[Microsurgical treatment of cerebral arteriovenous malformations: a 20-year experience of the Burdenko Neurosurgical Center].

Abstract

Objective: To evaluate the results of microsurgical treatment of cerebral arteriovenous malformations (AVMs) over a 20-year period and their dynamics taking into account clinical and morphological characteristics of malformations, baseline functional status of patients and clinically relevant outcome measures.

Material and methods: A single-center retrospective cohort study included 1.273 cases of microsurgical treatment of cerebral AVMs between 2006 and 2025. Demographic data, AVM morphology, Spetzler-Martin grading, hemorrhage and seizures before surgery, preoperative embolization, early postoperative complications, and mRS scores before surgery and at discharge were assessed. A favorable outcome implied improvement or no deterioration compared to preoperative status. Clinically significant deterioration («new disability») was defined as deterioration compared to baseline status with mRS ≥3. Visual field defects were analyzed separately and not included in morbidity.

Results: In-hospital mortality was 0.6%. Favorable outcomes were observed in 1.165 out of 1.271 patients (91.7%). Clinically significant deterioration («new disability») was observed in 8.3% of patients. The incidence of complications and adverse outcomes increased along with higher Spetzler-Martin grades. Patients with previous hemorrhage were more likely to have baseline neurological deficit, but the incidence of «new disability» in this group was no different from that in patients without hemorrhage. Preoperative embolization was more common in patients with more difficult AVMs.

Conclusion: Microsurgical treatment of cerebral AVMs at a specialized center is characterized by low in-hospital mortality and high proportion of favorable functional outcomes.