抄録
There were 127 patients (91 males and 36 females) with arteriovenous malformation of the brain who were admitted to the neurosurgical department of Tohoku University School of Medicine during the years 1959 to 1974.
In 118 patients with supratentorial lesion, 82 (69.5%) had total extirpation, 6 had partial extirpation and 13 had ligation or clipping of afferent vesseles.
In the group of total extirpation, operative results were good in 63 cases, fair in 16 cases and death resulted in 3 cases (mortality rate of 3.7%).
In the group of partial extirpation and ligation clipping of feeders, the operative results were good in 10, fair in 5, poor in 3 and fatal in one.
Although attempts were made to remove the malformations as totally as possible, in some cases of deep malformations-such as in the deep occipital, basal ganglionic or paraventricular regions-partial resection or feeder clipping were performed after considering grate post-operative neurlogical consequences.
Recently with newly developed techniques, in paraventricular region and in the deep medial surface of the hemispheres can be removed radically without any neurological deficits in some instances.
We have experienced 4 cases of malformations in the corpus callosum and radical excision were performed in 3 cases.
Post-operatively, the first case died and the results of the next 2 cases were good.
In the one fatal case, the delay in performing the veutricular drainage may have resulted in the patient's poor preoperative coudition which may have caused postoperative cardiac arrest following convulsions.
Therefore in the 2nd case immediate aspiration of the hematoma in the ventricle by bilateral ventricular tapping was considered essential to improve consciousness disturbance before the radical operation.
Prior to excision of malformation, especially deeply located, clipped the main feeders temporary under administration of 20% mannitol to minimize the risk of bleeding and to simplify the excision by reducing the volume of the malformation.
We must emphasize here, great caution should be taken based on possible neurological consequences in selecting operative and non operative cases.
