Table 3.
Perioperative complications and long-term outcomes among different treatment modalities in the ruptured and unruptured elderly AVMs.
| Characteristics (Ruptured) | Conservation (n = 13) | Microsurgery (n = 28) | Embolization (n = 9) | SRS (n = 4) | p-value |
|---|---|---|---|---|---|
| Age (years) | 63.7 ± 4.2 | 65.8 ± 3.6 | 64.2 ± 1.8 | 62.3 ± 2.2 | 0.122 |
| Age (>65 years) | 5 (38.5) | 18 (64.3) | 3 (33.3) | 1 (25.0) | 0.166 |
| Admission mRS score | 1.1 ± 0.9 | 2.1 ± 1.4 | 1.0 ± 0.5 | 0.8 ± 0.5 | 0.010* |
| SM grade (IV-V) | 3 (23.1) | 5 (17.9) | 0 (0.0) | 0 (0.0) | 0.173 |
| Perioperative complications | NA | 18 (64.3) | 2 (22.2) | 0 (0.0) | 0.005* |
| Intracranial hemorrhage | NA | 4 (14.3) | 1 (11.1) | 0 (0.0) | 0.560 |
| Epilepsy | NA | 1 (3.6) | 0 (0.0) | 0 (0.0) | 0.679 |
| New-onset neurofunctional deficit | NA | 6 (21.4) | 2 (22.2) | 0 (0.0) | 0.398 |
| Wound infection | NA | 2 (7.1) | 0 (0.0) | 0 (0.0) | 0.456 |
| Intracranial infection | NA | 7 (25.0) | 0 (0.0) | 0 (0.0) | 0.050 |
| Lung infection | NA | 5 (17.9) | 2 (22.2) | 0 (0.0) | 0.435 |
| MACEs | NA | 2 (7.1) | 1 (11.1) | 0 (0.0) | 0.678 |
| DVT | NA | 6 (21.4) | 2 (22.2) | 0 (0.0) | 0.398 |
| Electrolyte disturbance | NA | 7 (25.0) | 2 (22.2) | 0 (0.0) | 0.345 |
| Discharge mRS | 0.8 ± 0.7 | 1.8 ± 1.5 | 1.9 ± 1.8 | 0.8 ± 0.5 | 0.096 |
| Follow-up duration (years) | 4.0 ± 2.1 | 4.3 ± 2.7 | 3.1 ± 1.8 | 4.1 ± 1.4 | 0.660 |
| Obliteration | 0 (0.0) | 25 (89.3) | 1 (11.1) | 2 (50.0) | <0.001* |
| Long-term mRS score | 1.9 ± 2.4 | 2.2 ± 2.2 | 2.4 ± 2.7 | 1.5 ± 3.0 | 0.904 |
| Neurological disability (mRS > 2) | 3 (23.1) | 11 (39.3) | 3 (33.3) | 1 (25.0) | 0.748 |
| Worsened mRS | 4 (30.8) | 7 (25.0) | 3 (33.3) | 1 (25.0) | 0.957 |
| No. of subsequent hemorrhage | 4 | 1 | 0 | 0 | 0.034* |
| Annualized rupture riska | 7.8% | 0.8% | 0.0% | 0.0% | |
| Death | 3 (23.1) | 4 (14.3) | 3 (33.3) | 1 (25.0) | 0.654 |
| Annualized mortality (all causes) | 5.8% | 3.3% | 10.6% | 6.1% | |
| Annualized mortality (AVM-related) | 5.8% | 0.8% | 0.0% | 6.1% | |
| Annualized mortality (treatment-related) | NA | 2.5% | 7.1% | 0.0% | |
| Annualized mortality (other causes) | 0.0% | 0.0% | 3.5% | 0.0% | |
| Characteristics (Unruptured) | Conservation (n = 8) | Microsurgery (n = 2) | Embolization (n = 4) | SRS (n = 3) | p-value |
