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Medial trigonal arteriovenous malformations.

S Nair1, D Rout, G Menon

  • 1Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India. snair@sctimst.ker.nic.in

The Keio Journal of Medicine
|April 6, 2000
PubMed
Summary
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Medial paratrigonal arteriovenous malformations (AVMs) are prone to recurrent bleeding. Surgical resection offers acceptable outcomes, though visual field deficits may not improve post-operatively.

Area of Science:

  • Neurosurgery
  • Vascular Neurology
  • Neuroradiology

Background:

  • Medial paratrigonal arteriovenous malformations (AVMs) represent a significant subset of surgically managed AVMs.
  • Understanding their clinical presentation, radiological features, and surgical outcomes is crucial for effective patient management.

Purpose of the Study:

  • To analyze the clinical presentation, radiological characteristics, surgical approaches, and functional outcomes of medial paratrigonal AVMs.
  • To evaluate the morbidity and functional recovery associated with surgical management of these lesions.

Main Methods:

  • Retrospective analysis of 48 patients with medial paratrigonal AVMs treated over 16 years.
  • Review of clinical data, radiological findings, surgical techniques (interhemispheric vs. transcortical approaches), and postoperative outcomes.

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Main Results:

  • Hemorrhage was the most common initial presentation (35 patients), with 41 presenting with bleeding on admission.
  • Posterior and anterior cerebral arteries were the main arterial supply (43 and 25 patients, respectively), with predominant venous drainage into the galenic system (70%).
  • One operative mortality; 12 patients developed new visual field deficits postoperatively, with limited improvement in pre-existing deficits. Eight of ten patients with preoperative weakness improved.

Conclusions:

  • Medial paratrigonal AVMs are associated with a high risk of recurrent bleeding.
  • Surgical resection can be performed with acceptable morbidity, but visual field deficits are a significant concern.
  • Functional recovery from weakness is generally favorable, but visual field deficits are unlikely to improve post-surgery.