# Implementation of the open surgery reporting guidelines in ruptured brain arteriovenous malformations: Feasability and adaptations

## TL;DR

This study shows that applying the Open Surgery Reporting Guidelines to ruptured brain AVM surgery is feasible and improves reporting accuracy, while identifying areas needing adaptation for emergency contexts.

## Contribution

First application of OSRG to ruptured AVMs, identifying rupture-specific limitations and proposing adaptations for emergency settings.

## Key findings

- OSRG adherence reached 81.5%, with full completion in radiological, surgical, and administrative domains.
- WFNS >2 and acute hydrocephalus independently predicted poor functional outcomes.
- Microsurgery achieved durable cure and functional recovery in most patients.

## Abstract

Ruptured brain arteriovenous malformations (rAVMs) are a major cause of hemorrhagic stroke in young adults, often leading to severe neurological morbidity. The recently proposed Open Surgery Reporting Guidelines (OSRG) aim to standardize data reporting in microsurgical AVM studies.

This study assessed the feasibility of OSRG application in ruptured AVM surgery and identified limitations specific to this acute context.

A retrospective analysis of 86 patients who underwent microsurgical treatment for rAVMs between 2012 and 2022 was performed. The OSRG, encompassing eight domains and 65 items, was retrospectively applied to each case. Reporting completeness, feasibility challenges, and inter-domain consistency were evaluated. Predictors of poor functional outcome (modified Rankin Scale [mRS] > 2) were determined using uni- and multivariate logistic regression.

The mean age was 45.6 ± 17.2 years, and 59.4 % were female. Complete resection was achieved in 91.6 %, with a mortality rate of 4.6 %. Favorable outcome (mRS ≤2) increased from 53.4 % at 3 months to 72.0 % at last follow-up. WFNS >2 (OR 6.38, 95 % CI 1.50–31.36; p = 0.01) and acute hydrocephalus (OR 6.76, 95 % CI 2.09–25.97; p = 0.01) independently predicted poor outcome. OSRG adherence reached 81.5 % (53/65 items), with full completion in radiological, surgical, and administrative domains, while partial gaps concerned preoperative and adverse events reporting.

Applying the OSRG framework in rAVM surgery is feasible and improves reporting accuracy and transparency. Minor adaptations for emergency settings may further enhance its applicability and facilitate interstudy comparability in vascular neurosurgery.

•First application of OSRG to ruptured AVMs, demonstrating feasibility and identifying rupture-specific limitations.•Detailed practical breakdown of how OSRG guidelines were integrated in rAVMs.•Proposed adaptation of OSRG guidelines in the specific context of rupture.•Microsurgery achieves durable cure and functional recovery in most patients, WFNS >2 and acute hydrocephalus remaining independent prognostic factors.

First application of OSRG to ruptured AVMs, demonstrating feasibility and identifying rupture-specific limitations.

Detailed practical breakdown of how OSRG guidelines were integrated in rAVMs.

Proposed adaptation of OSRG guidelines in the specific context of rupture.

Microsurgery achieves durable cure and functional recovery in most patients, WFNS >2 and acute hydrocephalus remaining independent prognostic factors.