A joint protocol for the neurosurgical and neuroradiologic treatment of cerebral arteriovenous malformations: indications, technique, and results in 76 cases.
We report on a group of 76 patients who had been treated during a period in which preoperative embolization using interventional neuroradiologic technique was standard procedure. During this time, 20 consecutive patients were operated on without embolization, eight patients were treated with embolization only, and 48 patients were operated on after embolization. In 35 cases surgery immediately followed the last embolization procedure. All arteriovenous malformations (AVMs) were classified and the outcome analyzed according to Spetzler [J Neurosurg 1986; 65: 476-83]. Those lesions treated with a combination of embolization and surgery had higher Spetzler grading than those that had been operated without previous embolization. The overall recovery rate was 82.9%. In 7.9% of the cases the AVMs were not totally extirpated. The overall complication rate was 9.2%. It is concluded that preoperative embolization facilitates surgery and reduces the risk of severe morbidity and mortality, especially in high-grade lesions. In addition to the clinical results, the application and usefulness of Ethibloc as an embolizing agent is reported.
Grzyska
U
U
University Hospital Eppendorf, Department of Neuroradiology, Hamburg, Germany.
Westphal
M
M
Zanella
F
F
Freckmann
N
N
Herrmann
H D
HD
Zeumer
H
H
D000293:Adolescent; D000328:Adult; D002648:Child; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D008875:Middle Aged; D015641:Radiography, Interventional; D012720:Severity of Illness Index; D016896:Treatment Outcome