• Neurosurgery · Nov 2020

    Visual Field Defect Before and After Endovascular Treatment of Occipital Arteriovenous Malformations.

    • Stanislas Smajda, Gabriele Ciccio, Robert Fahed, Thomas Robert, Daniele Botta, Hocine Redjem, Jean-Philippe Desilles, Mikael Mazighi, Kevin Zuber, Simon Escalard, Humain Baharvahdat, Raphaël Blanc, Dorian Chauvet, Manon Philibert, Sylvie Chokron, and Michel Piotin.
    • Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France.
    • Neurosurgery. 2020 Nov 16; 87 (6): E663-E671.

    BackgroundOccipital arteriovenous malformations (AVMs) carry a high risk of postoperative morbidity because of their anatomic relation to the visual cortex and optic radiations. Data regarding endovascular management of these lesions are scant.ObjectiveTo report our single-center experience with occipital AVMs, most of which were treated endovascularly, with a special interest for postoperative visual impairment.MethodsFrom a prospective database, we assessed the clinical and radiological data of all patients with an occipital AVM managed between 1997 and 2018. The extension of the nidus to the primary visual cortex was assessed and correlated to the pre- and postintervention visual symptomatology. Modified Rankin Scale and visual fields (VFs) were assessed pre- and post-treatment and at the last follow-up.ResultsA total of 83 patients (47 males [56.6%]) with an occipital AVM were included in the study. Mean age at presentation was 33.5 ± 15.0 yr (min-max = 7-76). A total of 34 patients (41%) presented with hemorrhage related to the AVM. A total of 57 patients (68.7%) underwent endovascular treatment (EVT) alone, 20 (24.1%) underwent embolization and surgery, 3 (3.6%) underwent embolization and radiosurgery, and 3 (3.6%) were conservatively managed. A complete obliteration of the AVM was achieved in 53 patients (66.3%). A post-treatment worsening of the VF was found in 24 of the treated patients (30%), 3 patients (9%) for ruptured AVMs, and in 21 patients (46%) for unruptured AVMs. Morbidity rate was 3.7% and mortality rate was 2.5%.ConclusionEVT of occipital AVM carries a non-negligible rate of complications, especially regarding visual functions.Copyright © 2020 by the Congress of Neurological Surgeons.

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