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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Clinical outcome of 239 microsurgically treated intracerebral AV malformations: is preoperative embolization a necessity?

Klinische Ergebnisse von 239 mikrochirurgisch behandelten intrazerebralen AV-Malformationen: Ist die präoperative Embolisation notwendig?

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  • corresponding author P. Jans - Klinik für Neurochirurgie, Alfried-Krupp-Krankenhaus, Essen
  • J. Wirths - Klinik für Neurochirurgie, Alfried-Krupp-Krankenhaus, Essen
  • L. Büntjen - Klinik für Neurochirurgie, Alfried-Krupp-Krankenhaus, Essen
  • H. Henkes - Klinik für Neuroradiologie, Alfried-Krupp-Krankenhaus, Essen
  • W. Weber - Klinik für Neuroradiologie, Alfried-Krupp-Krankenhaus, Essen
  • R. Laumer - Klinik für Neurochirurgie, Alfried-Krupp-Krankenhaus, 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.02.03

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2006/06dgnc089.shtml

Published: May 8, 2006

© 2006 Jans 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: This series was initiated to investigate the usefulnes of preoperative embolisation, particularly in high grade arteriovenous malformations (AVMs).

Methods: According to the regime of our neurovascular center, AVMs were embolized whenever possible. In a retrospective study, between 1994 and 2004, clinical data, Spetzler-Martin-grades, pre- and postoperative angiograms and GOS were analysed.

Results: 224 pts. with AVMs were embolized prior to microsurgical resection. 15 AVMs underwent direct surgery in case of small lesion or due to space occupying hematomas. S-M grades were distributed as follows: I+II: 127 (53,1%), III: 67 (28,1%), IV+V: 46 (18,8%). Postoperative angiogram showed complete resection in 96%. 4% needed additional radiosurgery. There was no surgical mortality. Postoperative mortality within 30d was 0,8%. A good outcome was achieved in over 80% of the pts.: GOS 5131 (54,8%), GOS 467 (28,1%), GOS 334 (14,2%), GOS 24 (1,7%), GOS 13 (1,2%). During the last ten years, the embolisation techniques have improved as documented by an increasing embolisation rate especially in large and deep seated lesions, which were classified as inoperable in the years before. In these AVMs, the good results were definitely due to the stepwise embolisation, when compared to results without preoperative embolisation.

Conclusions: In our opinion preoperative embolisation is an absolute necessity in high grade AVMs and seems to be of a certain benefit in the resection of low grade AVMs. The advantages include a reduction of operation time and intraoperative bloodloss. Combined therapy performed in a neurovascular center helps to minimize morbidity and mortality.