Multidisciplinary treatment of cerebral arteriovenous malformations

• Published in: Neurological research (New York) Vol. 17; no. 3; p. 169
• Main Authors: Deruty, R, Pelissou-Guyotat, I, Amat, D, Mottolese, C, Bascoulergue, Y, Turjman, F, Gerard, J P
• Format: Journal Article
• Language: English
• Published: England 01.06.1995
• Subjects: Adolescent; Adult; Aged; Brain Ischemia - etiology; Cerebral Angiography; Cerebral Hemorrhage - etiology; Child; Child, Preschool; Combined Modality Therapy; Embolization, Therapeutic - adverse effects; Female; Follow-Up Studies; Humans; Intracranial Arteriovenous Malformations - diagnosis; Intracranial Arteriovenous Malformations - surgery; Male; Middle Aged; Models, Biological; Postoperative Complications - etiology; Radiation Injuries - etiology; Radiosurgery - adverse effects; Radiosurgery - instrumentation; Treatment Outcome
• ISSN: 0161-6412
• DOI: 10.1080/01616412.1995.11740307

A series of 67 patients treated for cerebral AVM with a multidisciplinary approach is reported. The malformations were classified after the Spetzler Grading Scale, with 67% low-grade and 33% high-grade AVMs. Three modes of treatment were used: surgical resection, endovascular embolization, and radiosurgery (linear accelerator technique). The actual treatment was: surgical resection alone (25% of cases), embolization plus resection (25% of cases), embolization alone (21%) and radiosurgery (30%) either alone (12%), or after incomplete embolization (15%) or after incomplete resection (3%). The clinical outcome was evaluated in terms of deterioration due to treatment. The treatment was responsible for a deterioration in 28% of all patients, either minor deterioration (19%) neurological deficit (4%), or death (4%). All complications of surgical resection (17% of all operated cases) and of radiosurgery (10% of irradiated cases) remained minor. None was haemodynamic-related. After endovascular embolization, a deterioration occurred in 25% of all embolized cases (minor 13%, neurological deficit 5% and death 8%). These complications occurring after embolization were haemodynamic related: ischaemia and haemorrhage (50% for each mechanism). Haemorrhage occurred either during or some days after the embolization procedure. The angiographic eradication rate was: 80% overall, 91% after resection (with or without previous embolization), 87% after radiosurgery (alone or after other techniques), and 10% after embolization alone. The discussion reviews in the literature the general evolution of the management of cerebral AVMs, with successive application of first surgical resection, the embolization and lastly radiosurgery.