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Surgical outcomes after classifying Grade III arteriovenous malformations according to Lawton's modified Spetzler-Martin grading system

Authors
 Hong Jun Jeon  ;  Keun Young Park  ;  So Yeon Kim  ;  Jae Whan Lee  ;  Seung Kon Huh  ;  Kyu Chang Lee 
Citation
 CLINICAL NEUROLOGY AND NEUROSURGERY, Vol.124 : 72-80, 2014 
Journal Title
CLINICAL NEUROLOGY AND NEUROSURGERY
ISSN
 0303-8467 
Issue Date
2014
MeSH
Adult ; Craniotomy ; Female ; Humans ; Intracranial Arteriovenous Malformations/classification* ; Intracranial Arteriovenous Malformations/surgery* ; Male ; Microsurgery ; Middle Aged ; Neurosurgical Procedures/methods* ; Radiosurgery ; Severity of Illness Index* ; Treatment Outcome ; Young Adult
Keywords
Cerebral arteriovenous malformation ; Microsurgery ; Modified Spetzler–Martin grading scale ; Treatment outcome
Abstract
OBJECTIVE:
We aimed to evaluate microsurgical outcomes after classifying Grade III arteriovenous malformations (AVMs) according to Lawton's modified Spetzler-Martin grading system.
METHODS:
Of 131 patients with Grade III AVMs, 55 had undergone microsurgery between 1995 and 2010. The 55 AVMs were classified as follows: Grade III-/S1E1V1, Grade III/S2E0V1, Grade III+/S2E1V0, or Grade III*/S3E0V0. The surgical obliteration rate, morbidity rate, and functional outcomes for each subtype were compared before surgery and after follow-up. Additionally, factors related with morbidity were investigated from demographic and morphological characteristics.
RESULTS:
We observed 18 Grade III-, 16 Grade III, 20 Grade III+, and 1 Grade III* AVMs. Complete resection was achieved in 49 patients (obliteration rate, 89.1%). Incomplete resection rates were higher for Grade III (12.5%) and III+ (15.0%) AVMs than that for Grade III- (5.6%) AVMs. Seven patients (12.7%) presented postoperative deficits, of which 3 (5.4%) experienced disabilities. Patients with Grade III+ (25.0%) had higher morbidity rates than those with other subtypes. Modified Rankin scale scores at the last follow-up indicated unfavorable outcomes for Grades III (18.8%) and III+ (25.0%) AVMs. AVM size (≥3 cm) and non-hemorrhagic type were associated with the occurrence of postoperative deficits (p<0.05).
CONCLUSION:
The modified classification of Grade III AVMs was useful to predict surgical morbidity and clinical outcomes. We recommend that microsurgery should be used to treat Grade III- AVMs, but should be considered carefully for the treatment of Grades III and III+.
Full Text
http://www.sciencedirect.com/science/article/pii/S0303846714002212
DOI
10.1016/j.clineuro.2014.06.017
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, So Yeon(김소연)
Park, Keun Young(박근영)
Lee, Kyu Chang(이규창)
Lee, Jae Whan(이재환)
Jeon, Hong Jun(전홍준)
Huh, Seung Kon(허승곤)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/99512
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