Premium
Combined staged therapy of complex arteriovenous malformations: initial experience
Author(s) -
RodríguezBoto G.,
GutiérrezGonzález R.,
Gil A.,
Serna C.,
LópezIbor L.
Publication year - 2013
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/j.1600-0404.2012.01706.x
Subject(s) - medicine , embolization , surgery , microsurgery , complication , angiography , modified rankin scale , arteriovenous malformation , cerebral angiography , radiology , ischemic stroke , ischemia , cardiology
Objectives Definitive treatment of complex supratentorial arteriovenous malformations ( AVMs ) has been classically assigned to ruptured or progressively symptomatic cases. The aim of this study is to report our initial experience in the treatment of complex AVMs by means of staged embolization with O nyx followed by microsurgery. Material and methods Thirteen consecutive patients with supratentorial S petzler– M artin grades III , IV and V AVM s were treated between J anuary 2009 and J une 2010. Mean age at the beginning of the therapy was 34. All patients were symptomatic. Mean AVM size was 48 mm, and mean volume prior to embolization was 47 ml. Results Mean number of endovascular procedures was 3, and mean volumetric obliteration prior to surgery was 79.2%. Mean time between two embolizations was 24 days. One patient showed a non‐disabling complication after endovascular procedures. Mean time between the last embolization and surgery was 42 days. Two patients showed disabling complications after surgery, and one patient showed a non‐disabling complication. Follow‐up angiography showed the complete removal of permeable AVM in all patients. According to the modified Rankin Scale, all patients were non‐dependent concerning daily life activity at 6‐month follow‐up. One‐year follow‐up angiography has been performed in 11 patients so far showing an absence of permeable AVM in spite of the remainder intravascular Onyx. Conclusions Staged preoperative embolization with Onyx followed by microsurgery has made possible 100% cure of complex AVMs with 0% mortality, 15.4% disabling complications and 15.4% non‐disabling complications. Complete Onyx resection is not essential to achieve the cure of the patient.