What is it about?
Demonstrating that a treatment paradigm for ruptured brain AVMs results in acceptable outcomes without exposing the patient to unnecessary risks. The rerupture risk in the first month is less than 1% if there is not a high risk feature such as a flow-related or nidal aneurysm. Patients in extremis can be temporized with an adequate decompressive surgery and the AVM itself can be managed in a delayed fashion in a more surgically favorable environment.
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Why is it important?
Our study adds valuable insight into the management of ruptured brain AVMs with and without peri-/intra-nidal aneurysms. This lends support to waiting and allowing a patient to recover from the initial insult of the rupture, and makes the intraoperative environment more favorable to the surgeon during AVM resection. Combined, these features enable the patient to make an optimal recovery from the rupture as well as the surgery.
Perspectives
I feel this is important because there is controversy in the literature about the timing of surgery for ruptured brain AVMs. There is a subset of neurosurgeons that intervene acutely on ruptured brain AVMs, and this may not be in this patient population's best interest. The risk the patient is exposed to in waiting to perform the surgery is minimal, and the benefits of operating after the hematoma has largely dissipated is tangible at the time of surgery. Furthermore, the patient's true neurologic function is more accurately assessed and understood after they have had time to recover. More attention can then be placed on preservation of function at the time of surgery.
Jeff Beecher
Read the Original
This page is a summary of: Delayed treatment of ruptured brain AVMs: is it ok to wait?, Journal of Neurosurgery, April 2018, Journal of Neurosurgery Publishing Group (JNSPG),
DOI: 10.3171/2017.1.jns16745.
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