Abstract
Background The treatment of brain arteriovenous malformations (AVMs) has been studied extensively.
With the use of the Spetzler-Martin (S-M) grading system, patients can be informed
appropriately about their possible surgical risks. This does not hold true for their
neuropsychological sequelae, which have not been studied widely. We evaluated the
neuropsychological outcome of our patients treated for brain AVMs.
Methods Of 113 patients treated for a brain AVM between 2001 and 2009, 66 patients were enrolled
in the study. All patients underwent treatment at our institution and neuropsychological
testing 2 years later using a test battery constructed specifically for this study.
A control group consisted of 10 subjects without any neurologic disease.
Results When the whole cohort was analyzed, no significant differences were found between
the groups distinguished by hemorrhage, gender, or hemispheric dominance. Patients
with S-M IV and V scores fared significantly worse than patients with S-M I to III.
Patients who presented with epilepsy scored lower than patients presenting with other
symptomatology, but the difference had only borderline significance. When we analyzed
patients according to the presence or absence of obliteration after treatment and
compared these with the control group, we found no significant differences. When the
patients with an obliterated AVM after treatment were subdivided according to treatment
modality, there were no significant differences in their S-M groups compared with
the control group. Similarly, those patients with nonobliterated AVMs analyzed according
to their S-M grade showed a borderline significant difference, with S-M IV and V having
a worse neuropsychological outcome compared with the other groups.
Conclusions Patients harboring nonobliterated high-grade AVMs (S-M IV and V) scored worse than
patients with nonobliterated AVM S-M grades I to III. This could be explained by the
steal phenomenon. No differences in neuropsychological testing were found when comparing
results according to nidus location. This study lends support to an active treatment
policy for cerebral AVMs. Those patients in whom complete obliteration was achieved
with treatment scored similarly to the background population, implying active AVM
treatment does not cause deterioration in neuropsychological performance. This, together
with a > 90% AVM obliteration rate, favors microsurgery as the treatment modality
of choice whenever the AVM can be safely resected.
Keywords
brain arteriovenous malformation - neuropsychology - microsurgery - outcome - cognitive
deficit
