Background: Cerebral arteriovenous malformation (AVM) is a common vascular disease in neurosurgery, and the indication for alternative treatments remains controversial. In a review of a series of 2086 patients with AVMs, the clinical characteristics and surgical results were assessed.
Methods: Collected data of 2086 consecutive patients with AVMs from January 1956 to October 2001 were analyzed. All patients were divided into 2 groups: traditional surgery group (from 1956 to 1991) and microsurgery group (from 1992 to 2001). The variables assessed for clinical characteristics in our study included age (at presentation), sex, Spetzler-Martin grade, and first presentations. Surgical complications were assessed between different surgery groups by chi(2) test.
Results: Cerebral AVMs are more commonly diagnosed at age of 20 to 40 years, which comprises almost one half of the whole population. The size of the AVMs ranged from 1 to 9 cm. There were 77 cases of giant AVMs in this series that were treated by a combination of surgical resection and intraoperative embolization. Hemorrhage (43.4%), headache (24.9%), and seizure (17.3%) were the first 3 common presentations. Regarding Spetzler-Martin grading system, the percentage of grade 3 to 5 patients increased, whereas that of grade 1 patients decreased in the microsurgery group (P = .00). However, compared with the traditional surgery group, the incidence of main surgical complications (death, hemiparalysis, cranial nerve dysfunction, and gastrointestinal hemorrhage) decreased significantly in the microsurgery group (P = .00). Although the incidence of main surgical complications had no statistical difference between early (from 1992 to 1996) and late microsurgery subgroup (from 1997 to 2001) (P = .796), the incidence really decreased with increase of higher-grading patients (grade 3-5) in the late microsurgery group (P = .00).
Conclusions: Cerebral AVM is one of the important reasons for spontaneous intracranial hemorrhage in patients younger than 40. Spetzler-Martin grading system is helpful to predict the surgical risk. Microsurgical technique has made surgical treatment safer and become the best choice for patients with cerebral AVM.