generally gave poorer adaptability ratings than staff at the beginning and discharge of treatment. Regression analyses revealed that after controlling for baseline ratings, psychiatric history was associated with worse participant-rated MPAI-4 Adjustment scores at treatment discharge, whereas better Trail Making Test Part B performance at initiation of treatment predicted better participant-rated MPAI-4 Ability at treatment discharge.

CONCLUSIONS:

Premorbid demographic and baseline neurocognitive factors should be taken into account prior to comprehensive treatment of mild traumatic brain injury, as they can influence long-term outcomes. Adaptability ratings from both staff and participants can be useful in gaining different perspectives and assessing factors affecting recovery.

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