Complications of Angioma Surgery:Personal Experience in 191 Patients with Cerebral Angiomas

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In the last years, treatment decisions of arteriovenous malformations (AVMs) were influenced by the improvementof stereotactic radiosurgery and were revolutionized by development of embolization techniques.The aim of this report was to examine the results, effectiveness, and complications associatedwith angioma surgery. 191 patients with AVMs were operated by the first author between 1981 and1996. Angioma localization was distributed as follows: frontal 51 (26.7%), temporal 44 (23%), parietal45 (23.6%), and occipital 24 (12.6%). Twelve (6.3%) AVMs were located in the cerebellum and 15 (7.9%)in other deep regions. Twenty-nine (15.2%) AVMs were associated with single or multiple aneurysms.The preoperative symptoms were hemorrhage (50.3%), seizure (33.5%), headache (23.0%), focal neurologicaldeficits (12.6%), and other minor symptoms. In 9.9%, the disease remains preoperatively asymptomatic.Based on the Spetzler/Martin scale (S/M), 38 patients were grade I, 39 grade II, 52 grade III, 39 grade IV, and 23 grade V. The following severe complications were observed: postoperative hemorrhagein 13 (6.8%), infection in six (3.1%), infarction in two (1.0%), and death in three (1.6%). The riskfor postoperative complications was related to the preoperative S/M grade of the AVM. Severe complicationsonly occurred in AVM grades IV and V. In 62 patients with grade IV and V AVM, three patientsdied (4.8%) and 12 showed neurological deterioration (19.4%). Only 3/129 (2.3%) patients with grade IIIIAVM deteriorated postoperatively. No severe complications were observed in preembolized and recentlyoperated patients. Microsurgical management of cerebral AVMs seems to be a reasonably safeprocedure especially in grade I-III AVMs, with a mortality of less than 2%. With enough experienceand exact attention to detail, the experienced neurosurgeon can remove many of these AVMs with aminimum of risk to the affected patient. Although hemorrhage from an AVM can be disabling or deadly, the course in many nonoperated high-grade AVMs (S/M grades IV and V) can be quite benign, if comparedwith their surgical risk. This may justify conservative treatment or treatment with radiosurgeryin some high-grade (S/M grades IV and V) angiomas, especially in elderly patients.
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Complications of Angioma Surgery:Personal Experience in 191 Patients with Cerebral Angiomas

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