Multi-stage treatment for Spetzler-Martin grades III, IV, and V arteriovenous malformations: preoperative embolization and microsurgical resection in a consecutive series of 250 patients
Purpose. The treatment of high-grade brain AVMs is challenging and has no guidelines available to date. This study was aimed at reporting the experience of two centers in treating these AVMs through a multi-stage approach consisting of preoperative embolization and microsurgical resection. Methods....
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| Hauptverfasser: | , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
15 September 2023
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| In: |
Journal of Clinical Medicine
Year: 2023, Jahrgang: 12, Heft: 18, Pages: 1-23 |
| ISSN: | 2077-0383 |
| DOI: | 10.3390/jcm12185990 |
| Online-Zugang: | Verlag, kostenfrei, Volltext: https://doi.org/10.3390/jcm12185990 Verlag, kostenfrei, Volltext: https://www.mdpi.com/2077-0383/12/18/5990 
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| Verfasserangaben: | Marcel Alfter, Pablo Albiña-Palmarola, Alexandru Cimpoca, Roberto Díaz-Peregrino, Paul Jans, Oliver Ganslandt, Dietmar Kühne and Hans Henkes |
| Zusammenfassung: | Purpose. The treatment of high-grade brain AVMs is challenging and has no guidelines available to date. This study was aimed at reporting the experience of two centers in treating these AVMs through a multi-stage approach consisting of preoperative embolization and microsurgical resection. Methods. A retrospective review was performed for 250 consecutive patients with a diagnosis of high-grade brain AVM (Spetzler-Martin grades III, IV, and V) treated in two centers in Germany between January 1989 and February 2023. The analyzed data included demographic, clinical, morphological, and neurological data. Results. A total of 150 cases (60%) were classified as Spetzler-Martin grade III, 82 cases (32.8%) were classified as grade IV, and 18 cases (7.2%) were classified as grade V. Eighty-seven cases (34.8%) presented with hemorrhage. The devascularization percentages achieved were <50% in 24 (9.6%), 50-80% in 55 (22%), and >80% in 171 (68.4%) cases. The average number of sessions was 5.65 ± 5.50 and 1.11 ± 0.32 endovascular and surgical procedures, respectively, and did not significantly differ by rupture status. Death or dependency (mRS score ≥ 3) after the last follow-up was observed in 18.8% of patients and was significantly associated with age > 80 years and poor baseline neurological condition. The complete resection rate was 82.3% and was significantly associated with age > 80 years, large nidus, and deep venous drainage. Permanent disabling neurological deficit after at least 3 months of follow-up was diagnosed in 13.2% of patients and was significantly associated with age > 80 years and infratentorial locations. Conclusion. A multi-stage treatment for high-grade AVMs is feasible for selected cases but comes at a functional cost. The devascularization percentage was not associated with the investigated outcomes. Age > 80 years was associated with poor safety and effectiveness outcomes; consequently, this treatment should be offered only in exceptional circumstances. |
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| Beschreibung: | Gesehen am 05.12.2023 |
| Beschreibung: | Online Resource |
| ISSN: | 2077-0383 |
| DOI: | 10.3390/jcm12185990 |