Risultati dei trattamenti chirurgico ed endovascolare delle micro-malformazioni arterovenose intracraniche con enfasi sull'angiografia superselettiva

Background. The authors retrospectively reviewed the results of two different treatment modalities (surgery and endovascular approach) in patients with intracranial micro-arteriovenous malformations.

Aim and Methods. The goal of this study is to evaluate the respective role of surgical treatment and superselective acrylic embolization in the management of micro-arteriovenous malformations.
Sixteen patients with micro-arteriovenous malformations that had been treated by surgical resection or endovascular acrylic embolization during a 10-year period were analyzed. The average age at presentation was 44 years (range, 24-65 yr). All patients but one presented an intracranial haemorrhage, which was superficial in thirteen patients and in eloquent brain area in eight patients. Severe neurological deficits were observed in eleven patients.

Results. Digital subtraction angiography demonstrated micro-arteriovenous malformation in thirteen patients (81.2%) while in three patients (18.8%) the micro-arteriovenous malformation was detected only by superselective angiography. Ten patients underwent surgical intervention which led to definitive resection in nine with no perioperative morbidity. Superselective angiography was performed in nine patients and followed by successful acrylic embolization of the micro-arteriovenous malformation in seven with haemorrhagic complications in two patients. All Sixteen lesions were completely obliterated as demonstrated angiographically. Outcomes were classified according to the Modified Rankin Scale. With a mean long term clinical follow-up of 33 months (range, 8-75 mo), nine patients were Grade 0, six patients were Grade I and one patient was Grade IV.

Conclusions: Superselective angiography is deemed necessary to visualize micro-arteriovenous malformation in case of questionable or negative findings also at delayed digital subtraction angiography in young healthy patients with otherwise unexplained intracranial haemorrhage. Obliteration of micro-arteriovenous malformation can be accomplished either surgically or endovascularly; however, the endovascular approach is associated with a defined procedural risk for haemorrhagic complications and long term angiographic follow-up is necessary.