The Unique Features and Outcomes of Microsurgically Resected Cerebellar Arteriovenous Malformations

Peyton L. Nisson, Salman A. Fard, Ali Tayebi Meybodi, Michael A. Mooney, Helen Kim, Heidi Jahnke, Christina M. Walter, Travis M Dumont, Gerald M Lemole, Michael T. Lawton, Robert F. Spetzler

Research output: Contribution to journalArticle

Abstract

Background: Cerebellar arteriovenous malformations (CAVMs) are challenging to treat given their close proximity to the brain stem, greater propensity for rupture, and greater rates of morbidity and mortality than other brain arteriovenous malformations. The present investigation sought to describe and characterize the features of these rare and unique lesions. Methods: A retrospective review of CAVM cases treated at 2 tertiary medical centers was performed. Patients surgically treated at institution 1 from September 1999 to February 2013 and institution 2 from October 2008 to October 2015 were included. Results: A total of 120 patients had been treated. Of the 120 patients, 85 (70.8%) had initially presented with hemorrhage, 45 (37.5%) of whom experienced hemorrhage requiring emergent surgery. A favorable neurological outcome was observed in 76 patients (63.3%; modified Rankin Scale score <3). The perioperative mortality was 2.5% (n = 3). The long-term mortality rate was 7.5% (n = 9). The mean follow-up time was 1.82 years. On average, the patients with large CAVMs (≥3 cm; P ≤ 0.001), who had received embolization before surgery (P = 0.04), did not have an associated aneurysm (P ≤ 0.001), or had a residual CAVM after surgery (P = 0.008) were significantly younger. Female patients had fewer CAVMs with deep venous drainage (54.3% vs. 72.3%; P = 0.049), experienced decreased mortality (1.4% vs. 16.7%; P = 0.003), and were less likely to have worse neurological status after treatment (P = 0.003). Conclusions: CAVMs are rare lesions that exhibit unique disease characteristics. Although most patients will experience a favorable outcome, CAVMs frequently present with hemorrhage, result in high rates of morbidity and mortality, and characteristically differ depending on patient age and gender.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Arteriovenous Malformations
Mortality
Hemorrhage
Morbidity
Brain Stem
Aneurysm
Rupture
Drainage
Brain

Keywords

  • Arteriovenous malformations
  • Cerebellar
  • Features
  • Microsurgery
  • Outcomes

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Nisson, P. L., Fard, S. A., Meybodi, A. T., Mooney, M. A., Kim, H., Jahnke, H., ... Spetzler, R. F. (Accepted/In press). The Unique Features and Outcomes of Microsurgically Resected Cerebellar Arteriovenous Malformations. World Neurosurgery. https://doi.org/10.1016/j.wneu.2018.08.194

The Unique Features and Outcomes of Microsurgically Resected Cerebellar Arteriovenous Malformations. / Nisson, Peyton L.; Fard, Salman A.; Meybodi, Ali Tayebi; Mooney, Michael A.; Kim, Helen; Jahnke, Heidi; Walter, Christina M.; Dumont, Travis M; Lemole, Gerald M; Lawton, Michael T.; Spetzler, Robert F.

In: World Neurosurgery, 01.01.2018.

Research output: Contribution to journalArticle

Nisson, Peyton L. ; Fard, Salman A. ; Meybodi, Ali Tayebi ; Mooney, Michael A. ; Kim, Helen ; Jahnke, Heidi ; Walter, Christina M. ; Dumont, Travis M ; Lemole, Gerald M ; Lawton, Michael T. ; Spetzler, Robert F. / The Unique Features and Outcomes of Microsurgically Resected Cerebellar Arteriovenous Malformations. In: World Neurosurgery. 2018.
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abstract = "Background: Cerebellar arteriovenous malformations (CAVMs) are challenging to treat given their close proximity to the brain stem, greater propensity for rupture, and greater rates of morbidity and mortality than other brain arteriovenous malformations. The present investigation sought to describe and characterize the features of these rare and unique lesions. Methods: A retrospective review of CAVM cases treated at 2 tertiary medical centers was performed. Patients surgically treated at institution 1 from September 1999 to February 2013 and institution 2 from October 2008 to October 2015 were included. Results: A total of 120 patients had been treated. Of the 120 patients, 85 (70.8{\%}) had initially presented with hemorrhage, 45 (37.5{\%}) of whom experienced hemorrhage requiring emergent surgery. A favorable neurological outcome was observed in 76 patients (63.3{\%}; modified Rankin Scale score <3). The perioperative mortality was 2.5{\%} (n = 3). The long-term mortality rate was 7.5{\%} (n = 9). The mean follow-up time was 1.82 years. On average, the patients with large CAVMs (≥3 cm; P ≤ 0.001), who had received embolization before surgery (P = 0.04), did not have an associated aneurysm (P ≤ 0.001), or had a residual CAVM after surgery (P = 0.008) were significantly younger. Female patients had fewer CAVMs with deep venous drainage (54.3{\%} vs. 72.3{\%}; P = 0.049), experienced decreased mortality (1.4{\%} vs. 16.7{\%}; P = 0.003), and were less likely to have worse neurological status after treatment (P = 0.003). Conclusions: CAVMs are rare lesions that exhibit unique disease characteristics. Although most patients will experience a favorable outcome, CAVMs frequently present with hemorrhage, result in high rates of morbidity and mortality, and characteristically differ depending on patient age and gender.",
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AU - Nisson, Peyton L.

