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(Stroke. 2006;37:1457.)
© 2006 American Heart Association, Inc.

Original Contributions

A Discriminative Prediction Model of Neurological Outcome for Patients Undergoing Surgery of Brain Arteriovenous Malformations

Julian Spears, MD; Karel G. TerBrugge, MD; Mona Moosavian, BSc; Walter Montanera, MD; Robert A. Willinsky, MD; M. Christopher Wallace, MD, MSc Michael Tymianski, MD, PhD

From the University of Toronto Brain Vascular Malformation Study Group (J.S., K.G.T., M.M., W.M., R.A.W., M.C.W., M.T.), Toronto Western Hospital, Ontario, Canada; the Division of Neurosurgery (J.S., M.C.W., M.T.), Toronto Western Hospital, Ontario, Canada; the Department of Medical Imaging (J.S., K.G.T., W.M., R.A.W.), Toronto Western Hospital, Ontario, Canada; the Department of Surgery (J.S., M.C.W., M.T.), University of Toronto, Ontario, Canada.

Correspondence to Dr Michael Tymianski, Toronto Western Hospital, Division of Neurosurgery, Suite 4W-435, 399 Bathurst St, Toronto, ON, M5T 2S8, Canada. E-mail mike.tymianski{at}uhn.on.ca

Background and Purpose— To develop and validate a discriminative model for predicting neurological morbidity after brain arteriovenous malformation (bAVM) surgery.

Methods— Of 233 consecutive, prospectively enrolled patients undergoing bAVM surgery, the first 175 were used to derive, and the last 58 to validate, the prediction model. Demographic and angiographic factors were related to modified Rankin Scale scores assigned before, within 72 hours, at 7 days and at 1 year after surgery to seek predictors of postoperative neurological deficits (modified Rankin Scale score 3). These factors included nidus size, eloquence, venous drainage, diffuseness, white matter configuration, arterial perforator supply and associated aneurysms.

Results— Brain eloquence, diffuse nidus and deep venous drainage were significant predictors of early disabling neurological deficits (odds ratios of 4.33, 3.49 and 2.38, respectively). The rounded odds ratios form a weighted 9-point prediction model (maximum scores for eloquence+diffuseness+deep drainage=4+3+2). The score discriminated the probability of experiencing both early (first week) and permanently (at 1 year) disabling neurological deficits as follows: 0 to 2: 1.8%, 3 to 5: 17.4%, 6 to 7: 31.6%, >7: 52.9% for early and 0 to 2: 1.8%, 3 to 5: 4.4%, 6 to 7: 18.4%, >7: 32.4% for permanently disabling outcomes. The discrimination of the model was 0.80 with 2.8% optimism. Validation in the second patient cohort revealed good performance at risk stratification.

Conclusions— Relative weights assigned to brain eloquence, diffuse nidus morphology and deep venous drainage of a bAVM provide a simple and discriminative prediction model for neurological outcome after bAVM surgery.

Key Words: cerebral arteriovenous malformation • decision aid • decision support models • outcome • surgery

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