title: [Clinical analysis of microsurgical treatment of giant intracranial arteriovenous malformations].
abstract: OBJECTIVE
  To explore the clinical features and microsurgical treatment strategies of giant intracranial arteriovenous malformations (AVM).
  
  
  METHODS
  A total of 15 cases of giant intracranial AVM treated with microsurgery were analyzed retrospectively. According to the Spetzler-Martin grade, there were 4 cases of grade Ⅳ, 11 cases of grade Ⅴ. Pre-operative endovascular embolizations were carried out in 3 AVMs.
  
  
  RESULTS
  All the included patients were confirmed as giant intracranial AVM by magnetic resonance angiography (MRA), digital subtraction angiography (DSA), 3-dimensional CT angiography (3D-CTA) before surgery. All the resected tissues were sent for pathological examination, and the diagnoses were confirmed as AVM. The average operation time of the 15 patients was 10.3 ±6.9 hours. After 1-3 months, all the patients were rechecked by DSA, the large vascular malformations in 12 cases were completely resected, 3 cases had a small amount of residual further treated with gamma knife treatment. Magnetic resonance imaging (MRI) and MRA examination indicated that the residual AVM was occluded after 12 months. Patients were followed up at 6, 12 and 24 months after operation, and assessed by Glasgow outcome scale (GOS) score: 13 cases good, 1 cases mild disability, 1 cases severe disability; the good rate was 86.6%, with no dead case.
  
  
  CONCLUSIONS
  Sufficiently preoperative preparation, appropriate operative methods and skills are necessary to treat giant intracranial arteriovenous malformation.
authors.affiliation: Department of Neurosurgery, Affiliated Zhongshan Hospital of Dalian University, Dalian 116001, China.
authors.forename: Xuxin
authors.initials: X
authors.lastname: Zhang
authors.forename: Peitong
authors.initials: P
authors.lastname: Sun
authors.forename: Dongfeng
authors.initials: D
authors.lastname: Deng
authors.forename: Baoshan
authors.initials: B
authors.lastname: Gao
authors.forename: Yanzhao
authors.initials: Y
authors.lastname: Li
mesh_terms: D015901:Angiography, Digital Subtraction; D003131:Combined Modality Therapy; D006233:Persons with Disabilities; D004317:Doxorubicin; D004621:Embolization, Therapeutic; D023261:Glasgow Outcome Scale; D006801:Humans; D002538:Intracranial Arteriovenous Malformations; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008727:Methotrexate; D008866:Microsurgery; D016634:Radiosurgery; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D004317:Doxorubicin; D008727:Methotrexate