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Titolo:
REFLECTIONS ON THE MANAGEMENT OF CEREBRAL ARTERIOVENOUS-MALFORMATIONS
Autore:
DERUTY R; PELISSOUGUYOTAT I; MOREL C; BASCOULERGUE Y; TURJMAN F;
Indirizzi:
HOP NEUROL,DEPT NEUROSURG,59 PINEL BVD F-69394 LYON FRANCE HOP NEUROL,DEPT NEURORADIOL F-69394 LYON FRANCE
Titolo Testata:
Surgical neurology
fascicolo: 3, volume: 50, anno: 1998,
pagine: 245 - 255
SICI:
0090-3019(1998)50:3<245:ROTMOC>2.0.ZU;2-G
Fonte:
ISI
Lingua:
ENG
Soggetto:
STEREOTAXIC RADIOSURGERY; SURGICAL RESECTION; PATIENT OUTCOMES; 35-YEAR PERIOD; 32 SERIES; EMBOLIZATION; BRAIN; RISK; COMPLICATIONS; HEMORRHAGE;
Keywords:
CEREBRAL AVMS; EMBOLIZATION; RADIOSURGERY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Science Citation Index Expanded
Citazioni:
36
Recensione:
Indirizzi per estratti:
Citazione:
R. Deruty et al., "REFLECTIONS ON THE MANAGEMENT OF CEREBRAL ARTERIOVENOUS-MALFORMATIONS", Surgical neurology, 50(3), 1998, pp. 245-255

Abstract

BACKGROUND The authors report their personal experience in the management of cerebral arteriovenous malformations (AVMs), using the three techniques now available: surgical resection, endovascular embolization, and radiosurgery. They review the recent literature on this topic and present their current;management algorithm based on this experience. METHODS A series of 90 patients treated for cerebral AVMs is reported(68% Grade I-III and 32% Grade IV-V, Spetzler scale). The three methods of treatment were used, either individually or in combination, based on the size and the location of the malformation, The first intervention was surgical resection in 26% of cases, endovascular embolizationin 57%, and radiosurgery in 17%. Surgery and embolization were followed by another technique in some cases and eventually single modality treatment was used in 58% of cases (surgical resection 21%, endovascular embolization 20%, radiosurgery 17%) and multimodality treatment in 42% (embolization + resection, 21%; embolization + radiosurgery, 17%; resection + radiosurgery, 4%). Embolization was used as reductive therapy in 38% of the overall series (65% of all embolized patients), and was followed by surgery in 56% of cases or by radiosurgery in 44%, Angiography was used to assess the cure rates. RESULTS The following cure rates were obtained, when each technique was used as a first treatment: surgical resection, 82%; embolization, 6%; and radiosurgery, 83% (2-year angiographic follow-up). After combined treatment, embolization and resection resulted in a 100% cure rate, embolization and radiosurgery produced a 90% cure rate. The clinical outcome was evaluated in terms of deterioration attributable to treatment, Seventy-one percent of patients had no complication, minor complications were observed in 18%, and severe complications in 11%. Treatment mortality was 3%. All deaths were attributable to hemorrhage during the embolization procedure. CONCLUSIONS In this management algorithm, AVMs submitted directly to surgery or to radiosurgery were considered ''good risk'' malformations, and the outcome for these cases was good in terms of clinical resultand cure rate. AVMs submitted first to endovascular embolization wereconsidered ''poor risk'' malformations, including a majority of Spetzler Grade IV-V lesions. Not surprisingly, the majority of severe complications occured in this group during embolization. Thus, the major risk of the treatment of AVMs has now shifted from surgery to endovascular techniques. Endovascular embolization as sole treatment gave a low rate of complete occlusion, but proved to be very useful as a reductive therapy, in preparation for further surgery or radiosurgery. Partialembolization permitted high rates of complete cure in difficult AVMs. Embolization should be used to the maximum extent possible as a reductive technique, despite the risks of the procedure. Because of its risks however, this technique of reductive embolization should be used only if absolutely necessary to allow the complete cure of the malformation. Thus, the use of embolization should be considered very cautiously in small malformations as well as in very large and complex AVMs in which partial embolization will not be sufficient to allow complete cure with either endovascular or surgical techniques. (C) 1998 by Elsevier Science Inc.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 26/11/20 alle ore 20:09:54