[Endovascular coiling and microsurgery of the cerebral arteriovenous malformations. Assessment of criteria of treatment and outcome].
BACKGROUND
Three available methods of therapy of arteriovenous malformations (AVM) i.e. microsurgical resection, intravascular embolization and stereotactic radiosurgery, make possible definitive treatment in the majority of patients. During qualification to these procedures the risk of complications and efficacy of each method should be considered.


OBJECTIVE
To analyze criteria of qualification, risk factors and results of embolization and surgical treatment of AVMs.


METHODS
Within four years (1999-2002) 53 patients were treated for arteriovenous malformations (AVMs) in the Department of Neurosurgery of the University Hospital in Krakow (24 women and 29 men). The group of 25 patients was treated with intravascular embolization, 20 patients were operated and 8 patients were treated conservatively or were qualified to radiotherapy. We retrospectively analyzed clinical findings, criteria of qualification and results of embolization as well as microsurgical treatment of AVMs with regard to Spetzler-Martin scale.


RESULTS
25 patients qualified for embolization underwent 39 embolization procedures. Complete embolization of AVM was obtained in 4 (16%) cases. 18 patients (72%) presented very good or good condition on discharge. In 5 (20%) serious complications were noted: in 2 hemorrhagic and in 3 ischemic. Three patients (12%) died. In the group of 18 operated patients, 13 (72%) patients presented very good or good condition on discharge and 1 patient died because of hemorrhagic complications.


CONCLUSIONS
1. Spetzler-Martin scale is very useful in evaluation of operative risk of AVM operations but, in our opinion, before operation there should be considered also such factors like number and diameter of feeding arteries, exact localization of AVM and initial condition of the patient. 2. Although intravascular embolization is less invasive than neurosurgical operation, the risk of hemorrhagic and ischemic complications is present. 3. Complete AVM embolization is possible in the minority of patients. The remaining group require follow up and control radiological examinations to establish indications for further treatment.
Czepko
Ryszard
R
Klinika Neurochirurgii Instytutu Neurologii Collegium Medicum Uniwersytetu Jagiellońskiegow Krakowie. rczepko@poczta.onet.pl
Pietraszko
Wojciech
W
Uhl
Henryka
H
Libionka
Witold
W
Krzyszkowski
Tadeusz
T
Turski
Tadeusz
T
D000293:Adolescent; D000328:Adult; D000368:Aged; D001164:Arteriovenous Fistula / Q000151:congenital; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000473:pathology* / Q000601:surgery / Q000628:therapy*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D016634:Radiosurgery; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome