Assessing the Role of Preoperative Embolization in the Surgical Management of Cerebral Arteriovenous Malformations.

Related Articles

Assessing the Role of Preoperative Embolization in the Surgical Management of Cerebral Arteriovenous Malformations.

World Neurosurg. 2017 May 13;:

Authors: Luksik AS, Law J, Yang W, Garzon-Muvdi T, Caplan JM, Colby G, Coon AL, Tamargo RJ, Huang J

Abstract
BACKGROUND: Preoperative embolization is established as an advantageous adjunct in multimodality treatment of cerebral arteriovenous malformations(AVMs). However, the benefit of preoperative embolization in AVMs with favorable surgical risk profile is debatable, as it has yet to be supported by evidence in comparative studies. In this study, we assessed outcome of surgically-treated patients in a comparative setting.
METHODS: Our institutional AVM database of retrospectively and prospectively collected data between 1990-2015 was reviewed. Patients with complete clinical data who underwent surgical resection for AVMs were included. We performed a 1:1 ratio propensity-score-match for baseline variables that differed between patients with or without preoperative embolization. Differences in surgical risk and outcomes were evaluated between these two groups.
RESULTS: AVM size, eloquence, deep drainage, MCA feeder and ruptured presentation differed significantly between the two groups. Forty-eight patients without preoperative embolization were matched to 48 with embolization, with no significant differences in baseline variables or AVM characteristics between the two groups. We found no significant differences in AVM obliteration and postoperative mRS between embolized and non-embolized patients, respectively. Change in mRS from preoperative score was also not significant, although more embolized patients had a decline in mRS. Secondary outcome measures including duration of surgery(p=0.172), intraoperative bleeding(p=0.280), duration of hospitalization(p=0.368), and postoperative symptoms were also similar between both groups.
CONCLUSION: Our data does not support substantial benefit of preoperative embolization for patients with favorable surgical risk-profile. Due to risks and costs with this intervention, the prudent utilization of preoperative embolization should be individually considered.

PMID: 28512050 [PubMed - as supplied by publisher]

http://ift.tt/2rhRYZd