![]() ![]() ![]() Due to literature controversies according to clinical outcomes of invasive treatment of AVMs, we decided to present the data from our Centre. Results of the randomised clinical trial ARUBA show that the risk of stroke and death after the initiation of unruptured AVM invasive treatment is more than threefold higher than in patients treated conservatively however, the study has important limitations, and its significance is discussed by some authors. ![]() Choosing the best therapeutic strategy could be difficult however, making a decision whether the preventive eradication of unruptured lesions is required seems to be the most significant dilemma connected with AVM treatment. These modalities could be applied alone or in combination. Nowadays four different types of therapeutic approach are considered: microsurgical resection, endovascular embolisation, stereotactic radiosurgery, and conservative management. Complete obliteration of AVM is the main goal of the treatment because subtotal therapy does not confer protection from haemorrhage. Optimal therapeutic strategy should be characterised by decreasing haemorrhage risk and alleviating neurological symptoms with an acceptable mortality and morbidity rate. The incidence of neurological deficits and deaths caused by AVM treatment ranges from 0 to 20% (mean 8%). In majority complications were minor or transient which led to similar clinical condition of patients in both groups on discharge – according to GOS (mean GOS: 5.00 in operation and 4.89 in the embolisation group). In several cases more than one complication appeared. Early complications after embolisation occurred in 20 cases ( Table 2). Acute cardiopulmonary failure, cerebral haemorrhage, and CSF subcutaneous collection occurred in three cases after surgical procedure. Patients who underwent endovascular embolisation had higher early complication ratio (21.28%) than patients after neurosurgical operation (17.65%). Fifteen procedures (15.96%) were unsuccessful due to complex anatomy of feeding vessels (11 cases), extravasation of contrast (three cases), and intraoperative haemorrhage (one case). Sixty-five procedures (69.15%) led to complete embolisation of one feeding vessel, fulfilling the aim of the procedure, as a part of multistage treatment. Fourteen procedures (14.89%) led to complete embolisation of the whole AVM in the first attempt. No patients were qualified for this procedure after surgical treatment. Ninety-four endovascular embolisations were performed. In both cases of unsuccessful procedures not all feeding arteries were clipped. Fifteen of 17 (88.24%) neurosurgical procedures had resulted in complete removal of the AVM. Only one patient underwent two surgical procedures. The remaining ones were preceded by endovascular embolisation. In nine cases, it was the first-choice treatment. Seventeen neurosurgical procedures were performed. The gathered data allowed us to classify all AVMs in Spetzler-Martin and Spetzler-Ponce scales.Ĭlassification of the arteriovenous malformations in Spetzler-Martin and Spetzler-Ponce scales Any other drainage, including sigmoid sinus, was considered as deep venous drainage. Superficial venous drainage was defined as drainage to superior sagittal sinus or transverse sinus. Superficial AVM was defined as pail with the stipulation that no part of the nidus can be localised deeper than 1 cm. Assessed parameters of AVMs involved: location (side and lobes), superficial or deep localisation, localisation of the AVM in eloquent or non-eloquent areas of the brain, feeding arteries (amount and type), venous drainage, size of nidus, and presence of an AVM-associated aneurysm. Other imaging data were not mandatory but assessed if available. Due to the small amount of SAH no differentiation into types of haemorrhage in further analysis was performed.Įach patient underwent 3D digital subtraction angiography (DSA). In a group of 37 patients with intracranial bleeding 35 presented with intracerebral haemorrhage and two with subarachnoid haemorrhage (SAH). Presence of haemorrhage, Glasgow Coma Scale (GCS) score, neurological symptoms, and co-morbidities on admission to hospital were assessed. Medical records were reviewed for all patients. Arteriovenous malformations characteristics and qualification for treatment ![]()
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