Medical Student Vanderbilt University School of Medicine Nashville, Tennessee, United States
Introduction: The optimal timing for surgical resection of a ruptured cerebral arteriovenous malformation remains controversial. Historically, ruptured AVM resection was often delayed to mitigate the risk of damaging edematous brain parenchyma, which facilitated improved visualization of the AVM. Herein, we analyze the effect of same day and next day surgery in ruptured AVMs.
Methods: The authors retrospectively analyzed patients who underwent surgical treatment for a ruptured cerebral AVM between 2/2014 to 3/2020. Inclusion criteria included the availability of admission bloodwork. The primary outcome was poor neurologic outcome as defined by mRS > 2 at final follow-up. Exclusion criteria consisted of lack of precise rupture day, lack of admission lab work, patients who were not operated on within a 30-day period, and patients without functional follow-up assessment.
Results: A total of 67 patients were included in the final analysis. Same day surgery (SDS) was performed in 14 (20.9%) patients, and the mean time to surgery in the delayed surgery (DS) group was 6 days (sD 7). The patients in the SDS group had significantly higher white blood cell count (13.5 sD 3.5) and absolute neutrophil count (11.3 sD 4.1, p = 0.022). The SDS patients had a greater proportion of poor neurologic outcomes (57%) when compared to the DS group (30%, p = 0.061). 28 (41.8%) patients had surgery same day or the following day after rupture, which exhibited similar inflammatory characteristics, and less drastic differences in proportions of poor neurological outcome for the delayed group (43% vs 31%, p = 0.31). Surgery before or on post-bleed day two in 38 patients (56.7%) resulted in near equivocal neurological outcomes (37% vs 34%, p = 0.84).
Conclusion : Patients operated on early in their post-rupture course had greater inflammatory states and experienced a greater proportion of poor neurological outcome with equivocation of outcomes at post-bleed day two.
