Safety and Efficacy of Surgical Resection of Unruptured Low-grade Arteriovenous Malformations From the Modern Decade

Karam Moon, Michael R. Levitt, Rami O. Almefty, Peter Nakaji, Felipe C. Albuquerque, Joseph M. Zabramski, John E. Wanebo, Cameron McDougall, Robert F. Spetzler

Research output: Contribution to journalArticle

Abstract

Background: Recent studies have questioned the utility of surgical resection of unruptured brain arteriovenous malformations (bAVMs). Objective: We performed an assessment of outcomes and complications of surgical resection of low-grade bAVMs (Spetzler-Martin grade I or II) at a single high-volume neurosurgical center. Methods: We reviewed all unruptured low-grade bAVMs treated with surgery (with or without preoperative embolization) between January 2004 and January 2014. Stroke rate, mortality, and clinical and radiographic outcomes were examined. Results: Of 95 patients treated surgically, 85 (25 grade I, 60 grade II) met inclusion criteria, and all achieved radiographic cure postoperatively. Ten patients (11.8%) were lost to follow-up; the mean follow-up of the remaining 85 was 3.3 years. Three patients (3.5%) with grade II bAVMs experienced a stroke; no patients died. Although 20 patients (23.5%) had temporary postoperative neurological deficit, only 3 (3.5%) had new clinical impairment (modified Rankin Scale score ≥2) at last follow-up. Eight of the 13 patients (61.5%) with preexisting clinical impairment had improved modified Rankin Scale scores of 0 or 1; and 17 of 30 patients (56.7%) with preoperative seizures were seizure-free without antiepileptic medication postoperatively. No significant differences existed in stroke rate or clinical outcome between grades I and II patients at follow-up (Fisher exact test, P .55 and P >.99, respectively). Conclusion: Surgical resection of low-grade unruptured bAVMs is safe, with a high rate of improvement in functional status and seizure reduction. Although transient postoperative neurological deficit was observed in some patients, permanent treatment-related neurological morbidity was rare.

Original languageEnglish (US)
Pages (from-to)948-952
Number of pages5
JournalNeurosurgery
Volume77
Issue number6
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

Fingerprint

Arteriovenous Malformations
Safety
Brain
Seizures
Stroke
Lost to Follow-Up
Anticonvulsants
Outcome Assessment (Health Care)
Morbidity
Mortality

Keywords

  • Arteriovenous malformation
  • Embolization
  • Surgical resection

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Moon, K., Levitt, M. R., Almefty, R. O., Nakaji, P., Albuquerque, F. C., Zabramski, J. M., ... Spetzler, R. F. (2015). Safety and Efficacy of Surgical Resection of Unruptured Low-grade Arteriovenous Malformations From the Modern Decade. Neurosurgery, 77(6), 948-952. https://doi.org/10.1227/NEU.0000000000000968

Safety and Efficacy of Surgical Resection of Unruptured Low-grade Arteriovenous Malformations From the Modern Decade. / Moon, Karam; Levitt, Michael R.; Almefty, Rami O.; Nakaji, Peter; Albuquerque, Felipe C.; Zabramski, Joseph M.; Wanebo, John E.; McDougall, Cameron; Spetzler, Robert F.

In: Neurosurgery, Vol. 77, No. 6, 01.01.2015, p. 948-952.

Research output: Contribution to journalArticle

Moon, K, Levitt, MR, Almefty, RO, Nakaji, P, Albuquerque, FC, Zabramski, JM, Wanebo, JE, McDougall, C & Spetzler, RF 2015, 'Safety and Efficacy of Surgical Resection of Unruptured Low-grade Arteriovenous Malformations From the Modern Decade', Neurosurgery, vol. 77, no. 6, pp. 948-952. https://doi.org/10.1227/NEU.0000000000000968
Moon, Karam ; Levitt, Michael R. ; Almefty, Rami O. ; Nakaji, Peter ; Albuquerque, Felipe C. ; Zabramski, Joseph M. ; Wanebo, John E. ; McDougall, Cameron ; Spetzler, Robert F. / Safety and Efficacy of Surgical Resection of Unruptured Low-grade Arteriovenous Malformations From the Modern Decade. In: Neurosurgery. 2015 ; Vol. 77, No. 6. pp. 948-952.
@article{2f4afcd067944a7c8709cb7bca95c985,
title = "Safety and Efficacy of Surgical Resection of Unruptured Low-grade Arteriovenous Malformations From the Modern Decade",
abstract = "Background: Recent studies have questioned the utility of surgical resection of unruptured brain arteriovenous malformations (bAVMs). Objective: We performed an assessment of outcomes and complications of surgical resection of low-grade bAVMs (Spetzler-Martin grade I or II) at a single high-volume neurosurgical center. Methods: We reviewed all unruptured low-grade bAVMs treated with surgery (with or without preoperative embolization) between January 2004 and January 2014. Stroke rate, mortality, and clinical and radiographic outcomes were examined. Results: Of 95 patients treated surgically, 85 (25 grade I, 60 grade II) met inclusion criteria, and all achieved radiographic cure postoperatively. Ten patients (11.8{\%}) were lost to follow-up; the mean follow-up of the remaining 85 was 3.3 years. Three patients (3.5{\%}) with grade II bAVMs experienced a stroke; no patients died. Although 20 patients (23.5{\%}) had temporary postoperative neurological deficit, only 3 (3.5{\%}) had new clinical impairment (modified Rankin Scale score ≥2) at last follow-up. Eight of the 13 patients (61.5{\%}) with preexisting clinical impairment had improved modified Rankin Scale scores of 0 or 1; and 17 of 30 patients (56.7{\%}) with preoperative seizures were seizure-free without antiepileptic medication postoperatively. No significant differences existed in stroke rate or clinical outcome between grades I and II patients at follow-up (Fisher exact test, P .55 and P >.99, respectively). Conclusion: Surgical resection of low-grade unruptured bAVMs is safe, with a high rate of improvement in functional status and seizure reduction. Although transient postoperative neurological deficit was observed in some patients, permanent treatment-related neurological morbidity was rare.",
keywords = "Arteriovenous malformation, Embolization, Surgical resection",
author = "Karam Moon and Levitt, {Michael R.} and Almefty, {Rami O.} and Peter Nakaji and Albuquerque, {Felipe C.} and Zabramski, {Joseph M.} and Wanebo, {John E.} and Cameron McDougall and Spetzler, {Robert F.}",
year = "2015",
month = "1",
day = "1",
doi = "10.1227/NEU.0000000000000968",
language = "English (US)",
volume = "77",
pages = "948--952",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Safety and Efficacy of Surgical Resection of Unruptured Low-grade Arteriovenous Malformations From the Modern Decade

