gms | German Medical Science

62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

07. - 11. Mai 2011, Hamburg

How to deal with incompletely treated AVMs – Experience of 67 cases and review of the literature

Meeting Abstract

  • M. Reitz - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg Eppendorf, Hamburg
  • N.O. Schmidt - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg Eppendorf, Hamburg
  • U. Grzyska - Neuroradiologische Abteilung, Klinik für Radiologie, Universitätsklinikum Hamburg Eppendorf
  • J. Fiehler - Neuroradiologische Abteilung, Klinik für Radiologie, Universitätsklinikum Hamburg Eppendorf
  • M. Westphal - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg Eppendorf, Hamburg
  • J. Regelsberger - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Hamburg Eppendorf, Hamburg

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocMO.10.06

DOI: 10.3205/11dgnc071, URN: urn:nbn:de:0183-11dgnc0710

Veröffentlicht: 28. April 2011

© 2011 Reitz et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

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Objective: Despite the availability of multimodal treatment options, some arteriovenous malformations remain difficult to treat, either for intrinsic reasons at initial presentation or for reasons evolving during the course of treatment. Frequently, such cases can be easily resolved with further therapy but some cases become a continuously growing treatment dilemma while exhausting dwindling therapeutic options.

Methods: A retrospective analysis was performed to identify patients with cerebral AVM who were treated unsuccessfully. Treatment was termed "not successful" if a) postoperative angiography showed a residual AVM or missing flow-reduction after palliative embolization, b) therapy was associated with a substantial deterioration of existing neurological deficits or death, or c) rebleeding from residual AVM occurred after therapy. Special interest was focused on the angiographic appearance of residual AVMs, their characteristic features, and their follow-up regarding second and third therapies.

Results: According to these criteria we identified 46 internal patients from our own series of 474 patients and 21 external patients who were referred from other institutions or sought a second opinion after incomplete treatment elsewhere. Out of those 67 cases, 50 patients (74.6%) were diagnosed with a residual AVM. Eleven patients (16.4%) experienced a deterioration of their clinical condition under therapy. Six patients did not show a flow- reduction after palliative embolization. Twenty-five of the 67 patients were readmitted because of an ICH, either originating from an AVM residual or under palliative embolization. Thus, an increased risk of re-haemorrhage was found for palliative embolization (n=16), in partially treated lesions (n=10) and in patients with AVM grade IV and V located in eloquent regions (n=22). In dealing with residual AVM, microsurgical resection alone or in combination was found to be the most efficient therapeutical option being successful in 58.9% of cases.

Conclusions: An estimated 10% of AVM treatments may fail due to inadequate selection of either patients or management. Besides thorough decision making, angiographic follow-up in all AVM-patients is mandatory to early identify patients with an incompletely treated AVM requiring a second attempt. Major attention should be focussed especially on high risk subgroups with complex AVMs, partially treated AVMs or those treated by palliative regimen only.