Same day embolisation followed by microsurgical resection of brain arteriovenous malformations: a single centre early experience.

Introduction: The purpose of this paper is to report our experience of treating cerebral arteriovenous malformations (AVM) in adults with pre-operative embolisation and microsurgical resection on the same day during a single anaesthetic at a single centre between April 2016 and December 2018. We included both elective AVM and AVM that had bled acutely.

Methods: We retrospectively analysed data from patients with cerebral AVMs who underwent embolisation followed by microsurgical resection on the same day at a single neurosurgical centre.

Primary Endpoints Included: Total procedure time (embolisation and microsurgical resection), procedure finish time, intra-operative blood loss, degree of nidus obliteration on postoperative angiography, intensive care unit (ICU) stay, total stay at the neurosurgical centre and modified Rankin Score (pre- and post-procedure).

Results: •Nineteen patients underwent same-day pre-operative embolisation and microsurgical resection over the 32-month period. The average patient age was 40 years (range 19-66 years). One patient had undergone a prior attempt at embolisation and one patient previously had sterotactic radiosurgery (STRS). •Thirteen of the AVM were in the dominant hemisphere and six in the non-dominant hemisphere. Sixteen AVM were located supratentorially and three were in the posterior fossa. Spetzler-Martin grades included 4 grade 1, 10 grade 2, 4 grade 3 and 1 grade 4. •The average blood loss intra-operatively was 289 mls. •The average list finish time was 19:56 (range 15:10-00:00). •Seventeen patients had 100% nidus obliteration on post-operative digital subtraction angiography, one patient had a small remnant and was referred to STRS and one patient died in the ICU post operatively.

Conclusion: Overall, the authors believe same-day embolisation and microsurgical resection represents a safe treatment strategy. The technique minimises hemorrhagic complications from delayed venous occlusion and avoids multiple anaesthetics and hospital admissions.