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

Surgery of 'wild-running' AVM after radiation therapy and/or 'curative' embolization

Operation 'verwildeter' AVM nach Strahlentherapie und/oder 'kurativer' Embolisation

Meeting Abstract

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  • corresponding author S. Asgari - Neurochirurgische Klinik, Universitätsklinikum Essen
  • A. Hunold - Neurochirurgische Klinik, Universitätsklinikum Essen
  • D. Stolke - Neurochirurgische Klinik, Universitätsklinikum Essen

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.02.07

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Asgari et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Often patients with cerebral arterio-venous malformations (AVM) and high surgical risk due to their location in an eloquent area or large size were treated solely by radiosurgery and/or embolization. Some of these patients underwent neurosurgery because of recurrent hemorrhage or neurological deterioration. In a retrospective study we want to analyze the clinical features of those patients.

Methods: Over 10 years, 14 patients with cerebral AVMs who had previously undergone radiosurgery (stereotactic proton beam, gamma knife) and/or embolization in curative intention, underwent operative treatment in our department. The mean duration between initial therapy and final resection was 5 years.

Results: Preoperative angiography demonstrated a nidus size of 4-5 cm and newly developed 'en-passant' feeding vessels in all patients. Other new phenomena were venous stenosis and involvement of the external carotid circulation. The mean operation time during neurosurgery was 4 hrs. 30 min.. The clinical outcome of the patients was not favorable. Half of the patients suffered from persistent neurological deterioration. The Glasgow Outcome Scale was 5 in three, 3 in nine and 1 in two patients.

Conclusions: AVM's previously treated in curative intention by radiation and/or embolization should be assigned an additional Spetzler and Martin grade before resection. Angiographic studies revealed a 'wild-running' morphology. Neurosurgery was very challenging and led to unfavorable outcomes in many of the patients. Therefore, the radiosurgeon and/or neuroradiologist have to re-evaluate their 'curative' approach in treatment of AVMs with a nidus size over 3 cm.