Abstract
The authors have already reported surgical problems of poor-risk patients with hemorrhagic infratentorial arteriovenous malformations (AVMs). In the presents study, fifteen good-risk patients of infratentorial AVMs, whose levels of consciousness was 0 to 30 according to the Japan Coma Scale, were reviewed and the problems of the surgical treatment are reported. Of this series, 12 patients had a good result, and 3 patients a poor result. Giant AVM and AVM extending from the cerebellum to the brainstem showed an unsatisfactory surgical result. Two out of 3 poor results were due to massive postoperative hemorrhage, related to a residual nidus in the brainstem in one patient, and probably related to a sudden rise in intravascular pressure after removal of giant AVM in one. The present study suggests that presurgical multiple-staged embolization of nidus and a strict control of postoperative systemic blood pressure are important in order to reduce surgical risks of giant AVMs. Furthermore, stereotactic radiosurgery must be considered in combination with surgical treatment for an AVM involving the brainstem.
