gms | German Medical Science

Objective: In our retrospective study we analysed the early postoperative outcome of our patients with cerebral arteriovenous malformations (AVM) treated with preoperative transarterial embolization and microsurgical resection.

Methods: The single-center retrospective analysis was performed on 107 AVM operations on 102 patients. The data was collected from pediatric and adult patients including all treated ruptured and unruptured AVMs between 2014 and 2021. Spetzler-Martin grades (SM), supplemented Spetzler-Martin grades (sSM) as well as neurological outcome using mRS score prior to and one week after the surgery were evaluated and compared to the available data of the current literature (Kim et al.)

Results: In the examined period we treated 51 unruptured (48%) and 56 ruptured (52%) AVMs. Extensive preoperative transarterial embolization was performed prior to microsurgical resection in every single case independent from AVM grade. Neurological worsening of mRS scores were observed after 18 operations (16%). Using SM grading 7, 11, 25, 25 and 33% of cases worsened gradually from SM grade I to V. Using sSM grading, we observed 0, 0, 4, 13, 33, 31, 30 and 0% neurological worsening gradually from sSM grade 2-9. The observed data were slightly better compared to the multicenter cohort of 1009 surgical patients published by Kim et al. [1]

Conclusion: The extensive use of preoperative transarterial embolization combined with microsurgical resection in a high-volume neurovascular center seems to be an effective tool to reduce the neurological risks related to the treatment of cerebral arteriovenous malformations in all grades.