gms | German Medical Science

62nd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Polish Society of Neurosurgeons (PNCH)

German Society of Neurosurgery (DGNC)

7 - 11 May 2011, Hamburg

Single-centre experiences in the interdisciplinary management of cerebral arteriovenous malformations – A report on 41 cases

Meeting Abstract

  • A. Patrona - Neurochirurgische Klinik, Klinikum Fulda
  • H. Füssler - Neurochirurgische Klinik, Klinikum Fulda
  • E. Hofmann - Neuroradiologische Abteilung, Klinikum Fulda
  • R. Behr - Neurochirurgische Klinik, Klinikum Fulda

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.10.02

DOI: 10.3205/11dgnc067, URN: urn:nbn:de:0183-11dgnc0673

Published: April 28, 2011

© 2011 Patrona et al.
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Outline

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Objective: To analyze clinical interdisciplinary management and outcome on patients with cerebral arteriovenous malformations in a single neurosurgical department.

Methods: We performed a retrospective study on 41 patients with cerebral arteriovenous malformations (cAVMs) treated in our department between 2002 and 2010. All patients, mean age 41 (10-71), were managed by an interdisciplinary team. Initial symptoms were headaches in 21.9%, seizures in 26.8%, hemorrhage in 46%, and neurological deficits in 46.3%. 4.9% were asymptomatic. The Spetzler-Martin grading scale was applied to all patients. Complications and functional results were analyzed. Outcome assessment was performed using the modified Rankin Scale (mRS) score.

Results: Grade III cAVMs were present in 22 patients. 33.3% were treated with surgery, 52.3% with embolization plus surgery, and 9.5% with embolization alone. Embolization + radiosurgery was used in one case (0.04%).One patient died on admission. The late mRS score was 0-1 in 52.3%, 2-3 in 23.8% and 4-5 in 23.8%. There were 13 grade I and II cAVMs: 7 were treated with surgery alone, 3 with embolization+surgery and 3 were treated conservatively. Grade IV and V lesions were present in six patients: two are under observation, two received surgery only, and two were treated with embolization +surgery. Seven complications occurred during or after embolization and two required emergency surgery a few hours later. One bleeding complication occurred after surgery. Angiographic evidence of complete angioma resection was achieved in all surgical patients. Six patients were treated conservatively: two patients with grade II and grade III cAVMs with major hemorrhage, who died soon after admission, two patients with grade II lesions who refused treatment and two asymptomatic grades IV and V patients. In the 35 cases with specific treatment, there was no mortality and functional results were better prior to treatment in 18 cases (51.4%), 10 remained unchanged (28.5%), and slight worsening occurred in 6 cases (17%), and severe and moderate worsening occurred in 2 cases (5.7%). We observed a high complication rate in the embolization of grade III cAVMs with no significant impact on late overall functional outcome.

Conclusions: The results are comparable to the current literature. Prior embolization in grade III-V lesions facilitated surgical removal. An interdisciplinary approach led to optimal results with the available treatment modalities, the main treatment remaining vascular microneurosurgery.