Posttreatment sequelae of palliatively treated cerebral arteriovenous malformations

Posttreatment sequelae of palliatively treated cerebral arteriovenous malformations (AVMs) were studied to evaluate the significance of these nonradical treatments.

Between 1987 and 1997, 46 patients with cerebral AVMs were managed with treatments such as partial embolization, radiosurgery, subtotal resection, or feeder ligation alone. Their AVMs were not radically resected because of difficulties in radical treatment, hesitance to treat eloquent area lesions, or residual nidi after subtotal obliteration. The patients' posttreatment sequelae were evaluated. The duration of follow-up ranged from 0.5 to 169 months (mean, 49.4+/-39.8 mo).

Twenty-six bleeding episodes from AVMs were documented in 18 patients. The annual risk of bleeding in this palliatively treated group was 14.6%. Persistent progressive neurological deficit was observed in one patient. Major neurological deficits occurred in 10 patients (23.3%), and the mortality rate was 9.3%.

Palliative treatments cannot prevent bleeding and may even worsen the posttreatment course compared with the natural history of cerebral AVMs. A more conservative indication is required in recommending palliative treatment alone.