For this study, researchers wanted to compare the clinical and surgical outcomes of patients who received contemporaneous emergency decompression and brain arteriovenous malformations (bAVM) resection vs. those who had bAVM resection later. The researchers looked back 15 years at a group of patients who had undergone microsurgical excision of a ruptured bAVM at their facility. Patients with clinical herniation or intractable intracranial hypertension were enrolled and divided into two groups based on when the bAVM was resected. The demographic and clinical characteristics of the participants were recorded. Complete obliteration (CO), Glasgow Coma Scale score, and modified Rankin Scale score at discharge and the most recent follow-up were all secondary outcomes. A total of 35/269 patients satisfied the study’s inclusion criteria, with 18 undergoing simultaneous decompression and resection (hyperacute group) and 17 undergoing emergent decompression only with bAVM resection afterward (delayed group).
Delayed and hyperacute groups differed only in the proportion that underwent pre resection endovascular embolization (76.5% vs 16.7%, respectively; p < 0.05). There wasn’t any significant difference between the hyperacute and delayed groups in hospital LOS (26.1 vs 33.2 days, respectively; p = 0.93) or ICU LOS (10.6 vs 16.1 days, respectively; p = 0.69). Rates of CO were comparable (78% vs 88%, respectively; p > 0.99). The two groups had similar medical consequences (33% hyperacute versus 41% delayed, p > 0.99). Based on mRS score at discharge, the delayed group had improved short-term clinical outcomes (4.2 vs. 3.2, p < 0.05); however, long-term results were similar between the groups. Ruptured bAVM is an uncommon complication of the clinical herniation that necessitates surgical decompression and hematoma removal. On low-grade lesions, simultaneous surgical decompression and excision of a ruptured bAVM can be done without compromising LOS or long-term functional results.
