TREATMENT OF CEREBRAL ARTERIOVENOUS-MALFORMATIONS BY NEURORADIOLOGICAL INTERVENTION AND SURGICAL RESECTION

We present the results of a series of 105 patients with cerebral arter iovenous malformations (AVMs) who were treated by a combined protocol including endovascular occlusive measures and open surgical resection. 25 patients were treated only by surgical intervention, 72 patients u nderwent preoperative endovascular embolization and 8 patients were tr eated only by embolization, seven of which were only treated for palli ation. After superselective angiography the vascular territories suita ble for endovascular or microsurgical approach were defined, and in mo st cases these territories were complementary to each other. In 56 cas es, only one embolization was necessary and due to an advantageous co- localization of the departments the whole combined endovascular/neuros urgical procedure was done in one anesthesia. If several endovascular sessions were necessary (16 patients), the resection was mostly carrie d out immediately after the last neuroradiological session in the same anesthesia with total time of such combined procedure now averaging a bout 7 hours. According to the proposed grading system by Spetzler we treated 25 grade 1, 24 grade 2, 40 grade 3, 11 grade 4, and 5 grade 5 lesions. The overall success rate defined as complete resection withou t additional permanent neurological deficit was 89.6% (87 out of 97 su rgical cases). The benefits of such combined approach to cerebral AVMs become apparent in shortened and safer surgical procedures as well as in a low complication rate.