Significance of factors contributing to surgical complications and to late outcome after elective surgery of cerebral arteriovenous malformations
- Dr Carlo Schaller, Department of Neurosurgery, University of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany. Telephone 0049 228 287 6501; fax 0049 228 287 6573; email schaller{at}mailer.meb.uni-bonn.de
- Received 18 June 1997
- Revised 9 March 1998
- Accepted 31 March 1998
Abstract
OBJECTIVES This study focuses on the relevance of size, eloquence, type of venous drainage, the Spetzler-Martin scale as a whole, and other factors, such as rupture of cerebral arteriovenous malformations (AVMs) for the prediction of neurological deficits in the context of microsurgical AVM removal.
METHODS One hundred and fifty patients with AVMs, whose data were retrieved from a prospectively employed computerised data bank were included. Seventeen patients (11.3%) underwent preoperative embolisation. According to the Spetzler-Martin scale they were graded as follows: 22.0% grade I, 32.0% grade II, 29.3% grade III, 14.0% grade IV, and 2.7% grade V. Intracerebral haemorrhage was present in 39.0%. The AVMs were <3 cm in 52.0%, 3–6 cm in 43.3% and >6 cm in 4.7%; 59.3% of the AVMs were eloquently located and 29.3% had deep venous drainage (DVD). Follow up information was assessed 6 months after surgery in all but one patient, who died. The applied statistical test was χ2.
RESULTS Surgical morbidity was 15.3%. Early new deficits were noted in 39.3%, permanent new deficits in 10.6%, being significant (major) in 7.3%. The ocurrence of permanent deficits correlated significantly with size, deep venous drainage, and the Spetzler-Martin scale. There was statistical evidence for a trend in risk of poor surgical outcome across the three categories non-eloquent, “less eloquent” (for example, visual cortex) and “highly eloquent” (brainstem, basal ganglia, or precentral cortex) with the last being associated with the highest risk for permanent neurological compromise.
CONCLUSION “Eloquence” of the Spetzler-Martin scale should be divided into “highly eloquent” and “less eloquent”, which is important for risk analysis of the treatment of asymptomatic and deep seated AVMs and for future trials comparing various treatment modalities. In addition, resection of eloquent AVMs v non-eloquent ones is significantly associated with higher surgical morbidity.
