ABSTRACT
â¢Our study did not support the hypothesis that small AVMs lead to larger hematoma volumes in the event of a rupture.â¢AVM size did not correlate with the clinical severity of the bleeding as measured with HH and WFNS scores.â¢Larger supratentorial hematomas were associated with a more severe clinical manifestation and a poorer outcome.â¢In the event of a rupture, the AVM size did not correlate with the 2-4-month GOS.â¢AVICH score showed a good correlation with the 2-4-month GOS score.
ABSTRACT
OBJECTIVE: We reviewed retrospectively the perioperative treatment of microsurgically resected brain arteriovenous malformations (bAVMs) at the neurosurgical department of Helsinki University Hospital between the years 2006 and 2014. We examined the performance of the treatment protocol and the incidence of delayed postoperative hemorrhage (DPH). METHODS: The Helsinki protocol for postoperative treatment of bAVMs was used for the whole patient cohort of 121. The patients who had subsequent DPH were reviewed in more detail. RESULTS: Five out of 121 (4.1%) patients had DPH. These patients had a higher Spetzler-Martin grade (SMG) (p = 0.043) and a more complex venous drainage pattern (p = 0.003) as compared to those who had no postoperative bleed. Patients with DPH had 43% larger intravenous fluid intake in the neurosurgical intensive care unit (p = 0.052); they were all male (p = 0.040) and had longer stay in the intensive care unit (p = 0.022). CONCLUSIONS: The Helsinki protocol for postoperative treatment of bAVMs was found to produce comparable results to a more complex treatment algorithm. DPH was associated with high SMG, complex venous drainage pattern, male gender and high intravenous fluid intake. Our findings support the use of SMG in defining patient's postoperative treatment as the DPHs in our study occurred in patients with grade 2-5.
