Treatment of cerebral arteriovenous malformation

Abstract

The management of cerebral arteriovenous malformation (AVM) is discussed. A series of 231 cases of AVM was treated from 1961 to March 1984 in our department. The treatments of these cases are classified as total removal 169, partial removal 8, feeder clipping 14, embolization 4 and conservative 36. Results at discharge and at follow-up are analyzed and the treatment evaluated. At follow-up, no rebleeding is reported in the patients who had undergone extirpation. Cases treated with other methods showed rebleedings and either their condition worsened due to hemorrhages or they died. On the basis of these results, it is suggested that AVM should be extirpated totally. Our surgical procedure consisted of temporary occlusion of feeders using cerebral protective substances, so called "Sendai Cocktail" (mannitol, Vitamin E, steroid). This procedure makes complete surgery safe. Surgical results of the cases which were totally extirpated were better than those reported in previous reports: the mortality rate was 3.6%, and the morbidity rate was 5.4%. Because of this, surgical treatment was preferred, that is when the location, size of AVM, age, patient's circumstances and the surgeon's experience allow. However, there are still cases which must be treated with other therapy. These patients are withheld surgery because they have inaccessible AVM or large AVM etc., whose operation would cause neurological deficits. For the treatment of these cases we have recently attempt the chemical embolization method with conjugated estrogen. This produced good outcomes.(ABSTRACT TRUNCATED AT 250 WORDS)