Anterior choroidal AVMに対する摘出術とその問題点

抄録

Thirteen cases of the anterior choroidal arteriovenous malformations (ACh AVMs) supplied by the anterior choroidal artery were reviewed and the problems of the surgical treatment characteristic to this lesion are reported.
Both the cerebral parenchyma and the lateral ventricle were the sites of the AVMs in seven cases (54%), which raised the characteristic problems of their surgical removal. In two cases (group A), the AVMs were predominantly located in the lateral ventricle and involved the medial wall of the temporal horn and the hippocampus. In five cases (group B), the large AVMs were situated in the deep cerebral hemisphere or the corpus callosum, and also were extending into the lateral ventricle. Residual AVMs were found in five cases after the first operation. In two cases of group A, the residual AVMs which were supplied by the cisternal segment of the anterior choroidal artery and situated in the medial wall of the temporal horn and the hippocampus were recognized. In three cases of group B, intraventricular residual AVMs fed by the anterior choroidal artery were identified.
It should be emphasized that the ACh AVMs often occupy portions of both the cerebral parenchyma and the lateral ventricle. Therefore, it is important to open the ventricular wall from the cerebral parenchymal side or from the inside the lateral ventricle and to carry out careful inspection in order to eliminate the risk of incomplete removal of the AVMs.