STAGED VOLUME RADIOSURGERY FOLLOWED BY MICROSURGICAL RESECTION - A NOVEL TREATMENT FOR GIANT CEREBRAL ARTERIOVENOUS-MALFORMATIONS - TECHNICAL CASE-REPORT

OBJECTIVE AND IMPORTANCE: We describe the successful treatment of symp tomatic giant arteriovenous malformations (AVMs) using staged volume r adiosurgery followed by microsurgical resection. CLINICAL PRESENTATION : A 57-year-old man presented with Spetzler-Martin Grade 5 AVMs, with persistent headaches and seizures. He had previously undergone eight a ttempts at AVM embolization and a craniotomy for attempted AVM resecti on; he had suffered four episodes of brain hemorrhaging but had made a good neurological recovery, INTERVENTION: Because of the persistent s ymptoms of the patient and his history of hemorrhaging, a treatment pl an based on staged radiosurgical treatments of different portions of t he AVMs (three sessions, spaced 6 mo apart), followed by delayed micro surgical removal of the much-reduced residual AVMs (3 years later), wa s undertaken. The patient did not suffer any additional hemorrhaging e pisodes, his AVMs were completely removed, and he has made a good reco very. CONCLUSION: Staged volume radiosurgery followed by microsurgical resection of the residual AVMs represents a novel treatment strategy for the management of Grade 5 AVMs that might be untreatable by any si ngle treatment method used alone.