A Prospective and Retrospective Study of Cerebral AVM Treatment Strategies 1990-2014

Although treatment options for cerebral arteriovenous malformations (AVMs) have changed since the advent of endovascular surgery and radiosurgery, microsurgery is still the major treatment option since it is effective for immediate cure. We proposed, and have applied, a revised treatment strategy to patients at our institution from February 2008 to May 2014, in which the final goal was disappearance of the nidus on angiography in patients who underwent surgical intervention. We followed 67 patients with cerebral AVMs, and in the 59 patients who had surgical intervention, the cure rate was 89.8 % (53 of 59). In all 67 patients, the surgical extirpation rate was 70.1 % (47/67). These rates were significantly higher than those between 1990 and 2008 at our institute. Microsurgical extirpation-related complications were a postoperative fatal hemorrhage in one patient, and visual field defects in two. In the endovascular treatment, two patients experienced hemiparesis, and radiosurgery-related complications were a fatal hemorrhage in one patient. Two patients from the non-surgical intervention group suffered from fatal hemorrhage. To achieve lower morbidity and mortality in AVM microsurgery, complete treatment until disappearance of the lesion, and an effective combination of available treatment modalities, are mandatory.