Sk. Huh et al., Selection of treatment modalities for cerebral arteriovenous malformations: a retrospective analysis of 348 consecutive cases, J CL NEUROS, 7(5), 2000, pp. 429-433
The objective was to establish the selection criteria for the optimal manag
ement modalities for cerebral arteriovenous malformations. We analysed the
complications and late outcomes in 348 consecutive cases (132 microsurgical
resections, 202 stereotactic radiosurgeries, 8 embolisations only, 6 combi
ned treatments) managed at Yonsei University Hospital from 1988 to 1997. Fi
les for all patients were analysed. The outcome was classified into good fo
r the patients who returned to their previous job with or without neurologi
cal deficits, fair for the patients who were unable to return to work but p
erformed daily activities independently with minor deficits, and poor for t
he patients who were performing dependent daily activities with major defic
its. The outcome of microsurgery was considered good in 108 patients (81.8%
), fair in 18 (13.6%), poor in 4 (3.1%), and 2 (1.5%) patients died. Initia
l insults and haemodynamic complications were the major cause of an unfavou
rable outcome. The cumulative occlusion rate of the nidus after radiosurger
y was 10.2% within 12 months, 75.3% within 24 months, and 89.8% within 36 m
onths. Perilesional imaging changes with neurological deficits (4 permanent
and 6 transient, 4.8%) and haemorrhage (16 patients, 7.7%) during the late
nt interval were the major cause of an unfavourable outcome (1 poor, 4 dead
after radiosurgery). Postradiosurgery bleeding occurred frequently within
6 months (6 patients), and between 13 and 24 months (8 patients). In conclu
sion, selection of treatment modality for cerebral AVMs depends on the preo
perative evaluation of the risk/benefit ratio in each case. Microsurgical r
emoval, which eliminates the risk of bleeding immediately, is preferred for
lesions in non-eloquent areas. Radiosurgery is an effective treatment moda
lity for small lesions in eloquent areas, but has a substantial risk of hae
morrhage during the latency period. Results of this study suggest that micr
osurgical removal should be considered for lesions in Eloquent areas with h
igh haemorrhage risk, such as prior haemorrhage, medium to large size lesio
n, and single deep venous drainage. (C) 2000 Harcourt Publishers Ltd.