Multi-stage treatment for Spetzler-Martin grades III, IV, and V arteriovenous malformations

• Verfasst von: Alfter, Marcel [VerfasserIn]
• Verfasst von: Albiña-Palmarola, Pablo [VerfasserIn]
• Verfasst von: Cimpoca, Alexandru [VerfasserIn]
• Verfasst von: Díaz-Peregrino, Roberto [VerfasserIn]
• Verfasst von: Jans, Paul [VerfasserIn]
• Verfasst von: Ganslandt, Oliver [VerfasserIn]
• Verfasst von: Kühne, Dietmar [VerfasserIn]
• Verfasst von: Henkes, Hans [VerfasserIn]
• Titel: Multi-stage treatment for Spetzler-Martin grades III, IV, and V arteriovenous malformations
• Titelzusatz: preoperative embolization and microsurgical resection in a consecutive series of 250 patients
• Verf.angabe: Marcel Alfter, Pablo Albiña-Palmarola, Alexandru Cimpoca, Roberto Díaz-Peregrino, Paul Jans, Oliver Ganslandt, Dietmar Kühne and Hans Henkes
• E-Jahr: 2023
• Jahr: 15 September 2023
• Umfang: 23 S.
• Fussnoten: Gesehen am 05.12.2023
• Titel Quelle: Enthalten in: Journal of Clinical Medicine
• Ort Quelle: Basel : MDPI, 2012
• Jahr Quelle: 2023
• Band/Heft Quelle: 12(2023), 18, Artikel-ID 5990, Seite 1-23
• ISSN Quelle: 2077-0383
• DOI: doi:10.3390/jcm12185990
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: arteriovenous malformation
• Sach-SW: embolization
• Sach-SW: microsurgical resection
• Sach-SW: multimodal treatment
• K10plus-PPN: 1871923573

Abstract

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.