Optimization Of Surgical Treatment Methods Of Cerebral Arteriovenous Malformations

Abstract

Research objective: to optimize surgical treatment methods of cerebral arteriovenous
malformations.
Material and methods. During the research we studied and analyzed the diagnosis and
treatment of 26 patients with cerebral arteriovenous malformations (AVMs). Patients were
distributed in groups, depending on the methods of surgical intervention: the group 1 -
microsurgical resection, the group 2 - endovascular intervention and the group 3 - combined
method, which included partial endovascular embolization with microsurgical resection. All
patients underwent multislice computed tomography (MSCT), magnetic resonance imaging
(MRI), MSCT angiography, and digital subtraction angiography (DSA). Treatment
outcomes were assessed using the Glasgow Outcome Scale (GOS), the Modified Rankin
Scale (mRS), the NIHSS Scale, and using nonparametric methods of statistical analysis.
Results and discussion. The treatment outcomes of all 3 groups of patients according to the
Glasgow Outcome Scale established the following: satisfactory recovery in the group 1 in
66.6% (n=6) cases, in the group 2 - 83.3% (n=10) and in the group 3 - 80 % (n=4). Moderate
disability in the group 1 was 11.1% (n = 1), in the group 2 - 8.3% (n=1) and in the group 3
- 20% (n=1), respectively. Severe disability was noted only in the group 1 (22.2% (n=2)).
No apallic syndrome was observed in the groups 1 and 3, but in the group 2 it concluded
8.3% (n=1). No mortal outcomes were noted in the surveyed groups. According to mRS
between the surveyed groups the following was determined: in the group 1 - 1.1±2.2 scores;
in the group 2 - 0.4±1.4 scores and in the group 3 - 0.2 ± 0.4 scores, respectively. The
comparative analysis of the surgical treatment outcomes in the group 3 revealed less trauma
of surgical intervention along the maximum radicalism x2 = 3.86 (p <0.05) in patients with
Grade III and higher (Spetzler-Martin and Lawton-Young scale). The treatment outcomes
in the group 2 with Grades I, III were characterized by the maximum AVM obliteration
when using a multistage approach - x
2 = 4.62 (p <0.05). The surgical intervention outcomes
in the group 1 were characterized by the development of a gross neurological deficit due to
the single modality application in patients with high degrees of grades - x
2 = 0.24 (p> 0.05)
Conclusion. For patients with Grade I, II AVMs, the most optimal treatment is the unified
modal approach. The method of choice of the surgical treatment in patients with Grade III
and higher AVMs is a combination of endovascular embolization with surgical resection.
This method allows not only to increase AVM resectability, but also to minimize
postoperative complications.