AVM is a mass of arteries and veins that are intertwined and intertwined, with one to several fistulae between the arteries and veins without capillaries. Therefore, active treatment is necessary. According to the different levels of AVM, individualized treatment plans are developed, and most of the cerebral AVMs can be treated with good results by combining embolization, radiation neurosurgery and microsurgery, together with appropriate perioperative management.
Microsurgery So far, surgical resection of cerebral AVM is still the most ideal treatment for this disease because of its rapid efficacy and high cure rate. However, the higher the AVM classification or Spetzler’s classification, the higher the risk of surgery, and therefore, it is necessary to grasp the appropriate indications and timing of surgery. Chen Tiao-Cheng et al . Between 1979 and 1999, 367 cases of microsurgery for cerebral AVM (374 lesions) were performed, with a total resection rate of 99.2%, a mortality rate of 0.26%, a good postoperative rate of 88.7%, a mild disability of 8.7%, and a severe disability of 2.4%, with satisfactory results. The authors’ unit usually follows the following principles: (1) AVMs with a history of intracranial hemorrhage and a grade of 1 to 3.5 on the Stichter scale, except for lesions involving the hypothalamus and brainstem, are feasible for surgical resection; (2) lesions without a history of intracranial hemorrhage, located in superficial nonfunctional areas and less than 5 cm in diameter, are selected for surgical resection; (3) intractable epilepsy without a history of intracranial hemorrhage but uncontrollable by medication, resection of the lesion may help to control seizures; (4) in the acute phase of intracranial hemorrhage, making cerebral angiography should be weighed against the advantages and disadvantages. In general, the incidence of recent rebleeding in AVM is low, and most patients with bleeding without brain herniation crisis should have cerebral angiography to understand the whole picture of AVM after the hematoma disappears and the systemic symptoms are stabilized by conservative treatment, and then elective resection of the lesion. However, when intracerebral hematoma leads to brain herniation crisis, the hematoma should be removed immediately by craniotomy, and lesion resection should not be performed blindly without angiography.
Second, stereotactic radiosurgery treatment The use of modern stereotactic technology and computer functions, the large dose of high-energy proton beam from multiple angles and directions at once gathered on the target tissue to achieve the purpose of destroying the target site to treat the disease. At present, the most used is Gamma Knife, whose therapeutic effect on AVM comes from radiation-induced endothelial proliferation of malformed vessels, structural destruction of the vessel wall and its gradual replacement by collagenous material, and finally thickening and stiffening of the vessel wall, progressive luminal narrowing and consequent slowing of blood flow, which eventually leads to thrombosis and AVM occlusion. The efficacy is closely related to the following factors: (1) The rate of complete occlusion increases accordingly with the extension of the follow-up time, so a 2-year or 3-year observation period should be given in assessing the effect of gamma knife treatment for AVM. (2) Most scholars believe that peripheral dose is the decisive factor affecting the rate of complete occlusion in AVM. The observation of the authors’ unit showed ] that 20-25 Gy is a more reasonable peripheral dose for treating AVM. (3) As the volume of AVM increases, the rate of complete occlusion gradually decreases. lunsford et al. reported the occlusion of 272 cases of AVM after 2 years of gamma knife treatment, the volume of the lesion.