A JOINT PROTOCOL FOR THE NEUROSURGICAL AND NEURORADIOLOGIC TREATMENT OF CEREBRAL ARTERIOVENOUS-MALFORMATIONS - INDICATIONS, TECHNIQUE, AND RESULTS IN 76 CASES

We report on a group of 76 patients who had been treated during a peri od in which preoperative embolization using interventional neuroradiol ogic technique was standard procedure. During this time, 20 consecutiv e patients were operated on without embolization, eight patients were treated with embolization only, and 48 patients were operated on after embolization. In 35 cases surgery immediately followed the last embol ization procedure. All arteriovenous malformations (AVMs) were classif ied and the outcome analyzed according to Spetzler [J Neurosurg 1986;6 5:476-83]. Those lesions treated with a combination of embolization an d surgery had higher Spetzler grading than those that had been operate d without previous embolization. The overall recovery rate was 82.9%. In 7.9% of the cases the AVMs were not totally extirpated. The overall complication rate was 9.2%. It is concluded that preoperative emboliz ation facilitates surgery and reduces the risk of severe morbidity and mortality, especially in high-grade lesions. In addition to the clini cal results, the application and usefulness of Ethibloc(R) as an embol izing agent is reported.