EMBOLIZATION OF CEREBRAL ARTERIOVENOUS-MALFORMATIONS .2. ASPECTS OF COMPLICATIONS AND LATE OUTCOME

OBJECTIVE: From 1987 through 1993, we performed embolizations on 150 p atients with cerebral arteriovenous malformations (AVMs) at Sahlgrensk a University Hospital. The patients ranged in age from 5 to 70 years ( 35.5 +/- 14.8 yr, mean +/- standard deviation) and were selected by ne urosurgeons in Scandinavia. We analyzed the risk of complications and late outcome to have a better basis for the decision to perform emboli zation. METHODS: The follow-up was a personal clinical examination of all surviving patients by a neurologist. Files for all patients were a lso studied. RESULTS: In 34 patients, the AVMs were eliminated by embo lization alone (20 patients) or by supplementary surgery (14 patients) . In 66 patients, the AVMs were embolized to a size suitable for suppl ementary stereotactic radiation. The clinical course was stable for th ose 100 patients. Another group of 50 patients who had undergone embol ization was only partially treated, and as a group, those patients had less favorable outcomes. The manifestations or symptoms leading to di agnosis were in concordance with other studies. Headache and epilepsy showed a positive response to treatment in patients whose AVMs had bee n eliminated as well as in those who received only partial treatment. A history of cerebral bleeding did not influence the prognosis of recu rrent bleeding. Conversely, AVMs with feeder or nidus aneurysms were r elated to an increased risk of bleeding. If there was a history of ble eding in a patient with large, partially treated AVMs, the prognosis f or survival was diminished. CONCLUSION: The indication for treatment i ncreases with the occurrence of AVMs with associated aneurysms. For pa tients with large AVMs, a history of bleeding justifies a more aggress ive approach to treatment. The reduced risk of complications during th e last years of the study also increases the indication for embolizati on.