Clinical outcome following cerebral AVM hemorrhage
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ORIGINAL ARTICLE - VASCULAR NEUROSURGERY - ARTERIOVENOUS MALFORMATION
Clinical outcome following cerebral AVM hemorrhage Bengt Karlsson 1 & Hidefumi Jokura 2 & Huai-Che Yang 3,4 & Masaaki Yamamoto 5 & Roberto Martinez 6 & Jun Kawagishi 2 & Wan-Yuo Guo 7 & Guus Beute 8 & Wen-Yuh Chung 3 & Michael Söderman 9 & Tseng Tsai Yeo 1 Received: 11 April 2020 / Accepted: 29 April 2020 # Springer-Verlag GmbH Austria, part of Springer Nature 2020
Abstract Background A significant difference exists between the published results reporting the clinical outcome following brain arteriovenous malformation (AVM) ruptures. Information about the outcome following hemorrhage in an AVM population treated with radiosurgery could provide additional information to assess the risk of mortality and morbidity following an AVM hemorrhage. Methods Clinical outcome was studied in 383 patients, the largest patient population yet studied, who suffered from a symptomatic hemorrhage after Gamma Knife® surgery (GKS) but before confirmed AVM obliteration. The impact of different patient, AVM, and treatment parameters on the clinical outcome was analyzed. The aim was to generate outcome predictions by comparing our data to and combining them with earlier published results. Results No relation was found between clinical outcome and treatment parameters, indicating that the results are applicable also on untreated AVMs. Twenty-one percent of the patients died, 45% developed or experienced worsening of neurological sequelae, and 35% recovered completely after the hemorrhage. Old age was a predictor of poor outcome. Sex, AVM location, AVM volume, and history of prior hemorrhage did not influence the outcome. The mortality rate was comparable to earlier published prospective data, but higher than that found in retrospective studies. Conclusions The mortality rates in earlier published retrospective series as well as in studies focusing on clinical outcome following AVM hemorrhage significantly underestimate the risk for a mortal outcome following an AVM hemorrhage. Based on our findings, an AVM rupture has around 20% likelihood to result in mortality, 45% likelihood to result in a minor or major deficit, and 35% likelihood of complete recovery. The findings are probably applicable also for AVM ruptures in general. The cumulative mortality and morbidity rates 25 years after diagnosis were estimated to be around 40% in a patient with a patent AVM. Keywords AVM . Hemorrhage . Clinical outcome
Introduction Knowledge about the risk for rupture, as well as the clinical consequences such rupture may result in, is necessary to
properly advise a patient harboring a cerebral arteriovenous malformation (AVM). The magnitude of the annual risk for AVM rupture, as well as the impact different AVM and patient parameters thereof, has been extensively analyzed, recently
This article is part of the Topical Collection on Vascular Neurosurgery Arteriovenous malformation * Bengt Karlsson [email protected] 1
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Department of Surgery, Div. of Neurosurgery, National Univer
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