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Related Experiment Video

Updated: Jan 22, 2026

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
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Curative treatment for low-grade arteriovenous malformations.

Arthur Wang1, Grace K Mandigo1, Neil A Feldstein2

  • 1Neurosurgery and Radiology, Columbia University Medical Center, New York City, New York, USA.

Journal of Neurointerventional Surgery
|July 14, 2019
PubMed
Summary

Preoperative embolization combined with surgery or radiosurgery offers a safe and effective treatment for Spetzler-Martin grade I-II arteriovenous malformations (AVMs), achieving high cure rates and good long-term outcomes.

Keywords:
angiographyarteriovenous malformationembolichemorrhageliquid embolic material

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Area of Science:

  • Neurosurgery
  • Interventional Neuroradiology
  • Vascular Neurology

Background:

  • Spetzler-Martin (SM) grade I-II arteriovenous malformations (AVMs) are typically treated with microsurgery or radiosurgery.
  • The role of preoperative embolization in reducing surgical risk for these low-grade AVMs is debated.

Purpose of the Study:

  • To evaluate the safety and long-term functional outcomes of combined treatment for grade I-II AVMs.
  • This combined treatment involves preoperative embolization followed by surgical resection or radiosurgery.

Main Methods:

  • Retrospective analysis of 258 patients with SM I-II AVMs (2002-2017).
  • Detailed review of endovascular procedures, embolic agents, and complications.
  • Comparison of functional status using the modified Rankin Scale (mRS) pre- and post-treatment.

Main Results:

  • 48% of patients presented with hemorrhage; 68% of unruptured and 59% of ruptured AVMs underwent embolization.
  • Four complications (2.4%) occurred in 164 embolized patients: two hemorrhages, one dissection, one infarct.
  • High cure rates (100% on angiography) and good long-term outcomes (mRS ≤ 2 in 92.5% unruptured, 88.0% ruptured) with low permanent morbidity (1.2%).

Conclusions:

  • Endovascular embolization followed by microsurgical resection or radiosurgery is a safe and effective curative treatment for selected SM I-II AVMs.
  • Preoperative embolization serves as a safe adjunct, improving outcomes compared to other published series.
  • Patients with low-grade AVMs treated with this combined approach demonstrate favorable long-term functional results.