Surgery for arteriovenous malformations

Mendelow, AD; Gholkar, A; Vindlacheruvu, R; Mitchell, P

doi:10.1017/CBO9780511659096.038

Surgery for arteriovenous malformations

Lookup NU author(s): Emeritus Professor David Mendelow, Dr Anil Gholkar OBE, Patrick Mitchell

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Abstract

© Cambridge University Press 2014. There are two main roles for surgery in the treatment of cerebral arteriovenous malformations (AVMs). Firstly, there is the prophylactic removal of a source of hemorrhage and secondly, the removal of hemorrhage caused by an AVM at which time the AVM itself is removed. These two circumstances are entirely different and the response time may also have to be different. With prophylactic surgical excision, the decision-making process has to be considered carefully in relation to the natural history, in relation to the risks and benefits of embolization, and in relation to the risks and benefits of stereoradiosurgery, as well as to the various combinations of these treatments. The decision-making process in prophylactic treatment is thus complex and it will be considered later in this chapter. The first section therefore deals with the technical aspects of surgery and the best intuitive indications and methods for surgical excision. Surgical techniques Operative excision has the advantage of immediate removal of the risk of hemorrhage from the AVM. This is an advantage it has over stereoradiosurgery. A disadvantage is the risk of post-operative hemorrhage which is about 4% in most craniotomy series (1), although this is dependent upon the size and Spetzler grading of the AVM (2). Larger lesions have a higher post-operative hemorrhage rate, while the smaller lesions have a lower post-operative hemorrhage rate.