Management of pericentral arteriovenous malformations

Pericentral arteriovenous malformations (AVMs) have more often been deemed inoperable lesions because of their complexity, owing to their critical locations and dismal outcome. This study discusses the management of this group of patients with a variety of treatments which includes surgery, nidus embolization, and radiosurgery. Out of 89 patients treated for AVMs in our institute over a period of 30 months (1992 through May 1995), we present a case series of 34 patients who had AVMs located in the pericentral region. All the treated AVMs were Spetzler and Martin grade III (6 patients), grade IV (13 patients), and grade V (15 patients). The neurological outcome remained, normal or improved from baseline in 68% of patients following treatments; of the remaining 32%, 19% remained in the same condition (with continuing preoperative deficits) and 10% showed some deterioration from their pretreatment condition. Thus 87% were unchanged or improved after the treatment regime. There was a 3% mortality (one patient who died as result of initial hemorrhage) in the series. Our multimodality treatment for this group of AVMs confirms the efficacy of the practiced strategies for their management. The results derived from the experience with this selected group of patients with AVMs lead us to recommend treating these patients with multimodality regimen rather than awaiting the natural history of the disease in the best interest of the patients.