Abstract
We retrospectively analyzed treatment modalities and outcomes in 51 cases of cerebral arteriovenous malformation Grade IV (Spetzler- Martin's classification) admitted to our institute since 1986. Twenty-five out of 33 cases with hemorrhagic onset received surgical resection with or without preoperative embolization. Total resection was achieved in 21 cases, and small residual nidus was treated by postoperative radiosurgery in 2 out of 4 subtotally resected cases. Six out of 33 hemorrhagic cases received radiosurgery with or without preradiosurgical embolization. Twenty-six out of 33 hemorrhagic cases obtained complete disappearance of nidus. On the other hand, 4 out of 18 non-hemorrhagic cases received surgical total resection, 4 radiosurgery, 6 partial embolization, and 4 observation. Surgical morbidity was 7% and mortality was 0%, and post-treatment hemorrhage was seen in 8 cases (1 after subtotal resection, 2 after radiosurgery, 5 after partial embolization). Surgical resection can be achieved with acceptable morbidity, and complete obliteration of nidus should be accomplished in any treatment modality to avoid post-treatment hemorrhage.
