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

Introduction: 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. Research question: This study assessed the feasibility of OSRG application in ruptured AVM surgery and identified limitations specific to this acute context. Methods and materials: 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. Results: 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. Conclusion: 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.