Risk factors for delayed postoperative hemorrhage in patients with brain arteriovenous malformations: an analysis of the nationwide multicenter prospective registry MATCH study

Debin Yan; Kexin Yuan; Yu Chen; Kaihong Zheng; Heze Han; Zhipeng Li; Haibin Zhang; Ruinan Li; Ke Wang; Yukun Zhang; Xiaolin Chen; Yuanli Zhao

doi:10.3171/2023.12.JNS231539

Risk factors for delayed postoperative hemorrhage in patients with brain arteriovenous malformations: an analysis of the nationwide multicenter prospective registry MATCH study

J Neurosurg. 2024 Mar 8:1-7. doi: 10.3171/2023.12.JNS231539. Online ahead of print.

Authors

Debin Yan¹, Kexin Yuan², Yu Chen², Kaihong Zheng³, Heze Han², Zhipeng Li², Haibin Zhang², Ruinan Li², Ke Wang², Yukun Zhang⁴, Xiaolin Chen², Yuanli Zhao⁵

Affiliations

¹ 1Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan.
² 2Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing.
³ 3Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan.
⁴ 4Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing; and.
⁵ 5Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

PMID: 38457809
DOI: 10.3171/2023.12.JNS231539

Abstract

Objective: Reducing the incidence of delayed postoperative hemorrhage (DPH) is one of the challenges in the surgical treatment of patients with brain arteriovenous malformations (bAVMs). This study aimed to identify several risk factors for DPH after bAVM resection and evaluate the impact of these risk factors in patients with bAVMs.

Methods: The authors retrospectively reviewed consecutive patients with bAVMs who underwent microsurgical resection between August 2011 and September 2021. Patients were divided into either the DPH group or non-DPH group based on whether they experienced a postoperative intracerebral hemorrhage into the bAVM bed within 14 days after bAVM resection. Factors associated with DPH were assessed using multivariate logistic regression analyses.

Results: A total of 1284 consecutive patients with bAVMs were evaluated; DPH events occurred in 18 patients (1.4%). There were several differences in vascular architecture between the two cohorts. A giant nidus, a nidus involved in the eloquent area, a periventricular nidus, and a nidus accompanied by venous ectasia were more likely to be associated with DPH events. The multivariate analysis identified two independent factors associated with DPH: maximum diameter (OR 1.44 per 1-cm increase, 95% CI 1.13-1.83) and periventricular lesion (OR 4.10, 95% CI 1.33-12.59). The area under the receiver operating characteristic curve for the maximum lesion diameter and development of DPH was 0.71 (95% CI 0.58-0.84). The cutoff value for the maximum bAVM diameter was 4.15 cm. Furthermore, patients with a giant bAVM, of which the maximum diameter was ≥ 4.15 cm, had a higher DPH risk after surgery (HR 5.79, 95% CI 2.01-16.67; p < 0.01). The incidence rates of DPH for patients with periventricular lesions were higher than those for patients without periventricular lesions (HR 4.50, 95% CI 1.77-11.40; p < 0.01).

Conclusions: Patients with giant bAVMs or periventricular lesions are at higher risk for DPH after surgery. Strategies such as blood pressure control, preoperative embolization, intraoperative monitoring, and careful patient selection should be considered to reduce the risk of DPH in high-risk patients.

Keywords: brain arteriovenous malformation; delayed postoperative hemorrhage; microsurgery; periventricular; risk factor; vascular disorders.