Treatment of cerebral arteriovenous malformation by endovascular embolization or resection surgery

Objective To explore the curative effects of resection surgery and endovascular embolization for intracranial arteriovenous malformation (AVM). Methods Twenty-three patients of AVM complicated with intracranial hematoma were treated by clearing of hematoma and resection of AVM. Fifty-eight cases of AVM without hemorrhage were treated by superselective embolization with N-butyl cyanoacrylate (NBCA). Two- or three-dimensional DSA were used before embolization. Results In surgery group, complete resection of AVM evaluating by post-operative MRI or DSA was achieved in 12 cases (52.2%). 6 cases were cured with the subtotal resection followed by intravascular embolization, and the disability rate was 26.1% and the mortality was 21.7%. In intravascular embolization group, 49 patients evaluated by the showing of lastest DSA got a complete embolization, and 8 patients'AVM got more than 50% embolization, and 1 patient's AVM got less than 50% embolization. Conclusion The AVM complicated with fatal hematoma must be emergently operated for the evacuation of hematoma and the resection of AVM. The AVM of small size or with single blood-suppling branch, grade-Ⅲ AVM or lower could be once completely embolized. The grade Ⅲ,Ⅳ or Ⅴ AVM could be treated for several times in separated stages, which can reduce complications and improve symptoms. In a word, the selection of methods for treating brain AVM should depend on patient's specific condition. [