Turkish Neurosurgery
Surgery in Intracerebral Arteriovenous Malformations. Role of Preoperative Embolization
Mahmut Ozden1, Koral Erdogan1, Melih Bozkurt1
1Memorial Hospital, Department of neurosurgery, Istanbul,
2Gelisim University, College of Health Sciences, Istanbul,
3Arel University, Faculty of Medicine, Istanbul,
DOI: 10.5137/1019-5149.JTN.44032-23.2

Aim:The optimal treatment of cerebral arteriovenous malformations (AVMs) is still debated. Microsurgery and endovascular embolization can be utilized separately and in combination. However, each of these modalities harbor their own risks. In this study, we compared the outcomes of microsurgery only versus combined microsurgery+embolization approach in the treatment of AVMs.Material and Methods:A total of 62 patients (34 men, 28 women) were recruited harboring Spetzler&Martin Grade-3 (n=44) and Grade-4 (n=18) AVMs. Among these, 37 were treated with combined microsurgery+embolization and 25 were treated with microsurgery alone. Their clinical features (ruptured/unruptured, eloquency, Modifed Rankin Scores, duration of surgery, pre- and post-op hemoglobin levels, usage of blood products) were compared. Results:Higher number of patients with ruptured or eloquently-localized AVMs was treated with the combined approach. Duration of surgeries, pre- versus postoperative hemoglobin levels and usage of blood products did not differ between combined approach versus microsurgery alone.Conclusion:As eloquently located AVMs may possess higher surgical risks due to the presence of deep venous drainage or nidus size, combined treatment was more preferred. Other differences regarding selection of combined versus single approach were not associated with the lesion anatomo-physiology. Rather, we thought combined therapy was more appropriate in our initial clinical practice and planned our clinical strategy accordingly. Nonetheless, now, we found no superiority of the combined treatment in management of AVMs in parallel to recent meta-analyses. Hence, embolization before surgery is not generally advisable in the treatment of AVMs, yet some exceptions shall be considered in a patient-tailored approach.

Corresponding author : Melih Bozkurt