The management of cerebral arteriovenous malformations

The presentation of 129 cases of cerebral angioma is reviewed. There were 4 main methods of presentation: haemorrhage, epilepsy, deteriorating neurological signs and headache. The fifth common method of presentation, heart failure, almost exclusively confined to infants, was not seen in the current series which includes no paediatric cases. Standard techniques of investigation principly angiography and CT scanning were used in diagnosis and the current indication for surgery was haemorrhage. The mortality rate per haemorrhage in the series considered in natural terms was 3.6%, neurological deficit as a result of the haemorrhage, either major or minor, occurred in a total of 8%, 4% each. Complete excision of the angioma was performed in 69 cases, although in 3 of these it was necessary to reoperate following postoperative angiography which was then used again to confirm total removal. There was 1 death in this series of radical removals, a mortality rate of 1.5%. Six cases however, showed significant neurological deterioration postoperatively, a major morbidity of 8.7%. From the period of observation of these cases and the instance of haemorrhage the annual bleeding rate would appear to be 4.2%. From follow-up of our cases where the lesion was not completely removed the re-bleeding rate would appear to be 2.6%.