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[Surgical treatment of arteriovenous malformations in the brain stem]
T Yasui1, H Yagura, M Komiyama
1Department of Neurosurgery, Baba Memorial Hospital, Osaka, Japan.
Insights
Surgical removal of brain stem arteriovenous malformations (AVMs) is feasible. This study shows acceptable risks and useful recovery for select patients with brain AVMs.
Area of Science:
- Neurosurgery
- Vascular Neurology
Background:
- Brain stem arteriovenous malformations (AVMs) pose significant surgical challenges due to their location and potential for hemorrhage.
- Hemorrhagic presentation of AVMs necessitates urgent and effective treatment strategies.
Observation:
- Four patients with brain stem AVMs causing hemorrhage underwent surgical intervention.
- Cases included two intra-axial and two extra-axial AVMs, with three located in the pons and one in the posterior medullary velum.
Findings:
- Complete surgical removal was achieved in three out of four patients (two extra-axial, one intra-axial).
- One patient with an unresectable intra-axial AVM received partial embolization and surgical coagulation of the feeding vessel.
- No patient experienced permanent worsening; one comatose patient died, while three achieved useful recovery.
Implications:
- Surgical and endovascular approaches are viable treatment options for select brain stem AVMs.
- Aggressive management of AVMs can lead to favorable outcomes with acceptable surgical risks.
- Further research into optimizing surgical techniques for complex AVMs is warranted.
Abstract:
The authors report the surgical removal of four arteriovenous malformations (AVM's) in the brain stem causing hemorrhage. These included two intra-axial and two extra-axial AVM's. Three of the four were situated at the pons, and the remaining one in the posterior medullary velum. Complete surgical removal was obtained in the two extra-axial cases and in one of the intra-axial cases. The patient in whom complete removal was not obtained received partial embolization therapy with the remaining feeder being coagulated surgically. No patient was made permanently worse after surgery. One patient, in a comatose state on admission, died, while the remaining three patients showed useful recovery. These data indicate that surgical therapy with or without endovascular surgery appears to be possible for some AVM's and can be performed at an acceptable risk.