LARGE CEREBRAL ARTERIOVENOUS-MALFORMATIONS - EXPERIENCE WITH 27 CASES

BACKGROUND The management of large cerebral arteriovenous malformation s is difficult. Surgical excision is often attempted after embolizatio n. Interventional neuro-radiology is available in only a few centers. If large AVMs can be safely excised without pre-operative embolization , then these lesions can be treated at many neurosurgical centers. MET HODS Between January 1986 and June 1992, a total of 210 patients with cerebral AVMs were diagnosed by angiographic studies. Twenty-seven of them had large AVMs wider than 5 cm in the longest diameter. The case records of these patients were retrieved and studied. RESULTS Two pati ents were treated with Bragg peak proton beam therapy, Twelve patients were treated conservatively with no improvement. Thirteen patients un derwent surgery and total AVM excision was achieved in 11. None of the patients who underwent surgery had any pre- or intra-operative emboli zation. All the patients had no neurological deterioration post-operat ively. CONCLUSIONS Large cerebral AVMs can be treated by surgical exci sion alone with acceptable results.