Background: Cerebral arteriovenous (AVMs) malformations carry a significant risk for hemorrhagic stroke in young adults. Management options for cerebral arteriovenous malformations include single or combined therapy applying; endovascular techniques, radiosurgery or both of them. The aim of treatment is total obliteration of the malformation to eliminate the risk of bleeding.
Objectives: This study aims to evaluate each treatment modality, as a single tool of management or in combined manner. With special focus on the clinical outcome, complications and the possibility of total obliteration in long term follow up periods up to thirty six months post procedure.
Methods: This study is registered after approval by the ethics committee Benha university, Egypt. 50 patients aged 7 – 55 years classified into three groups according to management modality ,each group of patients were evaluated pre intervention by ;clinical, radiological and laboratory assessment.post procedural evaluation of incidence of complications, clinical outcome and radiological outcome. All collected data were analyzed as regard the significance.
Results: Embolization alone used as a management modality in seven patients,with total nidal obliteration in (33.3%) of patients ,(50%) of patients attained variable occlusion rates.A mortality rate of (14.3%).Radiosurgery alone used for four patients, total nidal obliteration in (50%). Complications occurred in (50%) of the patients ,no patient developed any new neurological deficit. Embolization followed by stereotactic radiosurgery was the management modality 39 patients,total nidal obliteration was achieved in (56.4%) of patients .The complication rate was (18%),no one of our patients in this group had a new onset disabling deterioration.
Conclusion: The overall risk of AVM management using:endovascular embolization, followed by Gamma knife was reduced ,with higher rates of nidal obliteration and without significant deterioration of the clinical condition .