Combined (microsurgical and endovascular) treatment of cerebral arteriovenous malformations

• Main Authors: D.V. Shchehlov, M.S. Gudym, O.E. Svyrydiuk, I.M. Bortnik, M.B. Vyval
• Format: Article
• Language: English
• Published: Allukrainian Association of Endovascular Neuroradiology 2020-01-01
• Series: Ендоваскулярна нейрорентгенохірургія
• Subjects: arteriovenous malformations; microsurgical resection; endovascular embolization.
• Online Access: https://enj.org.ua/index.php/journal/article/view/116

Objective – to analyze the results of combined microsurgical and endovascular treatment of brain arteriovenous malformations (AVM). Materials and methods. Radiological and clinical data of 19 patients who underwent preoperative endovascular embolization and resection of the AVM at the SO «Scientific-practical Center of endovascular neuroradiology NAMS of Ukraine» in 2014–2019 were analyzed. Among patients were 11 (57.9 %) women and 8 (42.1 %) men. The average age of patient was 28.4 year (from 15 to 54 years). All AVMs were I–III grade according to the Spetzler–Martin scale. Results. The average AVM size in its maximum dimension was 3.2 cm (range 3.1–6.8 cm). 14 (73.7 %) AVMs were supratentorial and 5 (26.3 %) – subtentorial, in 9 (47.4 %) cases AVMs were located in eloquent areas of the brain, in 1 (5.3 %) – in the motor area. Cerebral or subarachnoid hemorrhage were observed in 12 (63.2 %) cases, seizures – in 4 (21.1 %), headache not associated with bleeding – in 2 (10.5 %) and neurological deficiency not related to the bleeding – in 1 (3.7 %). In 16 (84.2 %) patients total AVM resection was achieved, 3 (15.8 %) patients underwent subtotal resection. Fourteen (73.7 %) patients had good results at discharge (10 (52.6 %) patients had 0 or 1 according to modified Rankin score, and 4 (21.1%) patients had 2), 5 (26.3 %) – 3 and 4. There were no mortality cases after combined endovascular and microsurgical treatment. Onset of new neurological deficits occurred in 5 (26.3 %) patients, and in 3 (15.8 %) cases it regress at discharge and in 2 (10.5 %) cases was permanent. Conclusions. Combined treatment (endovascular embolization and microsurgical resection) of AVMs of the low grade AVM (I–III grade of the Spetzler–Martin scale) allows achieving good treatment results. The use of preoperative endovascular embolization reduces blood flow through the AVM and prevents postoperative hemodynamic overload, intraoperative and/or postoperative bleeding.