The Role of Preradiosurgical Embolization in the Management of Grades III, IV, and V Arteriovenous Malformations.

Objective: To evaluate the role of preradiosurgical embolization on obliteration rate, reduction of size, irradiation dose, and neurological outcome, in 90 patients presenting large arteriovenous malformations (AVMs).

Methods: Between October 1993 and October 2006, 90 radiosurgical procedures were performed to treat brain AVMs Spetzler-Martin (SM) grades III, IV, and V at the Department of Radiosurgery and Radiology of the Real e Benemérita Associação Portuguesa de Beneficência de São Paulo, São Paulo, Brazil. Fifty-nine patients had embolization before radiosurgery and complete clinical and radiologic follow-up for at least 3 years.