AU - Moon, Karam

AU - Levitt, Michael R.

AU - Almefty, Rami O.

AU - Nakaji, Peter

AU - Albuquerque, Felipe C.

AU - Zabramski, Joseph M.

AU - Wanebo, John E.

AU - McDougall, Cameron

AU - Spetzler, Robert F.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background: Recent studies have questioned the utility of surgical resection of unruptured brain arteriovenous malformations (bAVMs). Objective: We performed an assessment of outcomes and complications of surgical resection of low-grade bAVMs (Spetzler-Martin grade I or II) at a single high-volume neurosurgical center. Methods: We reviewed all unruptured low-grade bAVMs treated with surgery (with or without preoperative embolization) between January 2004 and January 2014. Stroke rate, mortality, and clinical and radiographic outcomes were examined. Results: Of 95 patients treated surgically, 85 (25 grade I, 60 grade II) met inclusion criteria, and all achieved radiographic cure postoperatively. Ten patients (11.8%) were lost to follow-up; the mean follow-up of the remaining 85 was 3.3 years. Three patients (3.5%) with grade II bAVMs experienced a stroke; no patients died. Although 20 patients (23.5%) had temporary postoperative neurological deficit, only 3 (3.5%) had new clinical impairment (modified Rankin Scale score ≥2) at last follow-up. Eight of the 13 patients (61.5%) with preexisting clinical impairment had improved modified Rankin Scale scores of 0 or 1; and 17 of 30 patients (56.7%) with preoperative seizures were seizure-free without antiepileptic medication postoperatively. No significant differences existed in stroke rate or clinical outcome between grades I and II patients at follow-up (Fisher exact test, P .55 and P >.99, respectively). Conclusion: Surgical resection of low-grade unruptured bAVMs is safe, with a high rate of improvement in functional status and seizure reduction. Although transient postoperative neurological deficit was observed in some patients, permanent treatment-related neurological morbidity was rare.

AB - Background: Recent studies have questioned the utility of surgical resection of unruptured brain arteriovenous malformations (bAVMs). Objective: We performed an assessment of outcomes and complications of surgical resection of low-grade bAVMs (Spetzler-Martin grade I or II) at a single high-volume neurosurgical center. Methods: We reviewed all unruptured low-grade bAVMs treated with surgery (with or without preoperative embolization) between January 2004 and January 2014. Stroke rate, mortality, and clinical and radiographic outcomes were examined. Results: Of 95 patients treated surgically, 85 (25 grade I, 60 grade II) met inclusion criteria, and all achieved radiographic cure postoperatively. Ten patients (11.8%) were lost to follow-up; the mean follow-up of the remaining 85 was 3.3 years. Three patients (3.5%) with grade II bAVMs experienced a stroke; no patients died. Although 20 patients (23.5%) had temporary postoperative neurological deficit, only 3 (3.5%) had new clinical impairment (modified Rankin Scale score ≥2) at last follow-up. Eight of the 13 patients (61.5%) with preexisting clinical impairment had improved modified Rankin Scale scores of 0 or 1; and 17 of 30 patients (56.7%) with preoperative seizures were seizure-free without antiepileptic medication postoperatively. No significant differences existed in stroke rate or clinical outcome between grades I and II patients at follow-up (Fisher exact test, P .55 and P >.99, respectively). Conclusion: Surgical resection of low-grade unruptured bAVMs is safe, with a high rate of improvement in functional status and seizure reduction. Although transient postoperative neurological deficit was observed in some patients, permanent treatment-related neurological morbidity was rare.

KW - Arteriovenous malformation

KW - Embolization

KW - Surgical resection

UR - http://www.scopus.com/inward/record.url?scp=84947751631&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84947751631&partnerID=8YFLogxK

U2 - 10.1227/NEU.0000000000000968

DO - 10.1227/NEU.0000000000000968

M3 - Article

C2 - 26287556

AN - SCOPUS:84947751631

VL - 77

SP - 948

EP - 952

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 6

ER -