Result of Treatment of Arteriovenous Malformation after Introduction of Embolization

We retrospectively analyzed treatment modalities and outcome in 26 patients with cerebral arteriovenous malformations (AVMs) since 1991, when endovascular treatment was introduced in our clinic. In treating AVM, it is our policy to: 1) Aim at surgical resection of AVMs except non-ruptured eloquent AVMs. 2) Resect AVM without endovascular embolization in emergent cases and AVMs with a small nidus fed by a few feeding cortical arteries. 3) Choose resection with preoperative indispensable embolization in AVMs with deep feeders or multiple feeders that hide behind the nidus at the surgery. 4) Choose radiosurgery or radiosurgery with endovascular embolization in non-ruptured eloquent AVMs. Fourteen of 17 patients (82.4%) had no complications after surgery. However, we could not avoid complication due to endovascular embolization in spite of careful procedure. Twenty of 24 patients (83.3%) had good recovery and moderate disability in Glasgow outcome scale three months after treatment. From these results, we conclude that our strategies for the treatment of AVMs are proper.