Twenty-nine arteriovenous malformations (AVM) in the motor-sensory and speech regions were followed up from 3 to 20 years. Of these, 17 received surgical care and 12 were treated conservatively.
The long-term follow-up results showed a mortality rate of 17% in the group of patients receiving conservative treatment; the post operative mortality was 6%.
None of the patients operated on had recurrence of bleeding, Whereas 6 of 12 patients treated conservatively had 1~3 bleeding occurrences. The rebleeding rate was more frequent in patients with small AVMs than in those with large AVMs.
Definite improvement in the preoperative neurological defect was observed in 53%(9/17) of operative cases. Eleven patients (65%) returned to normal. Neurological defects improved in only 17%(2/12) of the conservatively treated patients. The neurological defects, of 50%of these patients either deteriorated or remained unchanged. Forty-one percent of the conservatively treated patients returned to normal work.
The operative treatment had no benefit for patients with epilepsy; and there also had been no difference in long-term outcome between conservatively and surgically treated patients with large AVMs.
We have come to the conclusion that surgical treatment is the method of choice in small and medium size AVMs in the speech and motor-sensory regions, especially when they bled. Large AVMs are also operable, but they must be well demarcated.
