Treatments for cerebral arteriovenous malformations (AVMs) remain controversial due to frequent unfavorable results at long-term follow-up after stereotactic radiodurgery and the improved results of microsurgical resection, especially in high-graded AVMs by the Spetzler-Martin grading. We investigated previously treated AVM cases and discuss the efficacy and safety of microsurgical resection utilizing preoperative embolization and intraoperative monitoring.
We evaluated the efficacy of the multimodality treatment based on 137 previously treated AVM cases in Shinshu University Hospital during the last 27 years.
Of a total of 137 cases, 82 were treated before the introduction of embolization, while 55 were treated after the introduction of embolization. Of the 82 cases treated before embolization was introduced, 63 (77%) lesions were removed totally and 11 (13%) removed partially, with 8 (10%) untreated. Of the 74 surgically removed cases before embolization was introduced, 12 cases (16%) showed severe intra/post-operative bleeding. Of the 55 cases treated after embolization was introduced, 40 (73%) lesions were removed totally, 3 (5%) were partially removed, 7 (13%) were treated with radiosurgery and 5 (9%) were untreated. In the 43 surgically removed cases after embolizaton was introduced, 1 (2%) case encountered severe intra/post-operative bleeding during surgical removal and 2 (5%) suffered embolization-related complications.
The introduction of multimodality treatment for AVM has enabled safer surgical resection and improved the results even in cases of high-graded AVMs using Spetzler-Martin grading.