gms | German Medical Science

Objective: We analyzed multicenter data of surgical treatment for cerebral unruptured and ruptured AVMs with particular attention for patients' functional outcome in relation to the recent ARUBA Study.

Method: We retrospectively reviewed a database of cerebral unruptured and ruptured AVMs surgically treated in five Neurosurgical centers between 2001 and 2012. The functional outcome of the patients was evaluated by Glasgow Outcome Scale at discharge and at 1 year follow-up.

Results: 443 surgically treated pts were identified. There were 170 pts (38%) with unruptured cerebral AVMs (31 grade I, 74 grade II, 48 grade III, 17 grade IV) and 273 pts (62%) with ruptured AVMs (60 grade I, 129 grade II, 64 grade III, 20 grade IV). There is a significant difference in post surgical outcome between ruptured and unruptured AVM: Overall patients with unruptured AVM had 5.3% of moderate disability and 1.7% of severe disability, compared to an overall 21% of moderate disability, 11% of severe disability and 2% of death in ruptured AVM. There is also a significative difference between evaluation at discharge and at 1 year follow-up. Most of the patients, but especially those with low-grade AVM recovered at follow-up from a temporary deficit that could be still evident at discharge.

Conclusions: Patients with ruptured AVM had a significantly worse outcome than those operated with unruptured AVM. Outcomes of unruptured AVM reflect what is previously known in literature. These results are discussed with respect to the recent ARUBA Study. A judgment and experienced patients selection and a multimodality treatment can be considered a better choice than observation alone for unruptured AVMs.