Postoperative morbidity and mortality after microsurgical exclusion of cerebral arteriovenous malformations. Current data and analysis of recent literature

Background and purpose. Microsurgical exclusion of a cerebral arteriovenous malformation (AVM) can compare favorably with radiosurgery. We sought to a ssess its rate of morbidity-mortality as it is presently reported in the li terature, and to discuss some of its current and worthwhile indications. Methods. Through Medline and additional searches by hand, we retrieved stud ies reporting the clinical and angiographic results after microsurgical exc ision of an AVM published between january 1990 and december 2000. Results. a) Postoperative mortality was 3.3% (68/2 452 patients from 25 stu dies). Permanent postoperative morbidity was 8.6%. Morbidity was never abse nt varying from 1.5% to 18.7%. The morbidity-mortality rate increased with an increasing Spetzler-Martin's grade, and was I elated to rite location of the AVM. A 4.6% morbidity (from 1.5% to 9.7%) and a zero mortality were re ported after microsurgical removal of small lesions of less than 3 cm in di ameter. b) Postoperative angiography confirmed a total excision of the AVM in 97% of the cases (1 050/1 076 patients over II series), varying front 91 % to 100%. c) Permanent morbidity related to pre-surgical embolization vari ed from 4% to 8.9%.Results from multiple or combined treatment including mi crosurgery could not be summed up. Conclusions. A complete and definitive microsurgical excision of an AVM can be achieved with a high success rate and a low morbidity-mortality rate, a ccording to sound indications and to the neurosurgeon's personal experience . The choice for a best treatment of an AVM is no longer limited to microsu rgery; it is a team decision where the neurosurgeon play's a determining ro le.