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. 2019 Feb;61(2):195-205.
doi: 10.1007/s00234-018-2140-z. Epub 2018 Nov 28.

Single-stage planning for total cure of grade III-V brain arteriovenous malformations by embolization alone or in combination with microsurgical resection

Naci Kocer  1 , Sedat Giray Kandemirli  2 , Reza Dashti  3 , Osman Kizilkilic  2 , Hakan Hanimoglu  4 , Galip Zihni Sanus  4 , Yusuf Tunali  5 , Ercan Tureci  5 , Civan Islak  2 , Mehmet Yasar Kaynar  4
Affiliations

Single-stage planning for total cure of grade III-V brain arteriovenous malformations by embolization alone or in combination with microsurgical resection

Naci Kocer et al. Neuroradiology. 2019 Feb.

Abstract

Purpose: There are no established guidelines for treatment of Spetzler-Martin grade III-V brain arteriovenous malformations (bAVMs). The purpose of this study is to report our institutional experience in total obliteration/eradication of grade III-V bAVMs by single-stage planning of embolization combined with microsurgical resection when necessary.

Methods: All patients harboring Spetzler-Martin (S-M) grade III-V bAVMs treated with single-stage planning between January 2006 and January 2018 were retrospectively reviewed. This treatment paradigm is applicable only to surgically accessible bAVMs and does not include deep-seated bAVMs. Indications for treatment, clinical presentation, imaging characteristics, and treatment outcomes were analyzed. Outcomes were assessed based on modified Rankin Scale.

Results: A total of 31 patients were identified. Seventeen patients (54.8%) presented with hemorrhage, 10 (32.3%) with seizures, 3 (9.7%) with headaches, and 1 (3.2%) with progressive neurological deficit. Based on S-M grading system, 25 patients (80.6%) harbored grade III bAVM, 5 patients had grade IV bAVMs (16.1%), and 1 patient (3.2%) had a grade V bAVM. There were no treatment-related complications in 24/31 (77.4%) patients. Of the total of seven patients with complications, four patients had clinical deterioration. The long-term (> 6-month), non-disabling morbidity (mRS ≤ 2) rate was 6.5%. The long-term, disabling morbidity rate was 3.2% with a mortality of 3.2%. Complete angiographic obliteration was achieved in 30/31 (96.8%) patients.

Conclusion: Single-stage treatment strategy can be considered as an alternative to multistage embolization prior to surgery in grade III-V bAVMs. In this study, a high rate of total obliteration with relatively low rates of permanent morbidity and mortality was achieved.

Keywords: Arteriovenous malformation; Embolization; Microsurgical resection; Multimodality treatment; Single-stage treatment.

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References

    1. Stroke. 2002 Jul;33(7):1816-20 - PubMed
    1. Stroke. 2002 Dec;33(12):2794-800 - PubMed
    1. J Neurosurg. 2003 Jan;98(1):3-7 - PubMed
    1. Neurosurgery. 2003 Apr;52(4):740-8; discussion 748-9 - PubMed
    1. Lancet Neurol. 2005 May;4(5):299-308 - PubMed

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