[Surgical treatment of arteriovenous malformations in the brain stem]

Abstract

The authors report the surgical removal of four arteriovenous malformations (AVM's) in the brain stem causing hemorrhage. These included two intra-axial and two extra-axial AVM's. Three of the four were situated at the pons, and the remaining one in the posterior medullary velum. Complete surgical removal was obtained in the two extra-axial cases and in one of the intra-axial cases. The patient in whom complete removal was not obtained received partial embolization therapy with the remaining feeder being coagulated surgically. No patient was made permanently worse after surgery. One patient, in a comatose state on admission, died, while the remaining three patients showed useful recovery. These data indicate that surgical therapy with or without endovascular surgery appears to be possible for some AVM's and can be performed at an acceptable risk.