Combination of intraoperative embolisation with surgical resection for treatment of giant cerebral arteriovenous malformations.
OBJECTIVE
To reduce the risk of surgical resection of giant arteriovenous malformation (AVM) and prevent normal perfusion pressure breakthrough (NPPB) and thus to lower postoperative mortality.


METHODS
During the operation, which was carried out under general anaesthesia, the proximal ends of the feeding arteries were first ligated and 0.5 ml IBCA mixed with 0.5 ml of 5% glucose was injected into the vessels towards the AVM, then the malformed vessels were totally resected. Postoperative digital subtraction angiography (DSA) of the four vessels was performed in all patients.


RESULTS
Fifty patients with giant AVMs survived after operation, only 6 (12.0%) had transient neurological dysfunction and 44 (88.0%) recovered after a follow-up of 6-36 months. No patient suffered from NPPB.


CONCLUSIONS
The embolisation could block the arteriovenous shunts sufficiently to decrease the blood flow away from the normal areas of the brain so as to prevent the incidence of intra- and post-operative rebleeding, especially in NPPB. Therefore, the combination of intraoperative embolisation with surgical resection is an effective strategy in the treatment of giant cerebral AVMs, which makes it possible to operate on patients who used to be regarded as inoperable cases.
Jizong
Z
Z
Department of Neurosurgery, Beijing Tiantan Hospital, Capital University of Medical Science, Beijing, China.
Shuo
W
W
Jingsheng
L
L
Dali
S
S
Yuanli
Z
Z
Yan
Z
Z
D000293:Adolescent; D000328:Adult; D002648:Child; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic / Q000379:methods; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis / Q000628:therapy*; D007430:Intraoperative Care / Q000379:methods; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome