LONG-TERM OUTCOME AFTER SURGICAL EXCISION OF PARENCHYMAL ARTERIOVENOUS-MALFORMATIONS IN PATIENTS OVER 60 YEARS OF AGE

BACKGROUND Age is considered an important limiting factor for surgical excision of parenchymal arteriovenous malformations (AVMs) and a more conservative therapeutic approach has been advocated in the elderly. There are no studies available investigating the long-term outcome aft er surgical excision of parenchymal AVMs in patients over 60 years of age. METHODS We report the surgical outcome after excision of an AVM i n a series of 13 consecutive patients older than 60 years. Medical rec ords were analyzed retrospectively. RESULTS Hemorrhage was the mode of presentation in all patients. Three patients were admitted in a comat ose state. Surgery was performed within 1 week from the initial bleedi ng in seven cases and within 2 weeks in five cases. There were no deat hs directly related to surgery in this series. However, one patient di ed as a result of an intracranial hemorrhage complicating preoperative embolization and another patient died 3 months after surgery from int ervening medical complications. During the follow-up period (mean 46 m onths), three more patients had died 8, 19, and 48 months after surger y, respectively Of the remaining eight patients, six are doing well an d are independent in the activities of daily living. One patient is in dependent but requires supervision, and the remaining one was lost to follow-up. CONCLUSIONS Age alone should no longer be considered a cont raindication to treatment. In selected cases, surgery can be performed safely even in the elderly patient with an AVM. After surgical excisi on, elderly patients have the potential for several years of active li fe. (C) 1997 by Elsevier Science Inc.