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Surgery After Embolization of Cerebral Arterio-Venous Malformation: Experience of 123 Cases

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Trends in Neurovascular Interventions

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 119))

Abstract

A group of 123 patients with large or critically located arterio-venous malformations (AVMs), operated on between 1990 and 2011 and who underwent preoperative embolization, was assessed in order to clarify the risks of this combined treatment. AVM location, volume, and Spetzler’s grade were assessed in each case; AVM volume was over 20 cm3 in 49 % of the cases; Spetzler’s grade was 3 or above in 76 % of the cases (with 34 cases in grades 4–5). A mean of 2.3 embolization procedures per patient were carried out, using bucrylate and, more recently, Onyx and/or Glubran; a 4.5 % procedure-related complication rate was observed. Complications occurring after surgery were classified as hemorrhagic (16 cases, 8 requiring surgical evacuation) or ischemic (4 cases); hemorrhagic complications were more common for AVMs with volumes >20 cm3 and/or deep feeders. Surgery-related unfavorable results (modified Rankin Score > 2) were observed in 6 % of patients in Spetzler’s grade 3, and in 20–25 % of patients in grades 4–5. More recently, a triple treatment (radiosurgery + embolization + surgery) allowed for obtaining favorable results (mRS 0–2) in all patients. It has been concluded that a combined treatment with embolization and surgery constitutes a reasonable choice for complex cerebral AVMs; the association of radiosurgery may improve the patients outcome.

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Conflict of Interest

We declare that we have no conflict of interest.

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Authors and Affiliations

  1. Section of Vascular Neurosurgery, Institute of Neurosurgery, Verona City Hospital, Via Milazzo, 2, 37128, Verona, Italy

    A. Pasqualin, A. Nicolato, P. Meneghelli & F. Cozzi

  2. Service of Neuroradiology, Verona City Hospital, Verona, Italy

    P. Zampieri & A. Beltramello

Authors
  1. A. Pasqualin
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  2. P. Zampieri
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  3. A. Nicolato
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  4. P. Meneghelli
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  5. F. Cozzi
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  6. A. Beltramello
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Corresponding author

Correspondence to A. Pasqualin .

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Editors and Affiliations

  1. Dept. of Neurosurgery, Kyoto Medical Center, Kyoto, Japan

    Tetsuya Tsukahara

  2. Klinik für Neurochirurgie UniversitätsSpital Zürich, Zürich, Switzerland

    Giuseppe Esposito

  3. Neurochirurgische Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany

    Hans-Jakob Steiger

  4. Department of Neurology, University Medical Centre Utrecht, Utrecht, The Netherlands

    Gabriel J.E. Rinkel

  5. Klinik für Neurochirurgie UniversitätsSpital Zürich, Zürich, Switzerland

    Luca Regli

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Pasqualin, A., Zampieri, P., Nicolato, A., Meneghelli, P., Cozzi, F., Beltramello, A. (2014). Surgery After Embolization of Cerebral Arterio-Venous Malformation: Experience of 123 Cases. In: Tsukahara, T., Esposito, G., Steiger, HJ., Rinkel, G., Regli, L. (eds) Trends in Neurovascular Interventions. Acta Neurochirurgica Supplement, vol 119. Springer, Cham. https://doi.org/10.1007/978-3-319-02411-0_18

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  • DOI: https://doi.org/10.1007/978-3-319-02411-0_18

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-02410-3

  • Online ISBN: 978-3-319-02411-0

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