Title: Comparative Analysis of Endovascular and Microsurgical Treatment of Intracranial AVM
Abstract:Background. Intracranial arteriovenous malformations (AVMs) are among the most frequent developmental anomalies of brain vessels. The most serious complication of AVM is intracranial hemorrhage. Treat...Background. Intracranial arteriovenous malformations (AVMs) are among the most frequent developmental anomalies of brain vessels. The most serious complication of AVM is intracranial hemorrhage. Treatment methods of intracranial AVMs include microsurgical techniques, endovascular embolization, and radiosurgery. As all these methods have their advantages and disadvantages, the choice of treatment depends mostly on the experience and capabilities of the treating hospital. Objectives. To analyze comparatively two treatment methods of AVMs: endovascular embolization and microsurgical resection. Material and Methods. Forty consecutive AVMs in 40 patients aged 4–60 years treated between 2002–2007 were analyzed retrospectively. Twenty of the patients were treated by microsurgical resection (subgroup S) and the remaining 20 (subgroup E) underwent embolization (36 sessions overall). There were 12 emergency cases (8 in subgroup S and 4 in subgroup E). Embolizations were performed with histoacrylic glue. Microsurgery included complete resection of the visible AVM and clipping of the feeding artery, in emergency cases also the removal of hematomas. The results of the treatment method were assessed on the last day of hospitalization according to the Glasgow Outcome Scale (GOS). Results. In both subgroups E and S, the most common AVMs were those with 3 points in the Spetzler-Martin classification (S-M) (6 and 9 AVMs, respectively). Mean S-M scores were 2.8 and 2.5, respectively. The most frequent feeding artery in both groups was the MCA (14 and 11, respectively). The degree of nidus embolization ranged from 33 to 100% and depended on S-M score (for S-M of 1 an average of 91.7%, of 2 88%, of 3 70.2%, of 4 65.8%, and of 5 40%). In 15 of the 20 surgical cases, AVMs were removed totally, while in 5 cases residual nidi were found in follow-up CT and/or angiography. In group E the mean GOS score at discharge from hospital was 4.35 points and in group S 3.95 points (no significant difference). In the case of elective embolization or surgery, the mean GOS was 4.7 and 4.5, respectively. The mean duration of hospitalization (in the case of multiple embolizations, hospitalizations during all the sessions were summed) was 14 days in subgroup E and substantially longer (23 days) in subgroup S (p < 0.05). Conclusions. Intravascular and microsurgical methods in many cases do not provide total cure of an AVM. A combination of these two methods and close cooperation between interventional neuroradiologists and neurosurgeons seem to be necessary to optimize the treatment results, shorten the hospitalization period, and reduce the costs of AVM therapy (Adv Clin Exp Med 2010, 19, 2, 219–226).Read More
Publication Year: 2010
Publication Date: 2010-01-01
Language: en
Type: article
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