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Impact on Seizure Control of Surgical Resection or Radiosurgery for Cerebral Arteriovenous Malformations

Wang, Joanna Y. BA; Yang, Wuyang MD; Ye, Xiaobu MD; Rigamonti, Daniele MD; Coon, Alexander L. MD; Tamargo, Rafael J. MD; Huang, Judy MD

Neurosurgery:
doi: 10.1227/NEU.0000000000000071
Research-Human-Clinical Studies
CNS University of Neurosurgery
Abstract

BACKGROUND: Seizures are a common presenting symptom of arteriovenous malformations (AVMs). However, the impact of treatment modality on seizure control remains unclear.

OBJECTIVE: To compare seizure control after surgical resection or radiosurgery for AVMs.

METHODS: We analyzed retrospectively collected information for 378 patients with cerebral AVMs treated at our institution from 1990 to 2010. The application of strict inclusion criteria resulted in a study population of 164 patients.

RESULTS: In our cohort, 31 patients (20.7%) had Spetzler-Martin grade I AVMs, 51 (34.0%) grade II, 47 (31.3%) grade III, 20 (13.3%) grade IV, and 1 (0.7%) grade V. Of the 49 patients (30%) presenting with seizures, 60.4% experienced seizure persistence after treatment. For these patients, radiosurgery was associated with seizure recurrence (odds ratio: 4.32, 95% confidence interval: 1.24-15.02, P = .021). AVM obliteration was predictive of seizure freedom at last follow-up (P = .002). In contrast, for patients presenting without seizures, 18.4% experienced de novo seizures after treatment, for which surgical resection was identified as an independent risk factor (hazard ratio: 8.65, 95% confidence interval: 3.05-24.5, P < .001).

CONCLUSION: Although our data suggest that achieving seizure freedom should not be the primary goal of AVM treatment, surgical resection may result in improved seizure control compared with radiosurgery for patients who present with seizures. Conversely, in patients without presenting seizures, surgical resection increases the risk of new-onset seizures compared with radiosurgery, but primarily within the early posttreatment period. Surgical resection and radiosurgery result in divergent seizure control rates depending on seizure presentation.

ABBREVIATIONS: AVM, arteriovenous malformation

CI, confidence interval

DSA, digital subtraction angiography

SD, standard deviation

Author Information

Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland

Correspondence: Judy Huang, MD, Department of Neurosurgery, The Johns Hopkins University School of Medicine, Zayed Tower 6115F, 1800 Orleans Street, Baltimore, MD 21287. E-mail: jhuang24@jhmi.edu

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Received December 08, 2012

Accepted June 24, 2013

Copyright © by the Congress of Neurological Surgeons