Total removal of arteriovenous malformations with preoperative embolization and intraoperative digital subtraction...

Between 1991 and 1995 we totally removed 24 cerebral arteriovenous malformations (AVMs), employing preoperative embolization in 9 patients and intraoperative digital subtraction angiography (DSA) in all 24. There was 1 patient with Spetzler grade I lesion, 6 with grade II, 9 with grade III, 5 with grade IV and 3 with grade V. Nine patients with large AVMs underwent preoperative embolization to occlude surgically inaccessible feeders and to reduce arterial blood supply by 50%. Surgery was performed 3-11 days after embolization. Twenty-one patients did well. One patient died of postoperative bleeding complications, and a mild neurological deficit appeared in 2 patients. We believe that intraoperative DSA is essential for the total removal of cerebral AVMs. The operative mortality and morbidity rates could be reduced with preoperative embolization of large AVMs.