抄録
The natural history and operative results of 85 cases of intracranial arteriovenous malformations (AVMs) were studied. Seventeen AVM patients had died due to initial bleeding, but are not included in this study. Of the 85 cases, 62 received surgical care, and 23 were treated conservatively. Of the patients treated surgically, total removal of AVMs was performed on 55 patients, subtotal removal was performed on 3, and proximal ligation was performed on 4. The mean period of follow-up was 6.5 years. The treatment results of the surgical and conservative groups were compared. The possible influence of age, the location and size of the AVM, and the type of onset were analyzed; but these factors were particularly studied in the conservative group to determine the bleeding characteristics of AVMs.
Of the 55 patients where a total resection of AVMs was performed, 2 died due to operative complications-a mortality rate 3.6%; 4 were dependent, and 46 were independent. In none of these 55 patients did the hemorrhage of AVMs occur during the follow-up period. On the other hand, of 23 patients that received conservative treatment, 6 died-a mortality rate of 26%; 3 were dependent, and 14 were independent. In the 7 cases (30.4%) where hemorrhage occurred during the follow-up period, 4 died due to fatal intracerebral hematoma. Where the age of the patients was young, bleeding of the AVMs from the onset, and where there were deep seated AVMs, there tended to be a higher risk of hemorrhage during the follow-up period. The size of the AVM was not significantly related to the risk of hemorrhage, however.
We conclude that the cases mentioned above (having a younger age, and/or with ruptured and deep seated AVMs) should be treated surgically if possible. Even in patients with unruptured AVMs, surgical treatment should be used if the lesions can be resected without causing additional neurological deficits.
