Combination of intraoperative embolization with surgical resection for treatment of giant cerebral arteriovenous malformation.
OBJECTIVE
To reduce the risk of surgical resection of giant arteriovenous malformation (AVM) (> 6.0 cm) and prevent normal perfusion pressure breakthrough (NPPB) for lowering the postoperative mortality.


METHODS
During the operation under barbiturate anesthesia, the proximal end of the feeding arteries were ligated at first, and 0.5 ml isobutyl 12-cyanoacrylate (IBCA) with 0.5 ml 5% glucose was injected into the vessels towards the AVM, then the malformed vessels were resected totally. Postoperative digital subtraction angiography of the four vessels was performed in all patients.


RESULTS
50 patients with giant AVM 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 normal perfusion pressure breakthrough (NPPB).


CONCLUSIONS
The embolization 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 postoperative rebleeding, especially in NPPB. Therefore, the combination of intraoperative embolization with surgical resection is an effective strategy in the treatment of giant cerebral AVMs, which make it operable for those used to be regarded as inoperable cases.
Zhao
J
J
Department of Neurosurgery, Beijing Tiantan Hospital, Capital University of Medical Science, Beijing 100050, China.
Wang
C
C
Wang
S
S
Li
J
J
Sui
D
D
Zhao
Y
Y
D000293:Adolescent; D000328:Adult; D015901:Angiography, Digital Subtraction; D002015:Bucrylate / Q000627:therapeutic use*; D002648:Child; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy; D008297:Male; D008875:Middle Aged
D002015:Bucrylate