Combination of intraoperative embolization with surgical resection for treatment of giant cerebral arteriovenous malformation

Objective To reduce the risk of surgical resection of giant arteriovenous m alformation (AVM) ( > 6.0 cm) and prevent normal perfusion pressure breakth rough (NPPB) for lowering the postoperative mortality. Methods During the operation under barbiturate anesthesia, the proximal end of the feeding arteries were ligated at first, and 0.5 mi isobutyl 12-cyan oacrylate (IBCA) with 0.5 mi 5% glucose was injected into the vessels towar ds the AVM, then the malformed vessels were resected totally. Postoperative digital subtraction angiography of the four vessels was performed in all p atients. Results 50 patients with giant AVM survived after operation, only 6 (12.0%) had transient neurological dysfunction and 44 (88.0%) recovered after a fo llowup of 6 - 36 months. No patient suffered from normal perfusion pressure breakthrough (NPPB). Conclusions The embolization could block the arteriovenous shunts sufficien tly to decrease the blood flow away from the normal areas of the brain so a s to prevent the incidence of intra- and postoperative rebleeding, especial ly in NPPB. Therefore, the combination of intraoperative embolization with surgical resection is an effective strategy in the treatment of giant cereb ral AVMs, which make it operable for those used to be regarded as inoperabl e cases.