La chirurgia delle malformazioni artero-venose cerebrali

Since the advent of alternative or complementary procedures which may offer a definitive treatment for cerebral AVM, the choice of whether to treat these lesions surgically has become one of the most controversial topics in current neurosurgical debate. We reviewed the records of 47 patients operated on consecutively at Bellaria Hospital in recent years to examine the criteria for surgical referral and the outcome of treatment. Our analysis showed that, excluding emergencies, the primary criterion for surgical treatment was to achieve a good final result (complete resection of the AVM) with minimum risk. In particular, surgery may still be preferasble to treat grade 1-II malformations on the Spetzler and Martin scale, except for special cases in critical brain locations. In grade IV malformations, surgery must be reserved for special cases when the AVM cannot be treated by alternative means and patients present with haemorrhage. In these circumstances pre-operative embolisation may offer a major contribution to surgical treatment.