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Surgical Treatment of Arteriovenous Malformations: Role of Preoperative Staged Embolization

  • Mattia Del Maestro
  • Sabino Luzzi
  • Massimo Gallieni
  • Donatella Trovarelli
  • Aldo Victor Giordano
  • Massimo Gallucci
  • Alessandro Ricci
  • Renato Galzio
Conference paper
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 129)

Abstract

Preoperative embolization is complementary to surgery for large brain arteriovenous malformations (AVMs). From January 2005 to December 2015, 69 patients harboring an AVM were managed in our department by the same surgeon (RG). Forty one were ruptured and 65 were supratentorial. Thirty nine smaller AVMs were treated with surgery stand-alone, whereas, for 30 larger malformations, surgery was combined with adjuvant treatment involving preoperative staged embolization and/or, less frequently, radiosurgery. In all patients treated with surgery alone, complete resection of AVM was achieved. A successful preoperative partial endovascular obliteration of AVM was obtained in 24 out of 27 more complex cases, with a zero mortality rate and a very low morbidity. Here, embolization was of a certain utility in the handling of deeper feeders and nidus excision, also facilitating intraoperative hemostasis. In three cases of residuals, radiosurgery was performed. In those patient treated with a combined approach, a good overall outcome, 0–2 modified Rankin Scale (mRS), was achieved in 25 cases. Preoperative embolization proved to be a reasonable option complementary to high-grade AVMs surgery, reducing the frequency of breakthrough hemorrhages, aiding the elimination of deep feeders, and making the nidus dissection easier.

Keywords

AVMs embolization AVMs surgery Brain AVMs Intracranial arteriovenous malformations Onyx embolization 

Notes

Conflict of Interest Statement

The authors have no conflict of interest.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Mattia Del Maestro
    • 1
  • Sabino Luzzi
    • 2
  • Massimo Gallieni
    • 1
  • Donatella Trovarelli
    • 3
  • Aldo Victor Giordano
    • 4
  • Massimo Gallucci
    • 4
  • Alessandro Ricci
    • 2
  • Renato Galzio
    • 1
    • 2
  1. 1.Department of Life, Health and Environmental Sciences (Me.S.V.A.)University of L’AquilaL’AquilaItaly
  2. 2.Department of Neurosurgery“San Salvatore” L’Aquila City HospitalL’AquilaItaly
  3. 3.Department of Anesthesiology“San Salvatore” L’Aquila City HospitalL’AquilaItaly
  4. 4.Department of Neuroradiology“San Salvatore” L’Aquila City HospitalL’AquilaItaly

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