AbstractOBJECTIVE AND IMPORTANCEWe describe the successful treatment of symptomatic giant arteriovenous malformations (AVMs) using staged volume radiosurgery followed by microsurgical resection.CLINICAL PRESENTATIONA 57-year-old man presented with Spetzler-Martin Grade 5 AVMs, w ith persistent headaches and seizures. He had previously undergone eight attempts at AVM embolization and a craniotomy for attempted AVM resection; he had suffered four episodes of brain hemorrhaging but had made a good neurological recovery.INTERVENTIONBecause o f the persistent symptoms o f the patient and his history of hemorrhaging, a treatment plan based on staged radiosurgical treatments of d ifferent portions of the AVMs (three sessions, spaced 6 moapart), followed by delayed microsurgical removal of the much-reduced residual AVMs (3 years later), was undertaken. The patient did not suffer any additional hemorrhaging episodes, his AVMs were completely removed, and he has made a good recovery.CONCLUSIONStaged volume radiosurgery followed by microsurgical resection of the residual AVMs represents a novel treatment strategy for the management of Grade 5 AVMs that might be untreatable by any single treatment method used alone.
Neurosurgery – Oxford University Press
Published: Nov 1, 1998
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