Cerebral AVM and principles of surgical treatment

Nikitin P.I., Panuntsev V.S., Asaturyan G.A., Pak V.A., Ivanova N.E., Semenyutin V.B., Alekseev V.V.

(Polenov Research Neurosurgical Institute, Saint Petersburg, Russia)

Surgical classification of cerebral arteriovenous malformations (AVM) is considered. It is based on their volume, localization in relation to eloquent areas of the brain, a character of drainage and envisages their subdivision into "small", "middle-sized" and "big" AVM. Progression of a course of cerebral AVM is proved; three phases of the disease (initial, developed and that of marked clinical manifestations) are discussed for the first time.

Results of surgical treatment were estimated in the archives group (1980 -1992, 211 patients) and the group, treated by the authors (1993-1999, 133 cases). A number of radical operations was 14% greater. There was 1.7-fold and 2.3-fold reduction in postoperative mortality and invalidism respectively. A system of surgical treatment, based on microsurgery and principles of stage-by-stage interventions with compulsory control of efficacy of AVM exclusion from blood circulation, was worked out. Microsurgical removal was used in "small" and "middle-sized" superficial AVM. When "middle-sized" AVM were localized in eloquent areas of the brain, extirpation was performed after preliminary embolization. Deep localization of these malformations was an indication for intravascular operations and/or radiosurgery. In case of "big" AVM multistage intravascular operation with control of changes of blood flow in cerebral and AVM vessels was made.