ORIGINAL ARTICLE  BRAIN ARTERIOVENOUS MALFORMATIONS 

Journal of Neurosurgical Sciences 2018 August;62(4):429-36

DOI: 10.23736/S0390-5616.18.04371-0

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

The role of embolization before surgery for Spetzler-Ponce Class B and C brain AVMs: a prospective cohort series

Michael K. MORGAN ¹ ✉, Gillian Z. HELLER ²

¹ Department of Clinical Medicine, Macquarie University, Sydney, NSW, Australia; ² Department of Statistics, Macquarie University, Sydney, NSW, Australia

BACKGROUND: There is uncertainty of the benefit of preoperative embolization for Spetzler-Ponce Class (SPC) B and C arteriovenous malformations of the brain (bAVM). We examined whether or not preoperative embolization reduces the risk of permanent neurological deficits in SPC B and C bAVM surgery.
METHODS: A prospective bAVM database (between1989 and 2015) was analyzed by regression for factors associated with a new permanent neurological deficit arising as a consequence of surgery or preoperative embolization with a modified Rankin Scale (mRS) score >1 at 12 months after surgery (adverse outcome).
RESULTS: From a cohort of 785 patients with bAVM, 277 patients with SPC B or C bAVM were planned for treatment by surgery with (N.=67) or without (N.=210) preoperative embolization. There were significant differences (embolization versus no embolization) in: permanent neurological deficits leading to a mRS>1 (45% versus 20%, P<0.01); permanent neurological deficits leading to a mRS>2 (22% versus 8.1%, P=0.04); perioperative transfusion of 2.5 liters of blood or more (31% versus 16%, P<0.01); and, delayed postoperative hemorrhage (19% versus 8.1%, P=0.01). Regression analysis identified the following factors to be associated with increased likelihood of an adverse outcome: infratentorial location (odds ratio 0.441, P=0.045); SPC C bAVM (OR=0.501, P=0.034); earlier rank order of surgery (OR=0.994, P<0.01); and, preoperative embolization (OR=0.313, P<0.01).
CONCLUSIONS: The use of preoperative embolization does not reduce adverse outcomes in SPC B and C bAVM. The role of embolization in the preoperative management of complex bAVM by surgery deserves further study.

KEY WORDS: Brain - Arteriovenous malformations - Therapeutic embolization