Microsurgical management of cerebral arteriovenous malformations

Abstract

Objective: To investigate the microsurgical management of cerebral AVMs and its efficacy, as well as the significance of intraoperative angiography. Method: A retrospective analysis of 24 cases of cerebral AVMs in our hospital from March 2014 to September 2018. There were 13 males and 11 females, with an average age of 28.4 years (4.6~71 years). There were 4 cases with past history of cerebral hemorrhage, and 12 cases with acute cerebral hemorrhage. Of the 12 patients with acute cerebral hemorrhage, 9 underwent CT angiography, and 6 underwent digital subtraction angiography (DSA) before operation. Result: All patients underwent microsurgical treatment, including 8 cases of emergency surgery and 16 cases of elective surgery. Intraoperative angiography was performed in 7 patients undergoing elective surgery, and residual lesions were found in 2 patients, thus complete resections were done finally. Postoperative DSA were done in 14 patients and suspicious residual lesions were found in 2 emergency operation cases. Nineteen patients were followed up for 2 to 48 months, with an average follow-up period of 10 months. The follow-up results according to Glasgow outcome score (GOS) were as follows: good recovery in 15 cases, moderate disability in 4 cases, severe disability in 0 cases, vegetative survival in 0 cases, and death in 0 cases. Conclusion: Microsurgical treatment of cerebral AVMs is safe and effective. Intraoperative angiography is helpful to detect residual lesions. For large cerebral AVMs, the combination of intraoperative embolisation with surgical resection will be an effective strategy.