1994 Volume 22 Issue 1 Pages 23-28
The problems of staged treatment for large or high flow cerebral arteriovenous malformations (AVMs) was studied in 15 patients (12 of men, and 3 of females whose age ranged from 12-50 years).
The AVMs were located on the surface of the cerebrum in 8, on the basal ganglia in 5, and on the corpus callosum and cerebellum in 2 patients. They are all categorized as grade III to V by Spetzler's classification, and treated by combined procedures with embolization, feeder clipping and surgical excision. Eleven out of 15 patients had total excision and showed a good outcome. But 2 patients had rebleeding from the residual AVM after the first procedure because of a long interval until the second procedure. One had massive brain swelling after feeder clipping, and one had a severe neurological deficit after embolization. Therfore, careful selection of staged treatment and a short an interval as possible between each stage are important in preventing serious complications in staged treatment for AVM.
