• World Neurosurg · Dec 2020

    Microsurgery for Spetzler- Martin Grade I-III AVMs: Analysis of surgical results and correlation of Lawton-Young supplementary grade, supplemented Spetzler- Martin score with functional outcome.

    • Sai Kiran Narayanam Anantha NA Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India., Kanneganti Vidyasagar, Vivek Raj, Laxminadh Sivaraju, Rakshith Srinivasa, Dilip Mohan, and Alangar S Hegde.
    • Department of Neurosurgery, Sri Sathya Sai Institute of Higher Medical Sciences, Bangalore, India.
    • World Neurosurg. 2020 Dec 1; 144: e227-e236.

    ObjectiveTo analyze the results of microsurgery for Spetzler-Martin (SM) grade I-III AVMs and evaluate the correlation of the Lawton-Young (LY) supplementary grade, supplemented Spetzler-Martin (SM-Supp/combined) score with the functional outcome.MethodsA total of 42 patients with SM grade I-III AVMs who had undergone surgery at our institute during a 3-year period (June 2013 to May 2016) were included in the present study.ResultsAll 42 patients had undergone primary surgery without previous embolization. Three patients (7.1%) had died due to surgical site hematoma in the postoperative period. One patient was lost to follow-up. The mean follow-up period for the remaining patients was 27 ± 14 months (range, 12-62 months). At the final follow-up examination of ≥12 months (FFU), 92.7% of the patients had a good outcome (modified Rankin scale [mRS] score ≤1), with an improved or unchanged mRS score in 87.8%. An AVM size >3 cm, diffuse AVM, SM grade III, and SM-Supp score >5 were associated with worsened mRS score at discharge and FFU. Higher LY grade (IV and V), eloquent AVM location, deep venous drainage, age >40 years, and unruptured presentation were not associated with worsened mRS score at both discharge and FFU. Of the 20 ARUBA-eligible patients, 19 (95%) had good outcomes. Postoperative angiograms for 39 patients revealed complete excision of the AVM in 37 (94.9%) and a residual AVM in 2 (5.1%).ConclusionsHigh cure rates and excellent clinical outcomes can be expected with microsurgery for most patients with SM grade I-III AVMs. An AVM size >3 cm, diffuse AVM nidus, SM grade III, and SM-Supp score >5 are associated with postoperative worsening of functional scores in patients with SM grade I-III AVMs.Copyright © 2020 Elsevier Inc. All rights reserved.

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