Abstract

BACKGROUND AND OBJECTIVE: Staged treatment of brain AVMs is sometimes necessary to minimize risks associated with sudden changes in cerebral hemodynamics. With the increasing availability and optimization of endovascular techniques, multiple surgical resections are rarely necessary, however due to specific anatomic circumstances, some AVMs still require staged surgery. Here, we describe the largest reported series of staged surgical resections of brain AVMs.METHODS: This is a retrospective review of surgically resected AVMs at a single institution from 1998-2018. Patients who underwent =2 resections within one year were reviewed. Only those in whom initial resection was terminated with intention for further resection were included in analysis.RESULTS: Twenty patients underwent deliberately staged resection from 1998-2018. Average age at treatment was 36.2 years (SD=16.5). Eleven patients (55%) were female, and 12 (60%) had left-sided AVMs. Median Spetzler-Martin grade was 4 (IQR3-4). Average AVM nidus diameter was 5.0cm (SD=1.7). Seven patients (35%) presented with AVM rupture, and 12 (60%) presented with focal neurologic deficits without hemorrhage. Seventeen patients (85%) underwent pre-operative embolization, median number of embolizations was 3 (IQR2-4). Three patients (15%) underwent pre-operative radiosurgery. Median number of days between surgeries was 28 (IQR8-41). Peri-operative course was complicated by hemorrhage in three patients (15%); one required decompressive hemicraniectomy prior to the second stage of surgery. Good functional outcome (defined as mRS=2) was achieved in 14 patients (70%).CONCLUSIONS: Staged surgical resection of large and complex AVMs can be performed with good outcomes in carefully selected patients.

View details for DOI 10.1016/j.wneu.2020.11.036

View details for PubMedID 33212272