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Preoperative staged endovascular treatment of cerebral arteriovenous malformations
Author(s): ,
M. Voormolen
Affiliations:
Antwerp University Hospital, Radiology, Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium
,
T. Menovsky
Affiliations:
Antwerp University Hospital, Neurosurgery, Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Siences, Antwerp, Belgium
,
T. van der Zijden
Affiliations:
Antwerp University Hospital, Radiology, Antwerp, Belgium
,
N. Kamerling
Affiliations:
Antwerp University Hospital, Neurosurgery, Antwerp, Belgium
,
L. Yperzeele
Affiliations:
Antwerp University Hospital, Neurology, Antwerp, Belgium
T. van Havenbergh
Affiliations:
Antwerp University Hospital, Neurosurgery, Antwerp, Belgium; St Augustinus hospital, Neurosurgery, Wilrijk, Belgium
EANS Academy. Voormolen M. Oct 21, 2018; 226055; EP1093
Prof. Dr. Maurits Voormolen
Prof. Dr. Maurits Voormolen
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Abstract
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Purpose: Evaluation of safety and efficacy of endovascular treatment of cerebral arteriovenous malformations (cAVMs) prior to surgical resection.

Methods and Materials: cAVMs are high risk vascular lesions difficult to treat. If possible, combined (endovascular and (radio-)surgical) approaches to completely remove the cAVM is advocated. Preoperative endovascular reduction of cAVM aims to facilitate definitive surgical resection. From 2010 until 2017, 33 cAVMs in 33 patients (19 female, 14 male; mean/median age 38 years (range 11-74)) were treated in our hospital by endovascular occlusion followed by surgical resection. Presentation: epilepsy (15), bleeding (11), headache (3), neurological deficit (2) and incidental finding (2). cAVMs were located in no deep brain locations in the hemispheres (27) and cerebellum (6). Sizes ranged from 2 to 15 cm (mean/median 4 cm). Spetzler Martin grading: 1 (4), 2 (17), 3 (7) and 4 (6). Nine intracranial ruptured flowaneurysms were present.

Results: Preoperative staged endovascular occlusion with Onyx™ to reduce the cAVM was performed in 82 embolisations with a mean of 2,5 embolisations (range 1 - 8). Seven flowaneurysms were coiled, one was clipped and one not treated. In total, 9 patients had complications (27%). Eight patients had perprocedural endovascular complications (10%): neurological deficit (5), hemorrhage (2) and thrombo-embolism (1), resulting in 4 patients with permanent neurological deficit and one patient died. One patient bled from the AVM during surgery resulting in neurological deficit. Overall morbidity of 15%, mortality 3%. All cAVMs could be completely resected.

Conclusion: In selected cases, the combination of staged preoperative endovascular reduction and neurosurgical resection of brain AVMs can completely cure patients from a potential high risk vascular lesion with a moderate complication rate.
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