Surgery of the arteriovenous cerebral malformations

Abstract

According to the present technical possibilities modalities of the treatment of the arteriovenous cerebral malformations (surgery, embolization, radiosurgery) for direct neurosurgical excision of malformations remains of cases. Decision to operate is made separately for each malformation and is based on anticipation of the natural course of the illness, precise estimate of the risk from operation and on the estimate of the condition of the patient. Surgical technique is also chosen for each malformation separately, depending on its size, angioarchitecture, hemodynamic characteristics and localization. The following techniques are used: resection of the malformation "en blocque", coagulation of the lesion in situ, gradual marginal coagulation in the lesion cleavage, "backword technique", perivenous approach and excision of the complex malformations in several acts. The safety of the surgical excision is increased by preoperative and perioperative actions already described. Intraoperative problems and postoperative complications (brain edema, uncontrolled hemorrhage, intracerebral hematoma and others) were discussed.