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Erschienen in: Neuroradiology 2/2019

28.11.2018 | Interventional Neuroradiology

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

verfasst von: Naci Kocer, Sedat Giray Kandemirli, Reza Dashti, Osman Kizilkilic, Hakan Hanimoglu, Galip Zihni Sanus, Yusuf Tunali, Ercan Tureci, Civan Islak, Mehmet Yasar Kaynar

Erschienen in: Neuroradiology | Ausgabe 2/2019

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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.
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Metadaten
Titel
Single-stage planning for total cure of grade III–V brain arteriovenous malformations by embolization alone or in combination with microsurgical resection
verfasst von
Naci Kocer
Sedat Giray Kandemirli
Reza Dashti
Osman Kizilkilic
Hakan Hanimoglu
Galip Zihni Sanus
Yusuf Tunali
Ercan Tureci
Civan Islak
Mehmet Yasar Kaynar
Publikationsdatum
28.11.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Neuroradiology / Ausgabe 2/2019
Print ISSN: 0028-3940
Elektronische ISSN: 1432-1920
DOI
https://doi.org/10.1007/s00234-018-2140-z

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