Abstract
The treatment of cerebral AVMs aims to prevent hemorrhage, control seizures and ameliorate neurological deficits. Of these, prevention of hemorrhage is the most important. There is no established treatment strategy for the lesion. The treatment strategy based on Spetzler-Martin grading is that Grades I, II, and III are a therapeutic target but Grades IV and V should be treated conservatively. According to an AHA Scientific Statement, surgical extirpation should be conceded for Spetzler-Martin Grades I and II, and surgical extirpation with preoperative feeder embolization is often effective for Spetzler-Martin Grade III, but single surgical extirpation is not recommended for Spetzler-Martin Grades IV and V. However, it is difficult to decide the treatment based only on Spetzler-Martin grading system, and applied treatments should be individualized even for patients with cerebral AVMs of the same size and location because each patient has a unique clinical condition and medical background.
In this paper, we analyze clinical date of patients with cerebral AVMs to estimate annual bleeding rate and re-bleeding rate, morbidity and mortality rates of surgical extirpation, and also discuss decision making of any treatment for patients without a history of hemorrhage.
