Treatment of Cerebral AVM's with Surgery, Radiosurgery and Embolization:Clinical Experiences in 74 Patients

Objective:With the greater availability of alternative techniques, different management strategies are evolving for the treatment of arteriovenous malformations(AVM's) and individual management decision became more complex. The purpose of this study is to report our experiences in treatment of AVM's. Methods:We retrospectively studied the result of 74 patients with cerebral AVM's treated in 1995- 1999 at our hospital. Results:Of the 74 patients, 38 patients had hemorrhage as presenting symptom. Surgery was done in 47 patients. Preoperative embolization was performed in 28 patients. In 44 of these patients(93.6%), the lesions were totally removed. Postoperative radiosurgery was done in two cases with partial removal. Radiosurgery was used as a primary treatment modality in 19 patients, in four of them preradiosurgical embolization was performed. In 15 patients who were followed over 12 months, complete obliteration of the nidus was confirmed in four cases(27.6%) and partial obliteration in six cases. Embolization was performed in eight patients as a primary treatment with complete obliteration verified in only one case. There were seven fatal cases. Conclusion:We conclude that microsurgical resection is the most effective treatment and surgical indication can be extended by embolization and functional evaluations. Radiosurgery may be a useful treatment modality for small, deep-seated, or inoperable lesions. Embolization facilitates surgery and radiosurgery, but should be used very carefully because of high complication rate.