Neuro-hybrid treatment for definitive resolution of unrupture cerebral arteriovenous malformations

Abstract

Cerebral arteriovenous malformations (AVMs) are a specific set of lesions with high variability in terms of site, size, angio-architecture, flow dynamics, and involvement of eloquent areas. Although there is uncertainty about the optimal treatment for unruptured AVMs, surgery preceded by preoperative embolization has been reported as a useful treatment option for these injuries. The objective of this study is report the results and experience of combine preoperative embolization and surgical resection in a consecutive series of unruptured cerebral AVMs. Between 2010 and 2018, 35 unruptured AVMs were treated by staged embolization and subsequent surgical treatment. We review the location, size of AVMs, details of pre-surgical embolization, complications, and clinical outcomes. All AVMs were supratentorial. The average size of AVMs was 3.1 cm. The average of embolization sessions were 1.7. The mean rate of obliteration related to embolization at the time of surgery and morbidity were 96.5% and 11.4%, respectively. Surgery was performed within 14.6 days on average after the last embolization. In our experience, preoperative embolization with Onyx provide an effective and safety for the surgical treatment of unruptured AVMs. Careful evaluation of morphology, an individualized strategy in the embolization process, and full cooperation neuroendovascular-neurosurgical team, are necessary for good end outcome.