• Miikka Korja, David Bervini, Nazih Assaad, and Michael Kerin Morgan.
• From the Australian School of Advanced Medicine, Macquarie University, Sydney, New South Wales, Australia (M.K., N.A., M.K.M.); Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland (M.K.); and Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland (D.B.).
• Stroke. 2014 Dec 1;45(12):3549-55.

Background And PurposeManagement of brain arteriovenous malformation (bAVM) is controversial. We have analyzed the largest surgical bAVM cohort for outcome.MethodsBoth operated and nonoperated cases were included for analysis. A total of 779 patients with bAVMs were consecutively enrolled between 1989 and 2014. Initial management recommendations were recorded before commencement of treatment. Surgical outcome was prospectively recorded and outcomes assigned at the last follow-up visit using modified Rankin Scale. First, a sensitivity analyses was performed to select a subset of the entire cohort for which the results of surgery could be generalized. Second, from this subset, variables were analyzed for risk of deficit or near miss (intraoperative hemorrhage requiring blood transfusion of ≥2.5 L, hemorrhage in resection bed requiring reoperation, and hemorrhage associated with either digital subtraction angiography or embolization).ResultsA total of 7.7% of patients with Spetzler-Ponce classes A and B bAVM had an adverse outcome from surgery leading to a modified Rankin Scale >1. Sensitivity analyses that demonstrated outcome results were not subject to selection bias for Spetzler-Ponce classes A and B bAVMs. Risk factors for adverse outcomes from surgery for these bAVMs include size, presence of deep venous drainage, and eloquent location. Preoperative embolization did not affect the risk of perioperative hemorrhage.ConclusionsMost of the ruptured and unruptured low and middle-grade bAVMs (Spetzler-Ponce A and B) can be surgically treated with a low risk of permanent morbidity and a high likelihood of preventing future hemorrhage. Our results do not apply to Spetzler-Ponce C bAVMs.© 2014 American Heart Association, Inc.

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