Staged Treatment of High Flow, Large Cerebral Arteriovenous Malformation with a Combination of Preoperative Embolization and Microsurgery

ABSTRACT

Surgical treatment of cerebral arteriovenous malformations(AVM's) that are high flow and large remain particularly difficult to manage. It has been reported that normal perfusion pressure breakthrough(NPPB) syndrome occur more frequently in such AVM's and managing such AVM's by staged treatment may help to avoid the occurrence of this complication. The authors report our experience with one case of high flow, large AVM that would pose a great operative difficulty if it was to be managed by surgical resection alone. The patient was treated by a staged procedure in which a preoperative embolization was followed by a complete microsurgical excision. The staged, complementary approach proved to be quite useful and safe for the treatment of high flow, large AVM.