Management of Intracranial Arteriovenous Malformations (AVMs) at a Tertiary Center

Objective:Treatment of arteriovenous malformations (AVMs) remains a challenge in the neurosurgical entity. Our study aimed to review the procedures outcomes and complications of different strategies. Clinical Materials and Methods:We retrospectively reviewed 304 patients with AVMs treated with various combinations of radiosurgery (RS), surgery, and endovascular techniques between December 2010 and July 2012. Their presentation, preoperative neurological status, and postoperative outcome were analyzed. Results:During the study period, there were 65.1% male and 34.9% female patients. Mean age was 33.31 years, ranging from 0 months to 78 years. According to the Spetzler-Martin (SM) grading system, 2 patients had grade I lesions, 69 patients had grade II, 159 patients had grade III, 65 had grade IV lesions, and 9 had grade V lesions. Of the total 304 patients, 106 underwent surgery, 60 underwent RS, 47 underwent embolization, and underwent conservative 34 and 57 multimodal therapies. Of all the patients presenting with AVM, 187 (61.52%) demonstrated excellent outcome and 70 (23%) showed no significant disability despite symptoms according to the Modified Rankin scale score. Twelve patients experienced rebleeding after procedure, 6 in endovascular group, 4 in RS, and 2 in surgery group. Statistically, we compared each procedure in between with Modified Rankin scale in first 3 SM grade and last 2, which indicated significance (P<0.05). Conclusions:Successful treatment of brain AVMs requires extensive preoperative planning. Surgery intervention or combined procedure has good outcome for SM grade I to III AVMs. Multimodality therapy has favorable outcome with minimum morbidity and mortality for SM grade IV to V AVMs.