Trends in Neurovascular Interventions

Steiger HJ, Etminan N, Hänggi D, Hans-Jakob Steiger, Nima Etminan, Daniel Hänggi, Steiger, Hans-Jakob, Etminan, Nima, Hänggi, Daniel

The therapeutic benefits of microsurgery for cerebral arteriovenous malformations (AVM) with regard to headache and epilepsy are not well known. The objective of the present review is to discuss the available evidence and our own experience, which showed that two-thirds of the patients with preoperative epilepsy experienced long-term improvement, one-sixth no significant change, and an equal number worsening. New seizures occurred postoperatively in 18 % of the patients presenting with hemorrhage. Regarding headache, 40 % of patients with preoperative chronic headache reported improvement and 50 % described no change, whereas 10 % suffered from deterioration. With regard to epilepsy, the available literature suggests, that an epileptological approach with preoperative identification of the seizure focus and corresponding resection might improve the results. With regard to headache outcome, almost no information is available in the literature, suggesting that these complaints of the patients have so far not received the necessary attention. In conclusion, the long-term treatment results regarding chronic epilepsy and chronic headache need further study and optimization.