Surgical treatment of giant intracranial arteriovenous malformations

Neurosurgery. 2010 Nov;67(5):1359-70; discussion 1370. doi: 10.1227/NEU.0b013e3181eda216.


Background: The treatment of giant arteriovenous malformations (AVMs) remains a challenge in the neurosurgical field. Microsurgery is one of the most effective ways for eliminating giant cerebral AVMs.

Objective: To review surgical outcomes in treating the disease, and form conclusions regarding the indications for and outcomes of surgical treatment in giant intracranial AVMs.

Methods: We studied 40 consecutive cases of giant AVMs treated in Beijing Tiantan Hospital between 2000 and 2008. The radiologic and clinical features were analyzed. The Spetzler-Martin grading system was used to classify the patients. All patients were surgically treated, and the final outcomes of the patients were gathered for analysis.

Results: The major presenting symptoms were seizures, headaches, hemorrhage, and neurological deficits. The mean AVM diameter was 6.3 cm. According to the Spetzler-Martin grading system, 5 patients had grade III lesions, 21 had grade IV lesions, and 14 had grade V lesions. Out of the total 40 patients, 31 (77.5%) demonstrated excellent or good outcome. Complications included hemiparalysis, aphasia, hemianopia, cranial nerve dysfunction, and seizures. After follow-up, 27 of 30 (90%) surviving patients presented normal function or minimal symptoms.

Conclusion: Presurgical evaluation of every candidate and treatment choice is the determining factor in therapy for giant AVMs. For giant cerebral AVMs located superficially or not involving critical components, a good outcome can be expected through surgical resection. The obliteration and recurrence rates were satisfying, and the complication rate was acceptable.

MeSH terms

  • Adolescent
  • Adult
  • Cerebral Hemorrhage / etiology*
  • Cerebral Hemorrhage / prevention & control
  • Female
  • Humans
  • Intracranial Arteriovenous Malformations / diagnosis*
  • Intracranial Arteriovenous Malformations / surgery*
  • Male
  • Middle Aged
  • Nervous System Diseases / etiology*
  • Nervous System Diseases / prevention & control
  • Neurosurgical Procedures / adverse effects*
  • Seizures / etiology*
  • Seizures / prevention & control
  • Young Adult