gms | German Medical Science

55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Microsurgical treatment of arteriovenous malformations: Analysis of 72 consecutively treated patients

Die mikrochirurgische Therapie von arteriovenösen Angiomen: Ergebnisse bei 72 operativ behandelten Patienten

Meeting Abstract

  • corresponding author Hans Herbert Steiner - Neurochirurgische Klinik, Ruprecht-Karls-Universität, Heidelberg
  • K. Geletneky - Neurochirurgische Klinik, Ruprecht-Karls-Universität, Heidelberg
  • P. Kremer - Neurochirurgische Klinik, Ruprecht-Karls-Universität, Heidelberg
  • R. Ahmadi - Neurochirurgische Klinik, Ruprecht-Karls-Universität, Heidelberg
  • R. Wirtz - Neurochirurgische Klinik, Ruprecht-Karls-Universität, Heidelberg
  • A. Unterberg - Neurochirurgische Klinik, Ruprecht-Karls-Universität, Heidelberg
  • S. Kunze - Neurochirurgische Klinik, Ruprecht-Karls-Universität, Heidelberg

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMO.03.02

The electronic version of this article is the complete one and can be found online at:

Published: April 23, 2004

© 2004 Steiner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.




In a retrospective series of 72 consecutive patients in a 10-years period (1992-2002) the results of microsurgical treatment of arteriovenous Angioma (AVM) were analyzed with regard to the Spetzler-Martin grading scale.


Patients were categorized by age, gender, presentation, and preoperative neurological status. The AVMs were categorized by size, location in functional area, and presence of deep venous drainage according to the Spetzler-Martin scale (SMS). Outcome was assessed for angiographic obliteration, haemorrhage following treatment, presence of new postoperative neurological deficit, and Glasgow-Outcome Scale (GOS) score. Ordinal logistic regression was used to model the GOS score and to predict new postoperative deficits. Overall, 72 patients, 5-78 years old (Ø 37.7 years), 29 female and 43 male, presented with either haemorrhage (56/64%) or epileptic seizures (13/18%) or both (4/6%). 39 patients (54%) showed a preoperative neurological deficit and 5 patients had an accompanying aneurysm. The angiomas were graded SMS I in 13 cases (18%), Grade II in 14 cases (18%), Grade III in 29 cases (40%), SMS IV and V in 15 vs. 1 case (21/1%). 28 patients (39%) were endovascular treated preoperatively.


Overall, 8 patients (9%) exhibited a new persistent neurological deficit postoperatively. 64 patients (89%) had a GOS score of 4 or 5. 7 patients were severely disabled, no patient was observed to be in a vegetative state and there was one treatment-related death by intraoperative heart failure. Of 13 patients with epileptic seizures preoperatively 11 patients (85%) were seizure-free postoperatively. 70 patients (96%) underwent postoperative angiography. Total excision of the AVM was angiographically confirmed in 69 patients (95%). To date one patient has suffered from hemorrhage since the microsurgical treatment (SMS IV). When analysis was confirmed to patients whose AVMs were SMS grade I to III (56 patients) the angiographic obliteration rate was 100%, new postoperative deficit showed 2 patients (2.2%), and good recovery rate (GOS 4 and 5) was 95%. Size of the AVM, preoperative neurological status, and patient age are associated with GOS score (for all, p< 0.02). The Spetzler-Martin grading system as well as each component of this system is associated with the development of a new postoperative neurological deficit (for all, p< 0.01).


Based on this analysis, microsurgical treatment of Spetzler-Martin grades I to III AVMs is an effective and low-risk therapy especially in patients presenting with haemorrhage or epilepsy. Treatment risks for higher grade angiomas IV and V according to the Spetzler-Martin grading system are clearly elevated and have to be taken into consideration for decision making.