Valutazione del rischio chirurgico nelle malformazioni artero-venose del sistema nervoso centrale

Recent advances in neurosurgery and neuroradiology allow cerebral arteriovenous malformations to be treated by different modalities or a combination of techniques. In particular, we refer to direct microneurosurgery, reduction or exclusion of the vascular malformation from the circulation by embolisation repeated if necessary, and radiosurgery. Different factors are correlated to an assessment of the surgical risk including the location, size and angioarchitecture of the lesion, especially the presence of arterial or venous aneurysms and the venous drainage pattern. Other factors influencing the surgical risk relate to the patient's general status and his/her neurological condition. Treatment of a vascular malformation is indicated if the risk of treatment is deemed "acceptable", i.e. inferior to the risk posed by the natural history of the condition. We report the results of our series of 20 patients treated by surgery and embolisation.