title: Large cerebral arteriovenous malformations: experience with 27 cases.
abstract: BACKGROUND
  The management of large cerebral arteriovenous malformations is difficult. Surgical excision is often attempted after embolization. Interventional neuro-radiology is available in only a few centers. If large AVMs can be safely excised without pre-operative embolizaton, then these lesions can be treated at many neurosurgical centers.
  
  
  METHODS
  Between January 1986 and June 1992, a total of 210 patients with cerebral AVMs were diagnosed by angiographic studies. Twenty-seven of them had large AVMs wider than 5 cm in the longest diameter. The case records of these patients were retrieved and studied.
  
  
  RESULTS
  Two patients were treated with Bragg peak proton beam therapy. Twelve patients were treated conservatively with no improvement. Thirteen patients underwent surgery and total AVM excision was achieved in 11. None of the patients who underwent surgery had any pre- or intra-operative embolization. All the patients had no neurological deterioration post-operatively.
  
  
  CONCLUSIONS
  Large cerebral AVMs can be treated by surgical excision alone with acceptable results.
authors.affiliation: Department of Neurosurgery, Tan Tock Seng Hospital, Republic of Singapore.
authors.forename: B
authors.initials: B
authors.lastname: Sadasivan
authors.forename: P Y
authors.initials: PY
authors.lastname: Hwang
mesh_terms: D000293:Adolescent; D000328:Adult; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000601:surgery / Q000628:therapy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D061766:Proton Therapy; D016896:Treatment Outcome; D011522:Protons
chemical_list: D011522:Protons