[Surgical treatment of giant cerebral arteriovenous malformations].

Acta neurologica latinoamericana Pub Date : 1981-01-01
G M Malik, C E Codas, J I Aussman, M Dujovny
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Abstract

Despite advances in the surgical management of cerebral arteriovenous malformations (AVMs), giant (AVMs (greater than 5 cm] are still considered unsuitable for direct surgical resection by most neurosurgeons. Some of the lesions are being treated with embolization, or embolization followed by surgical excision. Embolization alone is not curative and carries potential risks of neurological deficit as well involves multiple procedures. Fourteen patients with giant AVMs underwent surgical resection without prior embolization. Four of the AVMs were located primarily in the frontal lobe, two in the temporal lobe, one each in the parietal and occipital lobes, while six AVMs were localized to two lobes (temporal-occipital or parietal-occipital). Four patients had associated aneurysms with the arteriovenous malformation. Eight patients presented primarily with seizures. One of these had multiple subarachnoid hemorrhages while another had symptoms suggestive of transient vertebrobasilar ischemia. Two patients had one or more subarachnoid hemorrhages. The primary complaint in the remaining four patients was headache with other associated symptoms. The patients with AVMs involving the optic radiation have had varying degrees of visual field deficit not interfering with their function. There were no deaths and only three patients had deterioration of neurological function. One of these three had an intra cerebral hemorrhage secondary to an associated aneurysm rupture. We feel that the majority of these giant AVMs are amenable to direct surgical excision. It is difficult to asses, from the literature, the benefit of embolization prior to surgical excision in cases of giant AVMs. At least in one report dealing with combined treatment of seven giant AVMs, some authors stressed that preoperative embolization did not significantly alter the blood flow and, hence, potential of bleeding at the time of operation. Blood loss has not been a significant problem in our experience. When there is an associated aneurysm, it should be treated prior to or at the time of excision of the malformation.

巨大脑动静脉畸形的外科治疗。
尽管脑动静脉畸形(avm)的外科治疗取得了进展,但大多数神经外科医生仍然认为巨大(大于5厘米)的脑动静脉畸形不适合直接手术切除。一些病变采用栓塞治疗,或栓塞后手术切除。单纯的栓塞治疗并不能治愈,而且存在神经功能缺损的潜在风险,并且涉及多个手术。14例巨大动静脉畸形患者在没有栓塞的情况下进行了手术切除。其中4个avm主要位于额叶,2个位于颞叶,顶叶和枕叶各1个,6个avm定位于两个叶(颞枕叶或顶枕叶)。4例患者伴有动静脉畸形并发动脉瘤。8例患者主要表现为癫痫发作。其中一人有多发性蛛网膜下腔出血,另一人有提示短暂性椎基底动脉缺血的症状。2例患者出现一次或多次蛛网膜下腔出血。其余4例患者的主要主诉为头痛及其他相关症状。涉及视辐射的动静脉畸形患者有不同程度的视野缺损,但不影响其功能。无死亡病例,仅有3例患者出现神经功能恶化。这三人中有一人有继发于动脉瘤破裂的脑出血。我们认为大多数巨大的动静脉畸形都可以直接手术切除。从文献来看,很难评估在巨大的动静脉畸形手术切除前进行栓塞的益处。至少在一份关于联合治疗7个巨大动静脉畸形的报告中,一些作者强调,术前栓塞并没有显著改变血流,因此,在手术时出血的可能性。根据我们的经验,失血并不是什么大问题。当伴有动脉瘤时,应在切除畸形之前或同时进行治疗。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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