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Acta Neurochirurgica
Published in: Acta Neurochirurgica 11/2017

01-11-2017 | Original Article - Vascular

Timing of surgery for ruptured supratentorial arteriovenous malformations

Authors: Ahmad Hafez, Elias Oulasvirta, Päivi Koroknay-Pál, Mika Niemelä, Juha Hernesniemi, Aki Laakso

Published in: Acta Neurochirurgica | Issue 11/2017

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Abstract

Background

There are conflicting opinions regarding the optimal waiting time to perform surgery after rupture of supratentorial arteriovenous malformations (AVMs) to achieve the best possible outcome.

Objective

To analyze factors influencing outcomes for ruptured supratentorial AVMs after surgery, paying particular attention to the timing of the surgery.

Methods

We retrospectively investigated 59 patients admitted to our center between 2000 and 2014 for surgical treatment of ruptured supratentorial AVMs. We evaluated the effect of timing of surgery and other variables on the outcome at 2–4 months (early outcome), at 12 months (intermediate outcome) after surgery, and at final follow-up at the end of 2016 (late outcome).

Results

Age over 40 years (OR 18.4; 95% CI 1.9–172.1; p = 0.011), high Hunt and Hess grade (4 or 5) before surgery (OR 13.5; 95% CI 2.1–89.2; p = 0.007), hydrocephalus on admission (OR 12.9; 95% CI 1.8–94.4; p = 0.011), and over 400 cm3 bleeding during surgery (OR 11.5; 95% CI 1.5–86.6; p = 0.017) were associated with an unfavorable early outcome. Age over 40 years (OR 62.8; 95% CI 2.6–1524.9; p = 0.011), associated aneurysms (OR 34.7; 95% CI 1.4–829.9; p = 0.029), high Hunt and Hess grade before surgery (OR 29.2; 95% CI 2.6–332.6; p = 0.007), and over 400 cm3 bleeding during surgery (OR 35.3; 95% CI 1.7–748.7; p = 0.022) were associated with an unfavorable intermediate outcome. Associated aneurysms (OR 8.2; 95% CI 1.2–55.7; p = 0.031), high Hunt and Hess grade before surgery (OR 5.7; 95% CI 1.3–24.3; p = 0.019), and over 400 cm3 bleeding during surgery (OR 5.8; 95% CI 1.2–27.3; p = 0.027) were associated with an unfavorable outcome at last follow-up. Elapsed time between rupture and surgery did not affect early or final outcome.

Conclusions

Early surgery in patients with ruptured supratentorial arteriovenous malformation is feasible strategy, with late results comparable to those achieved with delayed surgery. Many other factors than timing of surgery play significant roles in long-term outcomes for surgically treated ruptured supratentorial AVMs.
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Metadata
Title
Timing of surgery for ruptured supratentorial arteriovenous malformations
Authors
Ahmad Hafez
Elias Oulasvirta
Päivi Koroknay-Pál
Mika Niemelä
Juha Hernesniemi
Aki Laakso
Publication date
01-11-2017
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 11/2017
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-017-3315-9

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