Artikel
Multiple-staged endovascular and surgical treatment of arteriovenous malformations of the brain – complications and outcome
Multiple intensivierte endovaskuläre und nachfolgende chirurgische Therapie von zerebralen arteriovenösen Malformationen – Komplikationen und Outcome
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Autoren
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D. Krex
- Klinik für Neurochirurgie, Technische Universität Dresden
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S. Lang
- Klinik für Neurochirurgie, Technische Universität Dresden
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D. Mucha
- Abteilung für Neuroradiologie, Universitätsklinik Carl Gustav Carus, Technische Universität Dresden
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R. von Kummer
- Abteilung für Neuroradiologie, Universitätsklinik Carl Gustav Carus, Technische Universität Dresden
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G. Schackert
- Klinik für Neurochirurgie, Technische Universität Dresden
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: Treatment of arteriovenous malformations is a growing interdisciplinary challenge and aims to prevent and resolve hemorrhage. Preoperative embolization is regarded as a useful adjunct to surgical therapy and has become a widely used strategy in many centres. However, it is debated whether surgical treatment should immediately follow after a single endovascular procedure or later when the maximum embolization has been reached even in multiple sessions. In our clinic we follow the latter strategy, and here we present our results.
Methods: A retrospective analysis was performed of all patients with brain AVM, who have been treated in the Departments of Neurosurgery and Neuroradiology in our University Hospital between 01/1998 and 12/2004. Follow-up was assessed on an out-patient basis and by a questionnaire.
Results: Between 1998 and 2004, there were 106 patients with arteriovenous malformations of the brain treated by embolization alone (n=28), surgery alone (n=6), or by a combination of both modalities (n=72). A complete occlusion of the AVM was achieved by embolization alone in 48%, while no residual AVM was detectable in 96% of cases after a combined treatment. In those 72 patients treated by a combined approach, neurological symptoms improved in 9%, worsened in 26%, and remained unchanged in 65% after embolization. Surgical treatment was associated with 37% improvement, and worsening of neurological symptoms in10%, while 53% remained unchanged. The mean follow-up was 37 months (range 11 to 92 months). Here, 42% of all patients reached a modified Rankin Score (mRS) of 2 or less.An intracerebral hemorrhage associated with embolization was found in 6 (8%) of thecases.
Conclusions: The treatment of brain AVM by extensive embolization and subsequent surgery after a time-interval is associated with an increased risk of neurological deterioration in some cases. However, surgery following embolization can be planned better and is therefore more effective and safer, resulting in a better long-term outcome of patients. This suggests that this multiple staged procedure is superior to other treatment modalities.
