Management of Brain AVMs at Bicêtre: a Comparison of Two Patient Cohorts Treated in 1985-1995 and 1996-2005.

Abstract

Management of brain AVMs at Bicetre Hospital has not changed significantly during the last 20 years since our initial description of their an- gioarchitecture and risk factors published in 1986. Our treatment strategy remains unchanged and prioritizes clinical over morphological results. The degree of risk during the procedures as well as the morbidity after treatment has been carefully analyzed and similar treatment strategies are employed for vein of Galen malformations, pediatric brain AVMs and spinal cord AVMs. The price paid for complete embolization is far from ideal and thus we introduced and de- velopped partial targeted embolization. This type of treatment is based on detailed angioarchitec- ture anatomic knowledge and high-quality angio- graphic images. These aspects, coupled to the clinical information provide invaluable information in the decision-making process. As such, many patients are better without intervention when its risk is high compared to their symptoms. In our Series of 1618 Braina AVMs, we present a comparison of two cohorts of patients treated during different time periods and analyze our clinical results. The morbidity and mortality for patients treated during 1985-1995 and from 19962005 is presented. For purposes of this presentation, we have excluded patients whose treatment overlapped both time periods. We excluded the children in the second cohort. The results in the first cohort have been already published in 2002 by Meisel et al.