OBJECTIVE: To assess the importance of microsurgery in 46 consecutive patients with intracranial arteriovenous malformations (AVMs).

METHODS: Forty-six patients underwent microsurgical removal of their AVMs in our clinic from 1992 to 2003. There were 26 males and 20 females. Thirty-two patients (69.5%) presented with hemorrhage. Three patients had associated aneurysms. Their presentation, pre-operative neurological status, post-operative outcome and determinants of postoperative outcome were analyzed.

RESULTS: Post-operative mortality was 6.5% and morbidity was 8.7%. Neurological improvement was observed in 9 patients (19.6%). Of 43 patients having control angiographies, 38 had angiographically confirmed total removal of their AVMs. Three patients were reoperated. We advised embolization to one patient and radiosurgery to another one. Three associated aneurysms were clipped in the same session. The preoperative neurological status, Spetzler-Martin grade of AVM and the presence of hemorrhage were found to be determinative factors about outcome.

CONCLUSION: Microsurgery is an effective treatment with reasonable safety for the majority of AVMs. Microsurgical removal also provides immediate protection against the risk of serious hemorrhage.