The Management Of Cerebral Anteriovenous Malformation On Spetler-Matin Grade Ⅳ～Ⅴ

Objective To study the management of cerebral AVMs on Spetler-Matin grade IV～V.Methods Thirteen cases of AVM on Spetler-Matin grade IV～V from 2000 to 2006 were analyzed retrospectively. Results Invasive treatments were operated on nine patients in which 6 cases achieved 100% obliteration and 3 cases achieved 75%～99%. Among them, 3 patients got posttreatment neurological deterioration and 1 patient died. Four patients underwent uninvasive treatments with 1 patient got neurological deterioration. Conclusion The management of cerebral AVMs on Spetler-Matin grade IV～V was very complicate and difficult. Invasive treatments is only considered to execute when the risk of therapy is lower than the natural risk of illness itself. In addition, completely obliteration must be achieved once invasive treatment taken into practice. In certain condition, we can only deal with the risk facts but not to treat the nidus. For AVMs on Spetler-Matin grade IV～V, Combined embolotherapy and microsurgery was most useful project.