Journal of Korean Neurosurgical Society

  • 제67권5호
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  • Pages.541-549
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  • 2024
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Surgical Results with Low-Grade Arteriovenous Malformations : A Single Center 14-Year Experience

  • Woo-Jun Hong (Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Kang-Hee Ahn (Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Yong-Jun Lee (Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Woong-Beom Kim (Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • You-Sub Kim (Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Tae-Sun Kim (Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School) ;
  • Sung-Pil Joo (Department of Neurosurgery, Chonnam National University Hospital, Chonnam National University Medical School)
  • 투고 : 2024.05.08
  • 심사 : 2024.08.13
  • 발행 : 2024.09.01
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초록

Objective : Advancements in AVM surgical techniques for cerebral arteriovenous malformation (AVM) underscore its efficacy. Our research aims to showcase the positive outcomes of treating low-grade AVMs surgically, focusing on safety and effectiveness. Methods : We retrospectively reviewed 55 patients (36 males and 19 females; average age 37.4 years) with Spetzler-Martin (S-M) grade 1 and 2 AVMs who underwent surgical resection between January 2009 and December 2022. Results : In our study, 55 patients with S-M grade 1 and 2 AVMs underwent surgical resection, evenly divided between grades 1 (50.9%) and 2 (49.1%). Intracranial hemorrhage was the primary symptom in 74.5% of cases. Pre-operative Glasgow coma scale (GCS) scores revealed 69.1% of patients scored above 13, with 18% below 8. Successful resection was achieved in 87.3%. Postoperatively, 95.5% of ruptured and 90.9% of unruptured AVM patients showed lower or same modified Rankin scale scores. Poorer outcomes were significantly linked to lower GCS scores and intranidal/flow-related aneurysms through multivariate logistic regression. Postoperative seizures noted in nine patients, were exclusive to the ruptured AVM group. Conclusion : Our findings indicate surgical resection as a beneficial treatment for low-grade AVMs, yielding high cure rates and positive functional outcomes in both ruptured and unruptured cases. Preoperative GCS scores and the presence of associated aneurysms are predictive of postoperative functional status. Additionally, managing postoperative seizures effectively is key to enhancing prognosis.

키워드

과제정보

This study was supported by a grant (BCRI24072) from the Chonnam National University Hospital Biomedical Research Institute.

참고문헌

  1. Baharvahdat H, Blanc R, Fahed R, Smajda S, Ciccio G, Desilles JP, et al. : Endovascular treatment for low-grade (Spetzler-Martin I-II) brain arteriovenous malformations. AJNR Am J Neuroradiol 40 : 668-672, 2019
  2. Davies JM, Kim H, Young WL, Lawton MT : Classification schemes for arteriovenous malformations. Neurosurg Clin N Am 23 : 43-53, 2012 https://doi.org/10.1016/j.nec.2011.09.002
  3. Englot DJ, Young WL, Han SJ, McCulloch CE, Chang EF, Lawton MT : Seizure predictors and control after microsurgical resection of supratentorial arteriovenous malformations in 440 patients. Neurosurgery 71 : 572-580; discussion 580, 2012 https://doi.org/10.1227/NEU.0b013e31825ea3ba
  4. Feghali J, Huang J : Updates in arteriovenous malformation management: the post-ARUBA era. Stroke Vasc Neurol 5 : 34-39, 2019 https://doi.org/10.1136/svn-2019-000248
  5. Gami A, Feghali J, Rapaport S, Sattari SA, Yang W, Tamargo RJ, et al. : Microsurgical resection versus stereotactic radiosurgery for low-grade intracranial arteriovenous malformations: a 27-year institutional experience. J Clin Neurosci 94 : 209-215, 2021 https://doi.org/10.1016/j.jocn.2021.10.036
  6. Gobin YP, Laurent A, Merienne L, Schlienger M, Aymard A, Houdart E, et al. : Treatment of brain arteriovenous malformations by embolization and radiosurgery. J Neurosurg 85 : 19-28, 1996 https://doi.org/10.3171/jns.1996.85.1.0019
  7. Guimaraes M, Wooster M : Onyx (ethylene-vinyl alcohol copolymer) in peripheral applications. Semin Intervent Radiol 28 : 350-356, 2011 https://doi.org/10.1055/s-0031-1284462
  8. Hamilton MG, Spetzler RF : The prospective application of a grading system for arteriovenous malformations. Neurosurgery 34 : 2-6; discussion 6-7, 1994 https://doi.org/10.1227/00006123-199401000-00002
  9. Josephson CB, Bhattacharya JJ, Counsell CE, Papanastassiou V, Ritchie V, Roberts R, et al. : Seizure risk with AVM treatment or conservative management: prospective, population-based study. Neurology 79 : 500-507, 2012 https://doi.org/10.1212/WNL.0b013e3182635696
  10. Link TW, Winston G, Schwarz JT, Lin N, Patsalides A, Gobin P, et al. : Treatment of unruptured brain arteriovenous malformations: a single-center experience of 86 patients and a critique of the a randomized trial of unruptured brain arteriovenous malformations (ARUBA) trial. World Neurosurg 120 : e1156-e1162, 2018
  11. Mohr JP, Parides MK, Stapf C, Moquete E, Moy CS, Overbey JR, et al. : Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, nonblinded, randomised trial. Lancet 383 : 614-621, 2014 https://doi.org/10.1016/S0140-6736(13)62302-8
  12. Moon K, Levitt MR, Almefty RO, Nakaji P, Albuquerque FC, Zabramski JM, et al. : Safety and efficacy of surgical resection of unruptured low-grade arteriovenous malformations from the modern decade. Neurosurgery 77 : 948-952; discussion 952-953, 2015
  13. Peschillo S, Caporlingua A, Colonnese C, Guidetti G : Brain AVMs: an endovascular, surgical, and radiosurgical update. ScientificWorld-Journal 2014 : 834931, 2014
  14. Potts MB, Lau D, Abla AA, Kim H, Young WL, Lawton MT, et al. : Current surgical results with low-grade brain arteriovenous malformations. J Neurosurg 122 : 912-920, 2015 https://doi.org/10.3171/2014.12.JNS14938
  15. Razavi SAS, Mirbolouk MH, Gorji R, Ebrahimnia F, Sasannejad P, Zabihyan S, et al. : Endovascular treatment as the first-line approach for cure of low-grade brain arteriovenous malformation. Neurosurg Focus 53 : E8, 2022
  16. Rubin BA, Brunswick A, Riina H, Kondziolka D : Advances in radiosurgery for arteriovenous malformations of the brain. Neurosurgery 74 Suppl 1 : S50-S59, 2014 https://doi.org/10.1227/NEU.0000000000000219
  17. Rutledge WC, Abla AA, Nelson J, Halbach VV, Kim H, Lawton MT : Treatment and outcomes of ARUBA-eligible patients with unruptured brain arteriovenous malformations at a single institution. Neurosurg Focus 37 : E8, 2014