Abstract
We reviewed the management strategies for arteriovenous malformations (AVM) treated in our department to assess the efficacy of a multimodality approach. Seventy-five consecutive patients of intracranial pial AVM treated over the last six years are retrospectively analyzed. Owing to the referral pattern of our hospital, 65% of cases presented with intracerebral hemorrhage (ICH). One-third of AVM located in the basal ganglia and infratentorial region. Seventy-three percent of cases were categorized into Spetzler's Grade I to III and 8% of cases had large AVMs, whose maximum diameters were larger than 6cm.
Multimodality options for the treatment of AVM consisted of preoperative staged embolization, microsurgical staged removal assisted by intraoperative angiography and LINAC radiosurgery. Treatment indication and options were decided depending on patients' age, their presentation, angiographic architecture and the extent of the parenchymal damage. We consider surgical removal the treatment of choice when non-giant, superficial AVM presented ICH. Preoperative embolization and surgical removal were performed on 29 and 43 patients, respectively. LINAC was adopted for 19 patients, and no treatment was indicated for 10 patients, all of whose AVMs were incidentally found. 76% of Glasgow Outcome Scale on discharge obtained from treated cases were good recovery and moderately disabled. Many of the poor outcome cases were due to primary brain damage of initial bleeding. Complications related to treatments were 3 bleeding and 1 ischemic event after embolization and 2 radiation necrosis after LINAC. Total removal or occlusion was obtained two-thirds of all the treated cases and 88% of operated cases. These results indicated that the indication for a multimodality approach should be determined on a case-by-case basis, and total extirpation or occlusion of the AVM with minimum complication can be achieved when an appropriate combination of these treatment options is selected.
