Introduction: Treatment of brain arteriovenous malformations (bAVMs) aims to change the natural history of the disease by eliminating the risk of bleeding or re-bleeding. Multimodality approach to bAVMs is frequently the preferred strategy for management of these lesions. While preoperative embolization is an important part of this, complete Microneurosurgical resection is definitive treatment in majority of cases. Goals of preoperative embolization is to reduce volume and blood flow of AVM, to minimize operative time and blood loss, and to reduce the risk of injury to eloquent structures. Complication rate of preoperative embolization is correlated with number of treatment sessions and embolized pedicles.
Methods: Between 2007 and 2012, 29 patients with bAVMs were treated by single staged combined endovascular and microneurosurgical technique by the team from departments of Neurosurgery and Interventional Neuroradiology at the Istanbul University, Cerrahpasa Faculty of Medicine. Series included 14 female and 15 males with the mean age of 34 (18-51). Among them 11 patients presented with hemorrhage (38%). Based on Spetzler Martin (SM) grade, there were 2 grade IV, 12 grade III, 13 grade II and 2 grade 1 AVMs.
Results: 14 patients were treated by embolization followed by surgery. In 11 patients AVMs were completely occluded by embolization. 3 patients underwent surgery as embolization was not possible. In one case, embolization was performed after partial surgical resection. There was one surgery related mortality in a patient with ruptured SM grade IV AVM (3%). Permanent visual field deficit was documented in 2 patients (7%). Transient neurological deficits was observed in 4 patients.
Conclusions: Single staged combined endovascular and microneurosurgical treatment of bAVMs is safe and feasible strategy in specialized centers. Careful patient selection and collaboration and teamwork in planning of treatment is mandatory.
Patient Care: Reducing the risks of preoperative embolization of brain AVMs and facilitate complete treatment in singe session.
Learning Objectives: By the conclusion of this session, participants should be able to: 1)Describe the importance of multimodality treatment of brain AVMs, 2)Discuss the benefits and risks of combined embolization and surgical treatment of bAVMs