Surgical management of large AVM's by staged embolization and operative excision

TLDR

The study proposes a staged approach to treat giant AVMs that were previously considered inoperable or marginally operable, aiming to render them totally excisable while keeping morbidity and mortality acceptable. The authors treated 20 patients with giant AVMs using staged embolization followed by surgical resection, and assessed low peri‑AVM perfusion with cortical perfusion pressure, cortical CBF, and xenon‑CT CBF measurements. Complete excision was achieved in 18 of 20 patients, with no deaths and only three complications, one of which was disabling.

Abstract

✓ A series of 20 patients with giant arteriovenous malformations (AVM's) managed with staged embolization and surgical resection is presented. Complete excision was accomplished in 18 of these patients. There were no deaths and only three complications, of which one was disabling. Further evidence for the presence of low perfusion surrounding the AVM, emphasizing the risk of normal perfusion pressure breakthrough, is provided by cortical perfusion pressure, cortical cerebral blood flow (CBF), and stable xenon computerized tomography CBF measurements. The staged approach to giant AVM management is a proposed method to render AVM's that were previously considered inoperable or marginally operable into totally excisable lesions, while maintaining an acceptable level of morbidity and mortality.