Differentiated neurosurgical treatment of cerebral arteriovenous malformations with epileptic seizures

Abstract

Introduction. Intracranial hemorrhages and epileptic seizures are the most common clinical manifestations of cerebral arteriovenous malformations (AVM). The study purpose — to assess efficiency of different surgical methods of symptomatic epilepsy in patients with cerebral AVM.Materials and methods. 67 patients with symptomatic epilepsy brain AVM were included in study. Microsurgical resection (MSR) was performed in 22 patients, endovascular embolization (EE) — in 21, radiosurgical gamma-knife (GK) intervention — in 24. Follow-up period — from 6 months to 10 years, mean — 4.2 years.Results. Complete MSR of AVM was performed in all 22 patients. There were postoperative neurological complications in 6 (27.3%) patients. Total EE of AVM was achieved in 2 (9.5%) patients. Postoperative morbidity observed in 4 (19.1) patients. After GK treatment complete obliteration of AVM was achieved in 17 (70.9%) patients, in 5 patients (20.8%) we observed subtotal occlusion of nidus and 2 (20.8%) patients refused from follow-up instrumental exam. Seizures control of was mostly effective after MSR of AVM — in 19 (86.4%) patients and after GK surgery — in 20 (83.3%), after EE such positive results was achieves just in 6 (28.6%) patients.Conclusions. AVM’s complete resection provides effective control of epileptic seizures. Combined treatment using all methods let to achieve the maximum positive effect in complex brain AVM treatment.