Endovascular embolization of cerebral AVMs prior to surgery or radiosurgery

We studied 18 patients with cerebral arteriovenous malformations (AVM) who underwent embolization prior to surgery or radiosurgery. Two patients were cured with total occlusion of the AVM by embolization alone. Successful size reduction of the nidus in the range of 60-99% was obtained in all the other patients. Twelve patients underwent the radiosurgery following the embolization, one of whom obtained a complete cure. The AVMs in four patients were totally removed after the embolization. Although the purpose of embolization of AVMs is to reduce AVM size and shunt flow, the strategy of the embolization should be adjusted according to the treatment that is to follow, i.e. radiosurgery or surgery. We believe that peripheral nidi must be embolized prior to the radiosurgery, while deep-sited feeders must be embolized along with main feeders prior to the surgery.