抄録
Ten patients with large or deep-seated arteriovenous malformation (AVM) were treated by preoperative or intraoperative embolization and direct surgery. AVMs were removed totally or subtotally in six cases. Partial removal of nidus or feeder clipping was performed in four cases. The outcome was as follows: excellent in 3 cases, good in 2 cases, fair in 1 case in the total or subtotalremoval group and excellent in 1 case, fair in 3 cases in the partial-removal or feeder-clipping group.
One patient revealed intracerebral hemorrhage on the 7th day after preoperative embolization. One patient with partially embolized and subtotally removed AVM manifested intracerebral hemorrhage during postoperative follow-up period. Those complications suggest the importance of hemodynamic changes and increasing risk of bleeding in residual AVM after embolization or direct surgical procedures.
Strategies of combined therapy on a programmed schedule of embolization, direct surgery and/or radiosurgery for large or deep-seated AVMs should be considered. Direct surgery should be planned soon after preoperative embolization procedure and total removal of AVM is highly recommended. Staged direct surgeries become possible after embolization in some cases.
