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Treatment for brain arteriovenous malformation in the 1998–2011 period and review of the literature

Ondrej Bradac, Frantisek Charvat, Vladimir Benes

Acta Neurochirurgica 155:2:199-209, 2013.

 

Abstract

Purpose

The results of the treatment of pial AVM provided at our neurosurgical centre are presented. Based on these results and on an overview of literary data on the efficacy and complications of each therapeutic modality, the algorithm of indications, as used at our institution, is presented.

Cohort of patients

The series comprises 195 patients, aged 9 to 87 years and treated in the years 1998–2011. The surgical group consists of 76 patients; of these, 49 patients solely received endovascular treatment, 25 were consulted and referred directly to the radiosurgical unit, and the remaining 45 were recommended to abide by the strategy of “watch and wait”.

Results

In the surgical group, serious complications were 3.9 %, at a 96.1 % therapeutic efficacy. As for AVM treated with purely endovascular methods, serious procedural complications were seen in 4.1 % of patients, with efficacy totalling 32.7 %. One observed patient suffered bleeding, resulting in death. For comparison with literary data for each modality, a survival analysis without haemorrhage following monotherapy for AVM with each particular modality was carried out.

Conclusions

Based on our analysis, we have devised the following algorithm of treatment:

  • We regard surgical treatment as the treatment of choice for AVM of Spetzler-Martin (S-M) grades I and II, and only for those grade III cases that are surgically accessible.
  • Endovascular intervention should mainly be used for preoperative embolisation, as a curative procedure for lower-grade AVM in patients with comorbidities, and as palliation only for higher-grade cases.
  • Stereotactic irradiation with Leksell Gamma Knife (LGK) is advisable, mainly for poorly accessible, deep-seated grade-III AV malformations. In the case of lower grades, the final decision is left to the properly informed patient.
  • Observation should be used as the method of choice in AVM of grades IV and V, where active therapy carries greater risk than the natural course of the disease.

 

 

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