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Surgery for cerebral arteriovenous malformation: risks related to lenticulostriate arterial supply
M K Morgan1, K J Drummond, V Grinnell
1Department of Neurosurgery, Royal North Shore Hospital, Sydney, Australia.
Abstract:
The aim of this study was to compare complications of surgery in arteriovenous malformations (AVMs) supplied by the middle cerebral artery (MCA) with and without a lenticulostriate arterial contribution. Ninety-two consecutive surgical resections of AVMs with an angiographically demonstrated MCA supply were performed between January 1989 and July 1996. Ten of these cases had a significant lenticulostriate arterial contribution. The cases were graded according to the Spetzler-Martin classification. There were no deaths and 4.3% of cases developed new major neurological deficit by the 3-month follow-up examination. All cases had angiographically confirmed obliteration of the AVM. There were no complications in 16 patients with Spetzler-Martin Grade I AVMs, one case of complications in 40 patients with Grade II AVMs, eight cases of complications in 26 patients with Grade III AVMs, and seven cases of complications in 10 patients with Grade IV and V AVMs. The supply of blood from lenticulostriate branches was associated with complications in eight of the 10 cases. The effect of the presence of a lenticulostriate arterial supply was most apparent in cases of Grade III AVMs: complications were experienced in three of 20 patients whose AVMs were not supplied by the arteries and in five of six patients whose AVMs were fed by the lenticulostriate arteries. This difference is significant (p < 0.0001). The conclusions drawn from this study are that for Grade III AVMs, the presence of a lenticulostriate arterial supply can be considered a factor predictive of an increased risk of surgical complications.
Insights
Surgery for brain arteriovenous malformations (AVMs) supplied by the middle cerebral artery (MCA) carries risks. A lenticulostriate arterial supply significantly increases surgical complications, particularly for Grade III AVMs.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Radiology
Background:
- Arteriovenous malformations (AVMs) are complex vascular lesions.
- Surgical resection is a primary treatment for AVMs.
- Identifying factors predicting surgical complications is crucial.
Purpose of the Study:
- To compare surgical complication rates in middle cerebral artery (MCA)-supplied AVMs with and without lenticulostriate arterial contribution.
- To assess the impact of lenticulostriate arterial supply on AVM resection outcomes.
- To evaluate the predictive value of lenticulostriate supply for surgical complications in different AVM grades.
Main Methods:
- Retrospective analysis of 92 consecutive surgical resections of MCA-supplied AVMs.
- Classification of AVMs using the Spetzler-Martin grading system.
- Comparison of complication rates between AVMs with and without lenticulostriate arterial supply.
Main Results:
- No deaths occurred; 4.3% developed new major neurological deficits.
- Lenticulostriate arterial supply was associated with complications in 80% of cases (8/10).
- For Grade III AVMs, lenticulostriate supply significantly increased complication rates (p < 0.0001).
Conclusions:
- Lenticulostriate arterial supply is a significant predictor of surgical complications in MCA-supplied AVMs.
- The risk is particularly elevated for Spetzler-Martin Grade III AVMs.
- Preoperative identification of lenticulostriate supply is vital for risk assessment and surgical planning.