J Neurosurg 142:667–675, 2025
Study Objective: To explore the natural history and management outcomes of patients with ruptured Spetzler-Martin grade IV and V brain arteriovenous malformations (bAVMs).
• Patient Selection: The study involved 84 patients with ruptured high-grade bAVMs, identified from a database spanning 1990 to 2020.
• Hemorrhagic Risk: Annual hemorrhagic risk was 2.68% for cortical bAVMs and 8.37% for deep-seated bAVMs during natural history.
• Treatment Outcomes: Surgery reduced hemorrhagic risk significantly in cortical bAVMs, while radiosurgery was effective for deep-seated bAVMs. Embolization alone increased hemorrhagic risk.
• Predictors of Success: Surgery and radiosurgery were significant predictors of bAVM obliteration for cortical and deep-seated bAVMs, respectively.
• Management Strategies: Conservative management was compared to surgical interventions, showing similar functional outcomes but differing in obliteration rates.
• Conclusion: Surgery and radiosurgery may be viable options for certain patients, while embolization alone should be avoided
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