Introduction The goal of arteriovenous malformation (AVM) treatment is elimination of hemorrhage risk and AVM symptoms. The emergence of advanced microsurgical and endovascular techniques, as well as radiosurgery, during the recent decades caused major improvement in AVM treatment outcomes. However, there is no uniform approach to combine different approaches in order to achieve the best treatment results. The goal of this study was to develop and check the algorithm of multimodality treatment of brain AVMs based on single center experience.
Methods We performed retrospective analysis of clinical and angiographic data of 563 patients with brain AVMs, treated in single institution between January 2011 and January 2018. Of them, 311 patients were included into this study and assigned into 2 groups: endovascular embolization only (EVE) – n=236 and multimodality treatment (MMT) – n=75. We assessed the AVM occlusion grade after the last treatment session, mRS score, occurrence of any intervention-related complications, and quality of life.
Results The groups were similar in terms of baseline characteristics. Depending on pre-treatment patient condition, previous treatment statues and technical possibility of different treatment methods, each patient underwent from 1 to 11 consecutive treatment sessions. There were total 722 treatment sessions in EVE group and 316 in MMT group. There was significant difference in treatment radicality between the groups (table 1).
Significantly larger proportion of patients in the multimodality group had an improvement of MRS score (p=0.0417, see figure 1). There was no difference between groups in terms of procedure-related morbidity (0=0.5243).
Groups were comparable by the rate of postoperative complications, but percentage of postoperative hemorrhages was lower in MMT group (table 2).
Conclusion Multimodality treatment of brain AVM’s allows to achieve higher radicality than embolization alone, with comparable complication rate.
Disclosures K. Orlov: None. D. Kislitsin: None. N. Strelnikov: None. A. Gorbatykh: None. A. Alshevskaya: None. V. Gladkikh: None. A. Moskalev: None.
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