Multimodality treatment of supratentorial arteriovenous malformations with microsurgery after embolization: A retrospective two-center study in Vietnam

Background: Preoperative embolization with microsurgical resection has been used as a multimodality treatment of cerebral arteriovenous malformations (AVMs) in recent years. However, the role of this combined approach has not been well established. Objectives: This retrospective study aims to evaluate the outcomes of multimodality treatment with microsurgery after embolization for supratentorial AVMs in Vietnam. Methods: A two-center, retrospective case series of 26 patients with supratentorial AVMs who underwent treatment with surgical resection after embolization between January 2017 and August 2020 was performed. Sixty-three feeding arteries were embolized preoperatively in 29 sessions. We analyzed the AVM size, degree of preoperative obliteration, complications related to embolization, intraoperative blood loss, surgical complications, complete resection rate, and postoperative outcomes at 3 months after discharge. Results: The average size and Spetzler-Martin (SM) grade of AVMs were 4.98 cm (largest, 8 cm) and 3.19, respectively. The average preoperative volumetric obliteration was 55.38%. The intraoperative average blood loss was 573 ml. Complications related to embolization were post-embolization cerebral hemorrhage in 2 cases (7.69%), new-onset neurological deficits in 1 (3.38%). Surgical complications included death in 2 cases (7.69%) and new-onset neurological deficits in 5 (19.23%). At 3-month follow-up, four patients with new-onset neurological deficits had recovered completely or nearly completely. Complete resection of AVMs was confirmed by postoperative imaging modalities in 24/24 cases. Favorable outcome was achieved in 23 cases (88.46%). Conclusion: Multimodality treatment with microsurgery after embolization is a relatively safe and effective method which can be considered for managing large and complex brain AVMs.