2005 年 14 巻 6 号 p. 363-367
The treatment of arteriovenous malformation (AVMs) depends on the efforts of a multidisciplinary team to provide better results than its natural course. Treatment options are reviewed based on our personal experience series of 208 grade III operated AVMs in a 10-year period. The Spetzler-Martin classification was modified to include subdivisions in the heterogeneous group of grade III AVMs as follows : IIIA(large cortical AVMs), IIIB(small limbic lobe AVMs) and IIIC(small insula lobe AVMs), to augment the surgical resection criteria. The treatment strategy was for most of the cases embolization plus surgery for grade IIIA, surgery for subdivision IIIB and radiosurgery for most and surgery for selected cases of IIIC. The surgical results (good outcome : IIIA 81%, IIIB 86% and IIIC 87%) showed that in spite of the higher surgical and anatomical complexity for the IIIC group in comparison with those IIIB and IIIA AVMs, there are selected cases that can be surgically approached with similar or even better surgical outcomes based on the subdivision proposed. Indeed, these data indicate that the treatment of AVMs can achieve better results when compared to its natural course if managed by a well-trained group of specialists led by an experienced neurosurgeon.
