gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

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Failed AVM therapy – experience with 70 cases

Nicht erfolgreiche AVM-Therapie – Erfahrungen aus 70 Verläufen

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  • corresponding author J. Regelsberger - Neurochirurgische Klinik, Universitätsklinikum Eppendorf, Hamburg
  • U. Grzyska - Neuroradiologische Abteilung, Universitätsklinikum Eppendorf, Hamburg
  • Z. Vukovic - Neurochirurgische Klinik, Universitätsklinikum Eppendorf, Hamburg
  • T. Martens - Neurochirurgische Klinik, Universitätsklinikum Eppendorf, Hamburg
  • H. Kränzlein - Neurochirurgische Klinik, Universitätsklinikum Eppendorf, Hamburg
  • H. Zeumer - Neuroradiologische Abteilung, Universitätsklinikum Eppendorf, Hamburg
  • M. Westphal - Neurochirurgische Klinik, Universitätsklinikum Eppendorf, Hamburg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocSA.02.05

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc091.shtml

Published: May 8, 2006

© 2006 Regelsberger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Objective: Recurrence of a completely eliminated cerebral arteriovenous malformations (AVM) is extremely rare. Partially treated AVMs need to be recognized as residual AVMs with the potential of expansion or “regrowth”. In this context an analysis of our own series was carried out to identify the clinical course of residual and recurrent AVMs.

Methods: In the ongoing study, we identified 70 patients with failed AVM therapy. Treatment modalities included surgical resection, embolization, different varieties of stereotactic radiosurgery and any possible combination of these. Clinical data, therapeutic regimen as well as radiographic follow-up studies were reviewed.

Results: 21 patients were treated in another clinic before and were believed to be cured. Postoperative angiography was not performed routinely in these patients and MRI seemed to be sufficient. Palliative embolization, surgical resection with or without prior embolization was the preferred treatment modality of our own 49 patients. 24 of 70 (34%) patients had unexpected rebleedings after the initial treatment. On revisitation in 52 (75%) patients eloquent location in the basal ganglia or functional areas, size exceeding 3cm in diameter or complex angioarchitecture was seen. According to the clinical charts and radiological studies, 29 patients experienced regrowth or further growth of an incomplete treated AVM. Overall complete resection or obliteration on second attempt, confirmed by angiography, was achieved in 23 of 38 cases. In four cases spontaneous thrombosis of the residual AVM was seen. True recurrences were seen in five patients, three under the age of 18 years. In 18 patients no further therapy was recommended or therapy was refused.

Conclusions: It is advisable not to treat an AVM if complete resection or obliteration is not achievable. It should be the consensus for all participating specialities that angiography remains the gold standard for documenting therapeutic results. Cure is reserved for angiographically confirmed AVM elimination but may not exclude the possibility of a true recurrence as well as spontaneous thrombosis in residual AVMs. Careful follow-up studies including angiography and MRI are warranted, especially in pediatric AVMs.