Treatment Strategies for Cerebral Arteriovenous Malformation Focusing on Resection

While the radicality of resection for cerebral arteriovenous malformation (AVM) is superb, it is regarded as a difficult type of neurosurgical operation. One reason for this is the risk of uncontrollable intraoperative hemorrhage. Preoperative embolization or staged operations are conducted to avoid this. We examined recent cases at our hospital. Among 124 cases of AVM treated at our hospital between January 2005 and June 2010, complete resection was conducted in 90 cases. We examined the operative procedures and outcomes of these 90 cases retrospectively. The Spetzler-Martin grade (S-M grade) in the 90 cases was 1-2 in 45 cases, 3 in 35 cases and 4 in 10 cases, with no cases of Grade 5. Preoperative embolization was conducted in 33 of the 90 cases (37%), while a staged operation was conducted in 12 cases (13%). In the cases with S-M Grade 3-4 (45 cases), preoperative embolization was conducted in 25 cases (56%) and a staged operation was conducted in 12 cases (27%). The outcome was undesirable in 0% of S-M Grade 1, 4% of S-M Grade 2, 11% of S-M Grade 3 and 30% of S-M Grade 4. Uncontrollable intraoperative hemorrhage did not occur in any of the cases. Although examination of the individual cases is necessary, the recent outcomes at our hospital demonstrate the utility of preoperative embolization and staged operations for high-grade AVM.