Microsurgery For Cerebral Arteriovenous Malformation

Objective: The present article aims at summarizing our operative experiences,exploring the diagnosis standard and the management strategies, investigating the clinical factors influencing the treatment efficacy of microsurgery treatment on people with cerebral arteriovenous malformation(c AVM).Methods: 60 patients with c AVM who were operated on were retrospectively analyzed from the Affiliated Hospital of Lu Zhou Medical College between January 2010 and October 2014. This study includes 38 male cases and 22 female cases, with an average age of 34.8 years. Sudden onset of 42 cases, mainly for different levels of headache 26 cases, 10 cases with disturbance of consciousness, 15 cases with nausea and vomiting, activity obstacle in 16 cases, cognitive impairment in 8 cases, 6 patients with grand mal. Chronic onset of 16 cases, 12 cases with mild headache, 4 cases were intermittent seizures; Found in 2 cases. All patients had done skull CT, CTA, MRA and(or) DSA examination before operation, imaging findings consistent with cerebral arteriovenous malformation. All patients had accepted the microsurgery treatment. We had done follow-up examination regularly in order to know patients wherther had hemorrhage、epilepsy again, and the prognosis of patients with level 5 according to the Glasgow Outcome Score(GOS) postoperative half a year, Binary logistic regression models was used to test the effect of patient’s age, gender, Spetzler-Martin grading, aneurysms, intracranial hemorrhage, the size and location of the nidus, deep venous drainage patternand residual lesions of c AVM on long-term treatment efficacy.Results: All patients’ specimen were accord with arteriovenous malformation pathological changes. According to Spetzler-Martin grading, 6 cases with gradeⅠ, Ⅱ 19 cases with grade Ⅱ, 26 cases with grade Ⅲ, 7 cases with grade Ⅳ, 2 cases with grade Ⅴ. 2 cases died after operation and 58 cases discharged with a better health condition; There were 3 patients who had cerebral hemorrhage again; Abnormal vascular residued in 7 cases(11.7%),radically removed in 53 cases(88.3%). According to the Glasgow Outcome Score(GOS), the prognosis of patients with 1 point in 2 cases; 3 points in 1 cases; 4 points in 6 cases; 5 points in 51 cases. Logistic regression analysis demonstrated that the patient’s gender, age, epilepsy and aneurysm have no obvious effect on postoperative half a year(P>0.05), while high Spetzler-Martin grading, intracranial hemorrhage, the location, size and deep venous drainage pattern of c AVM in patients were significantly associated with neurological deficits. Postoperative epilepsy cases related to preoperative epilepsy(P<0.05),Cases of postoperative headache increased significantly, but slight。Conclusions:The main clinical manifestations of cerebral arteriovenous malformation are headache, intracranial hemorrhage, and epilepsy. CTA 、MRA and DSA can make an accurate diagnosis of cerebral AVM. Microscopic surgery is still the most important therapy method of cerebral AVM. It can remove all lesions, control hemorrhage and epilepsy, improve the quality of patient life. We found that S-M grading and intracranial hemorrhage are the risk factors of prognosis. Preoperative epilepsy is a risk factor for postoperativeepilepsy. Postoperative deformity vascular residue is a risk factor for postoperative bleeding again.