• World Neurosurg · Dec 2019

    Multicenter Study

    Adult Spinal Arteriovenous Malformations: Natural history and a multicenter study of short-term surgical outcomes.

    • Abhiraj D Bhimani, Clayton L Rosinski, Saavan Patel, Nauman S Chaudhry, Steven Denyer, Mandana Behbahani, and Ankit I Mehta.
    • Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.
    • World Neurosurg. 2019 Dec 1; 132: e290-e296.

    ObjectiveSpinal arteriovenous malformations (SAVMs) are a very rare and complex spinal cord pathology that require high clinical acumen to diagnose and treat. Management includes both nonoperative and operative paradigms. A review of the literature yields a paucity of data regarding the surgical outcomes of SAVMs, with the majority of data limited to single-center outcomes and/or small sample sizes. The purpose of this study was to use a multi-institutional international database to study the natural history of SAVMs.MethodsWe used the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to select patients that underwent laminectomy for surgical excision of a SAVM between 2008 and 2017.ResultsThe data from 196 patients were studied (65.8% male, 34.2% female). A majority of cases were in the thoracic region (53.6%), followed by thoracolumbar (31.6%) and cervical (14.8%) regions. The mean age was 57.4 years and 52.5% patients were graded ASA class 3-5 before the operation. The mean operation time was 215 minutes, with a significantly lower operative time for thoracic arteriovenous malformations (195.6 minutes) when compared with cervical (266.6 minutes) and thoracolumbar (223.7 minutes). The mean length of hospital stay was 6.4 days. Patients had a 6.6% readmission rate and a 4.6% reoperation rate within 30 days.ConclusionsThis study presents the largest analysis of patients undergoing surgery for SAVMs and 30-day postoperative outcomes. Operative time differed based on SAVM location. The three most frequent complications (deep vein thrombosis, wound infection, and UTI) occurred at rates of 3.6% or less.Copyright © 2019 Elsevier Inc. All rights reserved.

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