SUPERSELECTIVE ANGIOGRAPHY, EMBOLIZATION AND SURGERY IN TREATMENT OF ARTERIOVENOUS-MALFORMATIONS OF THE BRAIN

We prospectively evaluated a diagnostic and therapeutic procedure comb ining superselective angiography, endovascular embolisation and surger y in arteriovenous malformations (AVM) of the brain. Our aim was to ac hieve the best possible result exposing the patients to the lowest pos sible risk. During a 3 year period 48 patients were studied, of whom 2 2 (46 %) were treated by incomplete preoperative embolisation and subs equent complete surgical removal of the AVM. All angiography and embol isations were performed with the Tracker catheter system using polyvin yl alcohol particles and/or platinum fibre coils. The other 26 patient s were treated as follows: incomplete embolisation in 11 (23 %), compl ete embolisation in 2 (4 %), angiography and surgery in 3 (6 %) and co mbined embolisation and radiation in 7 (15 %); 3 patients were exclude d from any therapy after superselective angiography. The total number of acute complications and permanent sequelae were 8 (17 %) and 3 (6 % ) respectively. We concluded that superselective cerebral angiography, a relatively safe procedure, should play an important role in decidin g treatment strategies for AVMs of the brain. The risks of combined em bolisation and surgery are probably lower than those of either alone. In a few cases surgery or embolisation alone carries an unequivocally lower risk, and combined therapy is not justifiable.