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Surgery for deeply seated arteriovenous malformation: with special reference to thalamic and striatal arteriovenous
K Yamada1, M Mase, T Matsumoto
1Department of Neurosurgery, Nagoya City University Medical School.
Abstract:
Surgery for deeply seated arteriovenous malformation (AVM) is controversial because stereotactic irradiation is applicable to the lesion. We have, however, experienced 30 deeply seated AVMs treated by direct surgery and/or endovascular treatment. The present study shows profiles of those patients and results of surgery. They include AVM in the thalamus in 12 cases, striatum in four cases, paraventricular area in five cases, medial temporal lobe in three cases, intraventricular area in three cases, and other regions in three cases. They were treated by surgery alone in 23 cases, embolization followed by surgery in four cases, and embolization alone in three cases. AVM in the mediodorsal thalamus and fornix (5 cases) was best treated by transcallosal approach. Venous aneurysm was commonly found in the AVM of this region and was a good navigator to the AVM. Pulvinar AVM was accessible through posterior interhemispheric approach (2 cases). None of these cases had additional neurological deficits. Cadaver dissection was useful for acquisition of surgical approach. Striatal AVM was approached through hematoma cavity with minimal manipulation to the surrounding structures, yet two of four cases showed progression of their weakness. The present study indicates that thalamic AVM can be approached surgically with careful selection of the approach. On the other hand, striatal AVM is not a good candidate for direct surgery and better treated by stereotactic irradiation.
Insights
Direct surgery for deep arteriovenous malformations (AVMs) is feasible, especially for thalamic AVMs. However, striatal AVMs may be better treated with stereotactic irradiation due to surgical risks.
Area of Science:
- Neurosurgery
- Vascular Neurology
Background:
- Deeply seated arteriovenous malformations (AVMs) present surgical challenges.
- Stereotactic irradiation is an alternative, but direct surgical or endovascular treatments are also explored.
Observation:
- Thirty cases of deeply seated AVMs were treated with surgery and/or endovascular methods.
- Locations included thalamus (12), striatum (4), paraventricular area (5), and others.
- Surgical approaches varied, including transcallosal and posterior interhemispheric routes.
Findings:
- Thalamic AVMs treated surgically showed no additional neurological deficits.
- Striatal AVMs approached surgically had a higher risk of neurological progression.
- Venous aneurysms served as useful indicators for AVMs in specific regions.
Implications:
- Surgical intervention for thalamic AVMs is viable with careful approach selection.
- Striatal AVMs may be better managed with stereotactic irradiation rather than direct surgery.
- Cadaver dissection aids in planning surgical access for complex AVMs.