Surgical Treatment of Arteriovenous Malformations: Role of Preoperative Staged Embolization
| Autor: | Massimo Gallieni, Renato Galzio, Aldo Victor Giordano, Massimo Gallucci, Donatella Trovarelli, Alessandro Ricci, Sabino Luzzi, Mattia Del Maestro |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
medicine.medical_specialty
business.industry Mortality rate medicine.medical_treatment Radiosurgery 030218 nuclear medicine & medical imaging Surgery 03 medical and health sciences Dissection 0302 clinical medicine Modified Rankin Scale Hemostasis Medicine Intracranial Arteriovenous Malformations Embolization business Surgical treatment 030217 neurology & neurosurgery |
| Zdroj: | Acta Neurochirurgica Supplement ISBN: 9783319737386 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|