The Role of Preoperative Endovascular Embolization in Surgical Management of Cerebral Arterio-Venous Malformation (AVM)

Background: Arteriovenous malformations (AVMs) are vascular lesions comprised feeding arteries shunted to draining veins without intervening capillary networks. Preoperative embolization has traditionally been regarded as a safe and effective adjunct to microsurgical treatment of brain arteriovenous malformations.Aim: The purpose of this study is to determine the impact of preoperative endovascular embolization on the outcome of surgically managed AVMs.Methods: This is a prospective non randomized controlled study of 30 patients with cerebral AVMs that are candidates for surgical resection and or endovascular embolization Patients was divided into two groups. Both groups underwent diagnostic preoperative angiography. In the first group 10 cases had preoperative endovascular embolization followed by microsurgical resection. Materials used for embolization are onyx in low flow AVM and N-butyle cyanoacrylate (NBCA) glue in high flow AVM. In the second group 20 cases had microsurgical excision without preoperative endovascular embolization. We assessed both intraoperative and postoperative variables. Results: There was no statistically significant difference between the two groups regarding the obliteration rate (P=0.272), estimated blood loss (P=0,286) and morbidity and mortality occurrence (P= 0.148). Conclusion: In our study, preoperative embolization was associated with higher rate of AVM obliteration and lower amount of intraoperative blood loss. However, the study outcome was statistically insignificant due to the small sample size. Preoperative embolization is to be considered with certain individual cases especially high grade AVMs