Superselective angiography, embolisation and surgery in treatment of arteriovenous malformations of the brain

We prospectively evaluated a diagnostic and therapeutic procedure combining superselective angiography, endovascular embolisation and surgery in arteriovenous malformations (AVM) of the brain. Our aim was to achieve the best possible result exposing the patients to the lowest possible risk. During a 3 year period 48 patients were studied, of whom 22 (46%) were treated by incomplete preoperative embolisation and subsequent complete surgical removal of the AVM. All angiography and embolisations were performed with the Tracker catheter system using polyvinyl alcohol particles and/or platinum fibre coils. The other 26 patients were treated as follows: incomplete embolisation in 11 (23%), complete embolisation in 2 (4%), angiography and surgery in 3 (6%) and combined embolisation and radiation in 7 (15%); 3 patients were excluded from any therapy after superselective angiography. The total number of acute complications and permanent sequelae were 8 (17%) and 3 (6%) respectively. We concluded that superselective cerebral angiography, a relatively safe procedure, should play an important role in deciding treatment strategies for AVMs of the brain. The risks of combined embolisation and surgery are probably lower than those of either alone. In a few cases surgery or embolisation alone carries an unequivocally lower risk, and combined therapy is not justifiable.