抄録
There is high risk of intraoperative hemorrhage in AVM surgery due to abnormal vessels and changing hemodynamic pattern of brain. Inadequate coagulation of vessels, arterialization of veins and loss of tissue planes are major pitfalls. Preoperative embolization and temporary clipping of feeding arteries contribute to safe surgical techniques.
There were 281 patients who underwent treatment for AVM in our institution: 242 were operated (99 of them with intracerebral hemorrhage) and 39 cases were treated with embolization and/or gamma knife. Radiological evaluation was carried out by CT, dynamic and 3D-CT, MRI, fMRI, MRA, and surface anatomy scanning. Strategic image analysis and preoperative embolization were employed where feeders were behind the nidus or vein and where another craniotomy was found necessary to secure feeding arteries.
Endovascular nidus obliteration is successful only in 10% of patients. Surgical results showed risk of intraoperative bleeding in Grade 4 and 5 cases (1.5%). Recovery showed GR (205), MD (13), SD (7), PVS (2), and death (15) on 242 cases, based on Glasgow Outcome Score.
Preoperative staged nidus embolization helps prevent bleeding in large AVM; small superficial lesions have the best results with surgery. Temporary clips for feeders, good plane between nidus and brain, definition of eloquent cortex, adequate coagulation of draining veins and total nidus excision are important steps in surgical strategy.
