Complications and functional outcomes of microsurgical removal of arteriovenous malformations with preoperative endovascular embolization

Background. Brain arteriovenous malformations (AVMs) are the most complex pathology in vascular neurosurgery. Collecting and summarizing data on the results of brain AVM treatment is extremely important.Objective. Analysis of complications and functional outcomes of the AVM microsurgery with preoperative endovascular embolization. Material and methods. The study included 56 patients with brain AVMs who underwent preoperative embolization at the N.N. Burdenko National Medical Research Center of Neurosurgery. The control group included 113 patients who underwent only microsurgical removal of AVM. Within the framework of this article, the features of preoperative embolization, such as radicality, timing and number of procedures, the choice of adhesive compositions, and the causes of functional deterioration and complications of the combined treatment are described. A comparative analysis of functional outcomes is performed by means of the pseudo-randomization method. Results. The radicality of AVM preoperative embolization was >75% in 21 patients (37.5%), 75-50% in 10 patients (17.9%), and <50% in 25 patients (44.6%), respectively. The average interval between embolization and surgery was 1.84 days (0-19 days). The mean 1.74 afferents (1-5 afferents) were embolized during one endovascular intervention. The radicality of the combined treatment of brain AVM was 98.2%; the lethality rate was 3.6% (2 cases). The functional outcomes of surgery in pseudo-randomization analysis did not differ statistically. In the discussion, the obtained results are compared with the published data. Conclusion. Preoperative endovascular embolization brings acceptable functional outcomes for complex brain AVMs; however, it has a risk of complications. Successful AVM treatment requires careful selection of patients and a multidisciplinary approach.