AU - Fard, Salman A.

AU - Meybodi, Ali Tayebi

AU - Mooney, Michael A.

AU - Kim, Helen

AU - Jahnke, Heidi

AU - Walter, Christina M.

AU - Dumont, Travis M

AU - Lemole, Gerald M

AU - Lawton, Michael T.

AU - Spetzler, Robert F.

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N2 - Background: Cerebellar arteriovenous malformations (CAVMs) are challenging to treat given their close proximity to the brain stem, greater propensity for rupture, and greater rates of morbidity and mortality than other brain arteriovenous malformations. The present investigation sought to describe and characterize the features of these rare and unique lesions. Methods: A retrospective review of CAVM cases treated at 2 tertiary medical centers was performed. Patients surgically treated at institution 1 from September 1999 to February 2013 and institution 2 from October 2008 to October 2015 were included. Results: A total of 120 patients had been treated. Of the 120 patients, 85 (70.8%) had initially presented with hemorrhage, 45 (37.5%) of whom experienced hemorrhage requiring emergent surgery. A favorable neurological outcome was observed in 76 patients (63.3%; modified Rankin Scale score <3). The perioperative mortality was 2.5% (n = 3). The long-term mortality rate was 7.5% (n = 9). The mean follow-up time was 1.82 years. On average, the patients with large CAVMs (≥3 cm; P ≤ 0.001), who had received embolization before surgery (P = 0.04), did not have an associated aneurysm (P ≤ 0.001), or had a residual CAVM after surgery (P = 0.008) were significantly younger. Female patients had fewer CAVMs with deep venous drainage (54.3% vs. 72.3%; P = 0.049), experienced decreased mortality (1.4% vs. 16.7%; P = 0.003), and were less likely to have worse neurological status after treatment (P = 0.003). Conclusions: CAVMs are rare lesions that exhibit unique disease characteristics. Although most patients will experience a favorable outcome, CAVMs frequently present with hemorrhage, result in high rates of morbidity and mortality, and characteristically differ depending on patient age and gender.

AB - Background: Cerebellar arteriovenous malformations (CAVMs) are challenging to treat given their close proximity to the brain stem, greater propensity for rupture, and greater rates of morbidity and mortality than other brain arteriovenous malformations. The present investigation sought to describe and characterize the features of these rare and unique lesions. Methods: A retrospective review of CAVM cases treated at 2 tertiary medical centers was performed. Patients surgically treated at institution 1 from September 1999 to February 2013 and institution 2 from October 2008 to October 2015 were included. Results: A total of 120 patients had been treated. Of the 120 patients, 85 (70.8%) had initially presented with hemorrhage, 45 (37.5%) of whom experienced hemorrhage requiring emergent surgery. A favorable neurological outcome was observed in 76 patients (63.3%; modified Rankin Scale score <3). The perioperative mortality was 2.5% (n = 3). The long-term mortality rate was 7.5% (n = 9). The mean follow-up time was 1.82 years. On average, the patients with large CAVMs (≥3 cm; P ≤ 0.001), who had received embolization before surgery (P = 0.04), did not have an associated aneurysm (P ≤ 0.001), or had a residual CAVM after surgery (P = 0.008) were significantly younger. Female patients had fewer CAVMs with deep venous drainage (54.3% vs. 72.3%; P = 0.049), experienced decreased mortality (1.4% vs. 16.7%; P = 0.003), and were less likely to have worse neurological status after treatment (P = 0.003). Conclusions: CAVMs are rare lesions that exhibit unique disease characteristics. Although most patients will experience a favorable outcome, CAVMs frequently present with hemorrhage, result in high rates of morbidity and mortality, and characteristically differ depending on patient age and gender.

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