Original ArticlesReflections on the management of cerebral arteriovenous malformations
Section snippets
Distribution of patients
From 1989 to 1995, 90 patients with cerebral arteriovenous malformations were treated in our department of Neurosurgery (7 years; average, 12.8 patients per year). Ages ranged from 11 to 69 years. The exact distribution of age is given in Table 1. The patients were one-third female and two-thirds male.
The malformations were classified according to the Spetzler scale in five groups. The distribution of these groups is given in Table 2. Overall, 68% were low-grade malformations (Grades I, II, and
Cure rate
No malformation was considered to be obliterated completely on MRI criteria alone. The cure rate was based on angiography. For irradiated patients, results were assessed on the 2-year post-treatment angiogram. Seventy-two patients (80%) underwent post-treatment angiography. The other 20% include those irradiated patients who have not yet reached this 2-year delay for angiography, and some operated patients who had no post-operative angiography. The cure rates are calculated on these 72 patients
Discussion
Since the beginning of the modern era (i.e., the advent of embolization and stereotactic radiosurgery) there has been a profusion of papers addressing the management of cerebral AVMs. However, the outcome of the various techniques of treatment is unclear. Review of the recent literature demonstrates that there are still many controversies.
Conclusion
In this series of 90 patients with cerebral AVMs, we propose management based on the three available techniques: surgical resection, endovascular embolization, and radiosurgery. Our policy was either single modality or multimodality treatment, based on the size and the location of the malformation. Direct microsurgery was recommended for small and readily accessible malformations, radiosurgery for small and deep ones, and reductive embolization for larger AVMs followed by resection or
References (36)
- et al.
Persistent feeding arteries to angiographically completely embolized AVMs demonstrated by intraoperative color-flow Doppler testingreport of two cases
Surg Neurol
(1995) - et al.
Large cerebral AVMs. Experience with 27 cases
Surg Neurol
(1996) - et al.
Delayed recanalization of a cerebral AVM following angiographic obliteration with Polyvinyl Alcohol embolization
Surg Neurol
(1995) - et al.
Linear accelerator radiosurgery of cerebral AVMsan update
Neurosurgery
(1994) Therapy of AVMsa decision analysis
Clin Neurosurg
(1995)Radiosurgery for Arterio-venous Malformations
Clin Neurosurg
(1995)- et al.
The risk of hemorrhage after radiosurgery for AVMs
J Neurosurg
(1996) - et al.
Cure, morbidity and mortality associated with embolization of brain AVMsa review of 1,246 patients in 32 series over a 35-year period
Neurosurgery
(1995) - et al.
Recurrence of a cerebral AVM after surgical excision
J Neurosurg
(1996) - et al.
Treatment of brain arteriovenous malformations by embolization and radiosurgery
J Neurosurg
(1996)
Even the smallest remnant of an AVM constitutes a risk of further bleeding
Acta Neurochir (Wien)
A joint protocol for the neurosurgical and neuroradiologic treatment of cerebral AVMs. Indications, techniques, and results in 76 cases
Surg Neurol
Comments on Cure, morbidity and mortality associated with embolization of brain AVMs
Neurosurgery
Deep central AVMs of the brainthe role of endovascular treatment
J. Neurosurg.
Simple risk prediction for arteriovenous malformation hemorrhage
Neurosurgery
Multimodality treatment of deep AVMsthalamus, basal ganglia, and brain stem
Neurosurgery
Embolization of cerebral arteriovenous malformations. Part II. Aspects of complications and late outcome
Neurosurgery
Superselective angiography, embolization and surgery in treatment of AVMs of the brain
Neuroradiology
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