title: [Surgical treatment of giant intracranial arteriovenous malformations].
abstract: OBJECTIVE
  To review surgical outcomes in treating intracranial Giant arteriovenous malformations (AVMs). To find out the prognosis factors of surgical treatment.
  
  
  METHODS
  We collected 46 consecutive cases of giant AVMs treated at Beijing Tiantan Hospital, reviewed the radiological and Spetzler-Martin grading. 25 of the patients selected were male (54%), and 21 were female (46%), with a mean age of 30.6. The major presenting symptoms were seizures, headaches, hemorrhage and neurological deficits. According to the Spetzler-Martin Grading, 8 patients were Grade III, 22 were Grade IV, and 16 were Grade V. All patients received surgical treatment and postoperative DSA were performed. Clinical results and long term follow-up (KPS) were gathered for analysis.
  
  
  RESULTS
  One of the 35 patients who received postoperative DSA revealed residual AVMs. Among all patients, severe complications were observed in 9 patients, and 1 patient died in the hospital. Complications included hemiparalysis (15 cases), aphasia (6 cases), hemianopia (9 cases), cranial nerve dysfunction (5 cases), and seizure (5 cases). Normal perfusion pressure breakthrough (NPPB) was observed in 6 patients. After 6 - 108 months of follow-up, 33 of 37 survived follow-up patients presented normal function or minimal symptoms and ability to work or study, 4 patients died (2 were surgical-related).
  
  
  CONCLUSIONS
  Pre-surgical evaluation of every candidates and treatment choice are the determining factors in giant AVMs therapy. Microsurgery remains one of the most effective ways for eliminating giant cerebral AVMs, and the complication rate was acceptable. For giant cerebral AVMs located superficially or do not involve critical components, a good outcome can be expected through surgical resection.
authors.affiliation: Department of Neurosurgery, Beijing Tiantan Hospital Affiliated to Capital Medical University, Beijing 100050, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Yu
authors.forename: Shuo
authors.initials: S
authors.lastname: Wang
authors.forename: Yuan-li
authors.initials: YL
authors.lastname: Zhao
authors.forename: Wu-yang
authors.initials: WY
authors.lastname: Yang
authors.forename: Ji-zong
authors.initials: JZ
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult