Surgical treatment of giant intracranial arteriovenous malformations.
BACKGROUND
The treatment of giant arteriovenous malformations (AVMs) remains a challenge in the neurosurgical field. Microsurgery is one of the most effective ways for eliminating giant cerebral AVMs.


OBJECTIVE
To review surgical outcomes in treating the disease, and form conclusions regarding the indications for and outcomes of surgical treatment in giant intracranial AVMs.


METHODS
We studied 40 consecutive cases of giant AVMs treated in Beijing Tiantan Hospital between 2000 and 2008. The radiologic and clinical features were analyzed. The Spetzler-Martin grading system was used to classify the patients. All patients were surgically treated, and the final outcomes of the patients were gathered for analysis.


RESULTS
The major presenting symptoms were seizures, headaches, hemorrhage, and neurological deficits. The mean AVM diameter was 6.3 cm. According to the Spetzler-Martin grading system, 5 patients had grade III lesions, 21 had grade IV lesions, and 14 had grade V lesions. Out of the total 40 patients, 31 (77.5%) demonstrated excellent or good outcome. Complications included hemiparalysis, aphasia, hemianopia, cranial nerve dysfunction, and seizures. After follow-up, 27 of 30 (90%) surviving patients presented normal function or minimal symptoms.


CONCLUSIONS
Presurgical evaluation of every candidate and treatment choice is the determining factor in therapy for giant AVMs. For giant cerebral AVMs located superficially or not involving critical components, a good outcome can be expected through surgical resection. The obliteration and recurrence rates were satisfying, and the complication rate was acceptable.
Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. zhaojz@public.bta.net.cn
Jizong
J
Zhao
Tao
T
Yu
Shuo
S
Wang
Yuanli
Y
Zhao
Wu Yang
WY
Yang
D000293:Adolescent; D000328:Adult; D002543:Cerebral Hemorrhage / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology* / Q000517:prevention & control; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D012640:Seizures / Q000209:etiology* / Q000517:prevention & control; D055815:Young Adult