The Effect Analysis Of Two Treatment Modalities For CAVM: Only Operation And Embolization Combined With Microsurgery

Objective: Reviewing the treatment of72patients with cerebral arteriovenousmalformation (CAVM), this article explore the CAVM ideally effective treatmentmodalities and the help of embolization in the resection of grade Ⅲ-ⅤCAVM, which willprovide reference for clinical treatment.Method: The neurosurgery department of the first affiliated hospital of SoochowUniversity admitted104patients confirmed CAVM, which account for the53per cent ofthe cerebral vascular malformations (104/196) admitted in the same period, thoughpreoperative DSA or postoperative pathology during the period from January2008toDecember2012. Excluding24emergency surgery (after the onset of24h) and6casesinvolved simple as well as2cases after Gamma Knife surgery, the complete informationof the remaining time-limited operations of72patients cases were included in this study.According to the different treatment modalities, all72cases have been divided into surgeryalone group:48cases (Ⅰ-Ⅱ grade42cases) and embolization combined surgery group:24cases (Ⅲ-Ⅴ grade17cases). Using Glasgow Outcome Scale (GOS) rate the treatmentresults respectively with early (7days after surgery) and late (after6months).Using theT-test compare the two-group cases of treatment results. Using pearson correlation test andhierarchical regression method analysis the impacts of Gender, age, Glasgow Coma Scale(GCS) and Spetzler-Martin grading (S-M grading) to the GOS.Results: All24cases of embolization combined surgery group totally carried26times embolism before operation:2feeding arteries per,52all. After embolization,malformation reduced49.5%on average volume and one patient with headache wasobserved remission after24hours with symptomatic treatment. After surgery, full cut24cases,100%total removal rate. Of the E-C-S group,21patients are good recovery (87.5%),3adverse (12.5%), No death case.Of all48cases of surgery alone group,45lesions weretotally cut (total removal rate:93.75%),3residual (Residual rate:6.25%) and45patients are good recovery (93.75%),2adverse (4.17%),1death (2.08%).On the whole72casesconcerned,69lesions were totally cut (total removal rate:95.83%),3residual (Residualrate:4.17%);67patients are good recovery (93.06%),4adverse (5.56%),1death (1.39%).Additionally, there was no new neurological dysfunction,7cases of epilepsy patients in6cases disappeared after surgery,1case of improvement. Statistics show thatage(r=0.275,p=0.019) and S-M grading(r=-0.354,p=0.002) was negatively correlated withthe GOS, however, GCS（r=0.393,p=0.001）was positively correlated. Further hierarchicalregression analysis found that the impacts of age(β=-0.22,p=0.043), S-Mgrading(β=-0.223,p=0.05) and GCS(β=0.299，p=0.009) to the GOS are remarkable. AfterT-test indicates: comparing with two sets of samples of different forms of treatment, nostatistically significant results of postoperative difference was found (p=0.309). However,difference between high-level (S-M) group with only surgery and high-level group withembolization combined surgery was significant (P=0.014).Conclusion:(1) Patient’s age, S-M grade and GCS affect treatment of CAVM.Specifically, the treatment of elderly patients with high S-M scores and low GCS is lesseffective.(2) Preoperative embolization reduces or improves S-M grading, reducingsurgical risks, and ultimately improves treatment results.(3) S-M grade Ⅰ-Ⅱ levels inCAVM patients, whose treatment is the primary means of microsurgery. However,microsurgical excision combined with preoperative embolization is the most direct andeffective method of treatment for the CAVM patients, whose S-M grade is Ⅲ-Ⅴ.