Intracranial arteriovenous malformations: an 11-year experience

A consecutive series of 107 patients with an intracranial arteriovenous malformation who were considered for surgical treatment over the 11-year period between 1974 and 1985 is analysed. In 71 (66.4%) patients complete obliteration (which in some cases was combined with pre- or peroperative embolization) by surgery was attempted and was achieved in all but two patients. Five patients were treated by embolization alone and three patients by radiotherapy alone. Twenty-eight patients were managed conservatively for one of four reasons: an expectation of a good outcome without treatment (six patients); the refusal of recommended surgical treatment (five patients); poor condition at presentation (eight patients); or the risks of operative treatment were thought to be too great (nine patients). There was a 9.9% mortality in the surgically-treated series and significant morbidity in 16 (22.3%) patients. In all but two of these 16 patients, morbidity was related directly to the initial intracerebral haemorrhage. The one-year mortality in the group that did not undergo operation was significantly higher than in those patients who were treated surgically. Some general guide-lines for the management of intracranial arteriovenous malformations are proposed.