2018 AANS Annual Scientific Meeting-Microsurgical Management of Unruptured AVMs: Results from a 1999-2016 Series

Video Transcription

Video Summary

In this video, Martin Sámez discusses the results of a series on unraptured arteriovenous malformations (AVMs) in the Czech Republic. The study aims to compare their surgical outcomes with those of the ARUBA study, which had a high morbidity and mortality rate of 30%. The Czech study involved 77 AVMs over 18 years, with a majority of male patients. The majority of patients presented with epileptic seizures, and the most common feeders were from the middle cerebral artery (MCA), anterior cerebral artery (ACA), and posterior cerebral artery (PCA). Preoperative embolization was found to be ineffective and was stopped in 2010. The overall results of the study showed good outcomes, with a morbidity and mortality rate of 3.7% and four notable successful cases. The presenter criticizes the ARUBA study for its short follow-up period of five years and its inclusion of different therapeutic modalities, arguing that microsurgery is the preferred treatment for small AVMs. The presenter concludes that the Czech study supports the indication for microsurgery for grade 1 and 2 AVMs, while medical management, radiosurgery, and embolization have higher risks. The audience praised the presentation for challenging the current focus on endovascular treatment and advocating for a return to surgical treatment for AVMs. The speaker also stated that surgical embolization could be beneficial in certain cases, and emphasized the importance of addressing deep arterial feeders early in the operation.

Asset Caption

Martin Sames, MD (Czech Republic)

Keywords

arteriovenous malformations

Czech Republic

surgical outcomes

epileptic seizures

microsurgery