Progress of Surgical Tactics and Changing Strategies in AVM

Abstract

Arteriovenous malformations (AVMs) are one of the cerebrovascular diseases that have benefited from advances in endovascular embolization and diagnostic equipment. At our institution, AVM treatment primarily involves surgical resection, and its evolution is reviewed in the current issue. We retrospectively assessed the progress and changes in AVM treatment strategies by comparing data between two time-periods: from the first half (before 2014, 30 cases) and the second half (after 2015, 35 cases). Cerebral hemorrhage occurred in 23 and 30 patients in the first and second halves, respectively. Although there was a higher proportion of cases in the second half, the difference was not statistically significant. Preoperative embolization was performed in 9 cases in the first half and 24 cases in the second half, showing a significant increase in the latter period. The proportion of high-grade cases (Grade 3 or higher) was significantly higher in the second half of the study period, indicating an increase in more challenging cases. A significantly higher number of cases were monitored in the second half. Treatment outcomes for eight cases of morbidity and one case of mortality were compared, with no significant difference between the first and second halves Multivariate analysis of the factors involved in morbidity and mortality risk indicated age (odds ratio 0.943, p=0.033) and high grade of AVM (odds ratio 16.728, p=0.006) to be significant factors. With increasing number of high-grade cases, surgical treatment with aggressive embolization and monitoring is becoming increasingly common. However, some cerebral hemorrhages have occurred after embolization, and the treatment protocol for staged embolization should be reconsidered. The treatment strategy now focuses more on brain function, and the safe and reliable resection of ruptured low-grade AVMs remains stable. However, the multimodal treatment for high-grade cases needs further improvement.