Microsurgery of the Brain Arteriovenous Malformations

Aim: To present the management strategy and outcome of the patients with brain arteriovenous malformations (AVM) at the department/country with limited treatment modalities. Material and Methods: A total of 84 patients with the brain AVM were admitted at our Department from January 2003 to Mart 2014. In all case MRI/MRA and DSA were performed. Most frequent initial event was serious intracranial hemorrhage followed by preoperative seizures. Forty patients were microsurgically operated. Thirty eight AVM patients were microsurgically treated by author (KD). Other neurosurgeons microsurgically operated two AVM patients and six additional patients who underwent ventriculostomy without microsurgery. Results: In authors’ microsurgical series, there was no mortality and the complete excisions of all AVM were achieved. One patient experienced the serious postoperative intracranial hemorrhage. The patient became independent four months later. Others have not showed any additional postoperative deficit. Operated patients were graded as Spetzler-Marting I-IV. Additional six patients were comatose at the admittance and received only urgent ventriculostomy by other neurosurgeons. All of them died. Two patients underwent microsurgery by other neurosurgeons, one experienced brain infraction with poor outcome (dependent state). Two patients refused surgery and left department without treatment. Four patients underwent Gamma Knife in foreign center. Three patients who were conservatively treated died. Total mortality rate were 11% (9/81). The average outcome after microsurgical excision was GOS 4. Average age was 41. Four patients with AVM grade V were recommended to be treated by multimodal approach abroad. Conclusion: Microsurgery is the only treatment option for the brain arteriovenous malformation (AVM) at our Institution and the country. Operative outcome was satisfactory but overall management mortality was high.