Arteriovenous malformations of the brain: Indications and outcome of microsurgical excision

This study is based on a retrospective analysis of 30 consecutive patients with previously untreated cerebral arteriovenous malformations (AVMs), who were seen at King Khalid University Hospital between 1987 and 1994. There were 17 males and 13 females, ranging in age between nine and 52 years. Twenty patients presented with intracranial hemorrhage, while the remaining 10 complained of epilepsy. The lesions were located as follows: 15 at the convexity, seven interhemispheric, four central, three basal, and one cerebellar. Nineteen patients (63%) underwent microsurgical excision, which was complete in 16 and incomplete in three. There were no postoperative deaths. Fifteen patients had no additional postoperative neurological deficit, while four patients sustained neurological deterioration, which was severe one. Two patients refused surgical treatment and the risk of surgery was considered too high in nine patients. Our result suggest that the local neurosurgical management standard of selected AVMs is quite satisfactory. However, for a more comprehensive therapeutic approach to these difficult lesions, national expertise in other therapeutic modalities, such embolization techiques and radiosurgery, is urgently needed.