| Age (years) | 65.7 ± 3.5 | 65.8 ± 1.0 | 64.0 ± 3.4 | 62.0 ± 2.0 | 0.380 |
| Age (>65 years) | 4 (50.0) | 1 (50.0) | 2 (50.0) | 0 (0.0) | 0.305 |
| Admission mRS score | 1.1 ± 1.0 | 1.0 ± 0.0 | 1.3 ± 1.0 | 0.3 ± 0.6 | 0.558 |
| SM grade (IV-V) | 0 (0.0) | 0 (0.0) | 1 (25.0) | 0(0.0) | 0.375 |
| Perioperative complications | NA | 0 (0.0) | 1 (25.0) | 0 (0.0) | 0.411 |
| Intracranial hemorrhage | NA | 0 (0.0) | 1 (25.0) | 0 (0.0) | 0.411 |
| Epilepsy | NA | 0 (0.0) | 0 (0.0) | 0 (0.0) | >0.999 |
| New-onset neurofunctional deficit | NA | 0 (0.0) | 1 (25.0) | 0 (0.0) | 0.411 |
| Wound infection | NA | 0 (0.0) | 0 (0.0) | 0 (0.0) | >0.999 |
| Intracranial infection | NA | 0 (0.0) | 0 (0.0) | 0 (0.0) | >0.999 |
| Lung infection | NA | 0 (0.0) | 0 (0.0) | 0 (0.0) | >0.999 |
| MACEs | NA | 0 (0.0) | 0 (0.0) | 0 (0.0) | >0.999 |
| DVT | NA | 0 (0.0) | 0 (0.0) | 0 (0.0) | >0.999 |
| Electrolyte disturbance | NA | 0 (0.0) | 0 (0.0) | 0 (0.0) | >0.999 |
| Discharge mRS | 1.0 ± 0.8 | 1.0 ± 0.0 | 1.3 ± 1.3 | 0.3 ± 0.6 | 0.568 |
| Follow-up duration (years) | 4.8 ± 2.5 | 4.4 ± 2.7 | 4.3 ± 1.9 | 5.1 ± 1.2 | 0.960 |
| Obliteration | 0 (0.0) | 2 (100.0) | 0 (0.0) | 2 (66.7) | 0.002* |
| Long-term mRS score | 1.3 ± 2.1 | 0.0 ± 0.0 | 1.5 ± 1.0 | 0.7 ± 1.2 | 0.728 |
| Neurological disability (mRS > 2) | 1 (12.5) | 0 (0.0) | 1 (25.0) | 0 (0.0) | 0.618 |
| Worsened mRS | 0 (0.0) | 0 (0.0) | 2 (50.0) | 1 (33.3) | 0.090 |
| No. of subsequent hemorrhage | 0 | 0 | 0 | 0 | >0.999 |
| Annualized rupture risk | 0.0% | 0.0% | 0.0% | 0.0% | |
| Death | 1 (12.5) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0.664 |
| Annualized mortality (all causes) | 2.6% | 0.0% | 0.0% | 0.0% | |
| Annualized mortality (AVM-related) | 0.0% | 0.0% | 0.0% | 0.0% | |
| Annualized mortality (treatment-related) | NA | 0.0% | 0.0% | 0.0% | |
| Annualized mortality (other causes) | 2.6% | 0.0% | 0.0% | 0.0% |
AVM, Arteriovenous Malformation; DVT, Deep Vein Thrombosis; MACE, Major Adverse Cardiac Events; mRS, modified Rankin Scale; SM grade, Spetzler-Martin grade; SRS, Stereotactic Radiosurgery.
Values are expressed as number of cases (%) or mean ± standard deviation, unless otherwise indicated.
a
Poisson rate test of annualized rupture risk for conservation and intervention during follow-up in the ruptured subgroup is significant (p = 0.014).
*
Statistical significance (p < 0.05).