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Clinical outcome following cerebral AVM hemorrhage

  • Original Article - Vascular Neurosurgery - Arteriovenous malformation
  • Published:
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Abstract

Background

A significant difference exists between the published results reporting the clinical outcome following brain arteriovenous malformation (AVM) ruptures. Information about the outcome following hemorrhage in an AVM population treated with radiosurgery could provide additional information to assess the risk of mortality and morbidity following an AVM hemorrhage.

Methods

Clinical outcome was studied in 383 patients, the largest patient population yet studied, who suffered from a symptomatic hemorrhage after Gamma Knife® surgery (GKS) but before confirmed AVM obliteration. The impact of different patient, AVM, and treatment parameters on the clinical outcome was analyzed. The aim was to generate outcome predictions by comparing our data to and combining them with earlier published results.

Results

No relation was found between clinical outcome and treatment parameters, indicating that the results are applicable also on untreated AVMs. Twenty-one percent of the patients died, 45% developed or experienced worsening of neurological sequelae, and 35% recovered completely after the hemorrhage. Old age was a predictor of poor outcome. Sex, AVM location, AVM volume, and history of prior hemorrhage did not influence the outcome. The mortality rate was comparable to earlier published prospective data, but higher than that found in retrospective studies.

Conclusions

The mortality rates in earlier published retrospective series as well as in studies focusing on clinical outcome following AVM hemorrhage significantly underestimate the risk for a mortal outcome following an AVM hemorrhage. Based on our findings, an AVM rupture has around 20% likelihood to result in mortality, 45% likelihood to result in a minor or major deficit, and 35% likelihood of complete recovery. The findings are probably applicable also for AVM ruptures in general. The cumulative mortality and morbidity rates 25 years after diagnosis were estimated to be around 40% in a patient with a patent AVM.

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Author information

Authors and Affiliations

  1. Department of Surgery, Div. of Neurosurgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119074, Singapore

    Bengt Karlsson & Tseng Tsai Yeo

  2. Jiro Suzuki Memorial Gamma House, Furukawa Seiryo Hospital, Furukawa, Osaki, Japan

    Hidefumi Jokura & Jun Kawagishi

  3. Department of Neurosurgery, Veterans General Hospital, Taipei, Taiwan

    Huai-Che Yang & Wen-Yuh Chung

  4. Yang-Ming University, Taipei, Taiwan

    Huai-Che Yang

  5. Katsuta Hospital Mito GammaHouse, Ibaraki, Japan

    Masaaki Yamamoto

  6. Ruber International Hospital, Madrid, Spain

    Roberto Martinez

  7. Department of Radiology, Veterans General Hospital, Taipei, Taiwan

    Wan-Yuo Guo

  8. St Elizabeth Ziekenhuis, Tilburg, the Netherlands

    Guus Beute

  9. Karolinska Hospital, Stockholm, Sweden

    Michael Söderman

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  1. Bengt Karlsson
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  2. Hidefumi Jokura
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  4. Masaaki Yamamoto
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  11. Tseng Tsai Yeo
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Corresponding author

Correspondence to Bengt Karlsson.

Ethics declarations

Institutional Review Board approval was obtained, and data extracted from ethics committees approved databases for all AVM patients treated with GKS in the participating centers (Sendai, Taipei, Ibaraki, Madrid, and Tilburg).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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This article is part of the Topical Collection on Vascular Neurosurgery Arteriovenous malformation

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Karlsson, B., Jokura, H., Yang, HC. et al. Clinical outcome following cerebral AVM hemorrhage. Acta Neurochir 162, 1759–1766 (2020). https://doi.org/10.1007/s00701-020-04380-z

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