Strategy for the treatment of arteriovenous malformations-a report of 136 cases and literature review

Objective To discuss the choice of treatment for cerebral arteriovenous malformation(AVM) including microsurgery,endovascular embolization,radiosurgery and combined therapy,we analyzed treatment for cerebral AVM in 136 patients. Methods AVM was classified on Spetzler-Martin grading system. There were 78 cases operated microsurgically,17 cases treated by embolization alone,6 cases by microsurgery followed by embolization,33 cases X-knife radiosurgery,2 cases X-knife plus pre-embolization at the region of basal ganglia . Results Angiography showed disappearance of AVM nidus in 76 cases of microsurgery;Complete embolization was done in 4 cases in the group of embolization alone;One showed residual nidus of AVM in the group of embolization plus microsurgery;Reexamination of 35 cases treated by X-knife or X-knife plus pre-embolization showed the AVM nidus disappearance in 21 cases and reduced in 8 cases in 3 year follow-up,2 cases developed new focal deficits and 3 experienced a seizure. The duration of follow-up for all cases ranged from 6 months to 36 months. The rates of GOS were 81.2%. There were 2 deaths in the group of embolization alone. Conclusion Microsurgery is a major treatment for cerebral AVM. Combination of microsurgery with pre-embolization is a best choice for the patients of Grade Ⅳ or Grade Ⅴ. The patients with small and in functioning areas AVM are suitable for X-knife therapy. Weighing the advantage and disadvantage,it is critical for improving prognosis of cerebral AVM to reasonably use these techniques.