Microsurgery for cerebral arteriovenous malformations: Postoperative outcomes and predictors of complications in 264 cases

Thana Theofanis, Nohra Chalouhi, Richard Dalyai, Robert M. Starke, Pascal Jabbour, Robert H. Rosenwasser, Stavropoula Tjoumakaris

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


Object: The authors conducted a study to assess the safety and efficacy of microsurgical resection of arteriovenous malformations (AVMs) and determine predictors of complications. Methods: A total of 264 patients with cerebral AVMs were treated with microsurgical resection between 1994 and 2010 at the Jefferson Hospital for Neuroscience. A review of patient data was performed, including initial hemorrhage, clinical presentation, Spetzler-Martin (SM) grade, treatment modalities, clinical outcomes, and obliteration rates. Univariate and multivariate analyses were used to determine predictors of operative complications. Results: Of the 264 patients treated with microsurgery, 120 (45%) patients initially presented with hemorrhage. There were 27 SM Grade I lesions (10.2%), 101 Grade II lesions (38.3%), 96 Grade III lesions (36.4%), 31 Grade IV lesions (11.7%), and 9 Grade V lesions (3.4%). Among these patients, 102 (38.6%) had undergone prior endovascular embolization. In all patients, resection resulted in complete obliteration of the AVM. Complications occurred in 19 (7.2%) patients and resulted in permanent neurological deficits in 5 (1.9%). In multivariate analysis, predictors of complications were increasing AVM size (OR 3.2, 95% CI 1.5-6.6; p = 0.001), increasing number of embolizations (OR 1.6, 95% CI 1.1-2.2; p = 0.01), and unruptured AVMs (OR 2.7, 95% CI 1-7.2; p = 0.05). Conclusions: Microsurgical resection of AVMs is highly efficient and can be undertaken with low rates of morbidity at high-volume neurovascular centers. Unruptured and larger AVMs were associated with higher complication rates.

Original languageEnglish (US)
Article numberArticle E10
JournalNeurosurgical focus
Issue number3
StatePublished - 2014
Externally publishedYes


  • Arteriovenous malformation
  • Embolization
  • Endovascular
  • Microsurgery
  • Spetzler-Martin grade

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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