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Academia Mexicana de Neurología, A.C.

2017, Number 1

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Rev Mex Neuroci 2017; 18 (1)

Cerebral arteriovenous malformation treatment in the Hospital Juarez de Mexico

Melo-Guzmán G, Padilla-Vázquez F, Escobar-de la Garma VH, Mendizábal-Guerra R

Language: Spanish
References: 25
Page: 65-75
PDF size: 200.82 Kb.


ABSTRACT

Introduction: A cerebral arteriovenous malformation (AVM) is a complex nidus of abnormal vessels in the absence of capillaries, which is generated during embryonic development. This disease is the main cause of intracranial hemorrhage in young patients, for which it is necessary to provide an early diagnosis and therapeutic methods .
Objective: To report our experience in managing cerebral AVMs and to analyze the advantages of embolization with subsequent surgical resection of AVMs.
Methods: Retrospective study of 29 patients with a diagnosis of AVM, to March 2010 to March 2013, in the department of neurosurgery at Hospital Juárez de México. We embolized the AVMs of I-V grade of Spetzler Martin, performing partial embolization to achieve complete occlusion of the nidus and subsequently perform surgical resection.
Results: Eight (27.5%) patients underwent surgical resection without embolization and 21 (72.5%) patients underwent dual treatment (embolization plus surgical resection). In all, 72 patients had a low-grade AVM, 62% received bimodal treatment, observing decrease in transsurgical bleeding (p=0.002). The remaining 38% only underwent surgical resection with increased risk of bleeding (p=0.029) .
Conclusions: Embolization of low-grade AVM offers a safe resection with low morbidity. Currently it is discussed the ideal treatment of highgrade AVM, presenting a strong predisposition to conservative management, while other groups prefer medical management with the purpose of reducing the risk of cumulative bleeding. Most of AVMs can be curable in its entirety.


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