Early microsurgical removal of 31 patients with low-grade (Spetzler-Martin I-II) bleeding arteriovenous malformations

Objective To explore the safety and effectiveness of early microsurgical removal of low-grade (Spetzler-Martin I-II) bleeding arteriovenous malformations. Methods The clinical data of 31 patients with low-grade AVM by microsurgical treatment in our hospital from October 2009 to December 2015 were retrospectively reviewed in the acute stage of bleeding (within the first week after bleed). All patients showed a cerebral AVM on DSA or CTA at admission, 18 of whom underwent intraoperative ultrasound. Neurological outcomes were assessed with Glasgow outcome scale (GOS) after operation. According to the GOS scores, the patients were divided into good prognosis group (scores of 4-5) and poor prognosis group (scores of <4); the differences of preoperative clinical data between the two groups were compared. After operation, cerebral DSA or CTA was performed. According to the postoperative brain AVM with or without residual, the patients were divided into residual group and no-residue group; the differences of the clinical data and use of ultrasound in operation were analyzed statistically between the two groups. Results A favorable functional outcome was observed in 27 patients (87.1%); as compared with that in the poor prognosis group, the proportion of Glasgow coma scale (GCS) scores>8 and young patients in the good prognosis group was significantly higher (P 0.05). Conclusions Early microsurgery for grade I-II bleeding AVMs is a safe and definitive treatment with intraoperative ultrasound, achieving both immediate cerebral decompression and protection against rebreeding, reducing hospital stays and allowing a more rapid rehabilitative course whenever necessary. Patients who are younger or with GCS scores>8 may have a better prognosis and high complete resection is achieved in those with SMG I. Key words: Cerebral arteriovenous malformation; Microsurgery; Intraoperative ultrasound