Personal experience in the treatment of 178 cases of arteriovenous malformations of the brain.

We have analysed our personal series of 178 consecutive cases of arteriovenous malformation (AVMs) treated since 1954. A surgical approach was used in 146 cases (82%), with direct attack on the malformations in 132 cases (74%). There was total extirpation of the malformations in 124 of the operation cases (94%). In the remaining cases, ligation of the carotid artery was performed in three, and ligation of the afferent feeding artery in five. Embolization was used in five cases, and stereotaxis cryocoagulation in one. The decision-making process was based on the size of the malformations and the clinical presentation, which was subarachnoid haemorrhage (SAH) in 64% of the cases, and epilepsy in 15%. The results were considered good in 117 of the cases (89%), and the mortality rate was 11%. As in other series, a high incidence of AVMs was encountered in patients under 40, and men predominated (74%) over women. Different criteria of operability are discussed, including a "New Look" at the venous components of the malformations as an important assessment.