Surgical management of large AVM's by staged embolization and operative excision

Robert F. SpetzlerDivision of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona

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Neil A. MartinDivision of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona

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L. Philip CarterDivision of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona

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Richard A. FlomDivision of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona

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Peter A. RaudzensDivision of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona

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Elizabeth WilkinsonDivision of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona

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Page Range:
17–28
Volume/Issue:
Volume 67: Issue 1
DOI link:
https://doi.org/10.3171/jns.1987.67.1.0017
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✓ A series of 20 patients with giant arteriovenous malformations (AVM's) managed with staged embolization and surgical resection is presented. Complete excision was accomplished in 18 of these patients. There were no deaths and only three complications, of which one was disabling. Further evidence for the presence of low perfusion surrounding the AVM, emphasizing the risk of normal perfusion pressure breakthrough, is provided by cortical perfusion pressure, cortical cerebral blood flow (CBF), and stable xenon computerized tomography CBF measurements.

The staged approach to giant AVM management is a proposed method to render AVM's that were previously considered inoperable or marginally operable into totally excisable lesions, while maintaining an acceptable level of morbidity and mortality.

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Contributor Notes

Address reprint requests to: Robert F. Spetzler, M.D., Editorial Office, Barrow Neurological Institute, 350 West Thomas Road, Phoenix, Arizona 85013.
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