Surgical Treatments of Cerebral Arteriovenous Malformations: Reduction in Bleeding Risks and Seizure Control

• Published in: Nōshotchū no geka Vol. 31; no. 2; pp. 87 - 91
• Main Authors: NOZAKI, Kazuhiko, HASHIMOTO, Nobuo, MIYAMOTO, Susumu, SADATO, Akiyo
• Format: Journal Article
• Language: Japanese
• Published: The Japanese Society on Surgery for Cerebral Stroke 2003
• Subjects: cerebral arteriovenous malformation; hemorrhage; seizure
• ISSN: 0914-5508; 1880-4683
• DOI: 10.2335/scs.31.87

We retrospectively analyzed the clinical courses and outcomes of cerebral arteriovenous malformations in 212 patients (3-79 years old) admitted to our institute between January 1987 and December 1999 to evaluate the reduction in bleeding risks and seizure outcome after surgical treatment for cerebral arteriovenous malformations. Cerebral arteriovenous malformations were located in the cerebral hemisphere in 141, basal ganglia-thalamus in 19, cerebellum in 24, corpus callosum in 12, brainstem in 6, and others in 10 (Spetzler & Martin grade I 17, II 44, III 81, IV 56, V 11, VI 3). The initial presentation was hemorrhage in 119, seizure in 40, ischemia in 21, headache in 18, and asymptomatic in 14. The annual re-bleeding risk was 11.9% in 119 cases with hemorrhagic onset, and the annual bleeding risk was 3.2% in 93 cases with non-hemorrhagic onset. In 127 cases who suffered from hemorrhage, total extirpation was done in 97 and complete obliteration was achieved in 109 in combination with transarterial embolization or radiosurgery or both. In 85 cases without hemorrhage, complete obliteration was obtained in 55 cases. Surgical morbidity and mortality were 5.9% and 0.7%, respectively. Recurrence of arteriovenous malformations after microsurgical extirpation occurred in 4 cases after angiographical cure, and the annual bleeding risk after angiographical cure was 0.14%. In 40 cases with seizure onset, hemorrhage occurred in 4 cases, progressive neurological deficits occurred in 4 cases, and repeated seizure occurred in 4 cases. Microsurgery was performed in 28 epileptic cases and 125 non-epileptic cases. In epileptic cases, seizure was improved in 26 cases and no aggravation of seizure was observed. In non-epileptic cases, 9 cases experienced de novo seizure attack within 2 years after microsurgery, and 4 cases suffered from seizure 2 or more years after microsurgery. In 153 operated cases, 141 were seizure free with or without medication 2 years after the operation. Microsurgical resection of cerebral arteriovenous malformations not only effectively eliminates hemorrhagic risk from nidus but also improves seizure outcome.