Comprehensive management of arteriovenous malformations

The treatment oi arteriovenous malformations depends on the efforts of a mu ltidisciplinary team whose ultimate goal is to achieve better results when compared to the natural history of the pathology. The role oi adjuvant trea tment modalities such as radiosurgery and endovascular embolization is disc ussed. Treatment strategies and surgical results from a personal series of 344 patients operated in a ten-year period are reviewed. The Spetzler and M artin classification was modified to include subgroups IIIA (large size gra de III AVMs) and IIIB (small grade III AVMs in eloquent areas) to assist th e surgical resection criteria. The treatment strategy followed was surgery for grades I and II, embolization plus surgery for grades IIIA, radiosurger y for grades IIIB, and conservative for grades IV and V. According to the n ew proposed classification 45 (13%) patients were grade I, 96 (28%) were gr ade II, 44 (13%) grade IIIA, 97 (28%) grade IIIB, 45 (13%) grade IV, and 17 (5%) were grade V. As for surgical results 85.8% of the patients had a goo d outcome (no additional neurological deficit), 12.5% had a fair outcome (m inor neurological deficit), 0.6% had a bad outcome (major neurological defi cit), and 1.2% died. These figures indicate that the treatment of arteriove nous malformations can achieve better results compared to the natural histo ry ii managed by a well trained group of specialists led by an experienced neurosurgeon.