Combined staged therapy of complex arteriovenous malformations: initial experience

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Complex supratentorial arteriovenous malformations (AVMs) present significant treatment challenges.
• Historically, definitive treatment was reserved for ruptured or symptomatic cases.

Purpose of the Study:

• To evaluate the initial experience of treating complex AVMs using staged embolization with Onyx followed by microsurgery.
• To assess the efficacy and safety of this combined treatment approach.

Main Methods:

• Thirteen consecutive patients with Spetzler-Martin grades III-V supratentorial AVMs were treated.
• Treatment involved staged embolization with Onyx, followed by microsurgical resection.
• Mean of 3 embolization procedures per patient was performed.

Main Results:

• Mean volumetric obliteration prior to surgery was 79.2%.
• All patients achieved complete removal of AVMs on follow-up angiography.
• At 6-month follow-up, all patients were independent in daily life activities.
• 0% mortality, 15.4% disabling complications, and 15.4% non-disabling complications were observed.

Conclusions:

• Staged preoperative embolization with Onyx followed by microsurgery provides a 100% cure rate for complex AVMs.
• This combined approach is safe and effective, with manageable complication rates.
• Complete resection of Onyx material is not necessary for successful patient cure.