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May 1986

Neurological Deficit From an Inoperable Arteriovenous Malformation: An Indication for Therapeutic Embolization?

Author Affiliations

From the National Hospital for Nervous Diseases, London.

Arch Neurol. 1986;43(5):508-509. doi:10.1001/archneur.1986.00520050080028

Approximately 50% of arteriovenous malformations (AVMs) present with an intracranial hemorrhage,1-4 and these are predominantly parenchymal.2,3 The evidence suggests that the risk of hemorrhage in an initially unruptured AVM is 1% to 3% per year, whereas the risk of rebleeding is higher (about 6%) during the first year, although it subsequently drops to just over 2% per year.5-7 The incidence of occult hemorrhage in resected specimens is high,8 and this may be an important factor in the progression of neurological deficit. In addition, there is some evidence that smaller AVMs are more dangerous than giant lesions.5,7 Although the prognosis for functional recovery is relatively good, with a morbidity and mortality of 10% and 30%, respectively, there is no doubt that deficits can accrue.3

So what has therapeutic embolization got to offer for this most feared complication of AVMs when site and location render surgery