Details

Autor(en) / Beteiligte

• Sen, Rajeev D
• Abecassis, Isaac J
• Barber, Jason
• Nistal, Dominic A
• Abecassis, Zachary A
• Levitt, Michael R
• Kim, Louis J
• Sekhar, Laligam N

Titel

Impact of Acute Microsurgical Resection for Ruptured Brain Arteriovenous Malformations on Hospital Length of Stay and Clinical Outcomes

Ist Teil von

• Neurosurgery, 2020-12, Vol.67 (Supplement_1)

Ort / Verlag

Philadelphia: Wolters Kluwer Health, Inc

Erscheinungsjahr

2020

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• INTRODUCTION Optimal timing of microsurgical resection for ruptured brain arteriovenous malformations (bAVM) is controversial. Some recommend operating in a delayed fashion to allow for clinical recovery from the initial hemorrhage and resolution of edema while others suggest that surgery in the acute (i.e. within 5 days of presentation) setting can facilitate recovery via clot removal and expedited rehabilitation. METHODS Retrospective review of 109 patients with ruptured bAVM that underwent surgical resection between 2005 and 2019. Demographics, bAVM information, and clot characteristics were collected. The acute and delayed groups were compared for primary outcomes including hospital length of stay (LOS) and ICU length of stay. Secondary outcomes included discharge modified Rankin Score (mRS), latest mRS, gross total resection (GTR), and rate of hospital-related medical complications. RESULTS Of the 109 patients with ruptured bAVMs, 58 belonged to the acute group and 51 to the delayed. Mean time between presentation and resection was 2.6 ± 1.4 days for acute and 21.6 ± 28.3 days for subacute. The acute group had lower presenting GCS scores (12.3 ± 3.4 vs. 13.3 ± 3.3; P = .043) and larger clot volumes (21.8 ± 19 mL vs. 11.5 ± 10.5 mL; P = .012). There was no statistical difference in discharge mRS or most recent mRS with an average follow up of 48.3 months, rates of GTR, or hospital complications. The acute group trended towards shorter LOS (14.7 ± 9.3 days vs. 17 ± 10.2 days; P = .171) and ICU LOS (8.1 ± 6.0 days vs. 10.2 ± 6.3 days; P = .096). CONCLUSION Delaying resection of rupture bAVMs with IPH provides no benefit with regards to clinical outcomes or length of stay.