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Updated: Jul 22, 2026

Permanent Cerebral Vessel Occlusion via Double Ligature and Transection
Published on: July 21, 2013
[Combined treatment of high-risk cerebral arteriovenous malformations according to Spetzler-Martin classification]
I V Senko1, K Yu Orlov1,2,3,4, S D Zalogin5
1Federal Center for Brain and Neurotechnology, Moscow, Russia.
Currently, the following strategies are preferable for high-risk AVMs: combination of preoperative embolization with microsurgical resection and combination of partial endovascular embolization with subsequent radiosurgery.
Background:
High-risk cerebral AVMs (Spetzler-Martin grade IV-V) are characterized by higher cumulative risk of hemorrhage during life, as well as higher mortality and disability rates in case of rupture compared to low-risk AVMs. Nevertheless, there are currently no clear indications for surgical intervention for high-risk AVMs, and most patients with this disease are followed-up. However, available data on less favorable course of high-risk AVMs requires active surgical tactics to reduce long-term disability and mortality.
Currently, the following strategies are preferable for high-risk AVMs: combination of preoperative embolization with microsurgical resection and combination of partial endovascular embolization with subsequent radiosurgery.
Objective:
To analyze the most common treatment combinations for high-risk AVMs regarding resection quality, functional outcomes and complications.
Material And Methods:
The study was carried out in accordance with international recommendations for systematic reviews and meta-analyses (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Searching was conducted in the Pubmed/Medline and eLibrary databases using the keywords «High grade», «Arteriovenous Malformations», «Management», «IV-V» and «AVM» for English-language search engines, "high-grade arteriovenous malformations." for Russian-language systems. Available full-text English- and Russian-language articles were selected between 1981 and 2024.
Results:
Among 371 articles, 6 studies met the inclusion criteria. There were 478 patients who underwent two most common strategies for combined treatment of high-risk AVMs.
Conclusion:
At present, there is no consensus on the advantage of certain combined method. There are data on less favorable course of high-grade AVMs and unsatisfactory outcomes after monomodal treatment. Thus, combined methods may be valuable for such AVMs.
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