Curative effect and surgical techniques of microsurgery for cerebral arteriovenous malformation: a report of 65 cases

Abstract

Objective To assess the safety and efficacy of microsurgical resection of cerebral arteriovenous malformation (AVM).  Methods A total of 65 patients with cerebral AVMs were treated with microsurgical resections from April to August 2010 in our hospital. Of the 65 patients, 26 were male and 39 were female with age ranging from 4 to 72 years (average 42 years). Initial symptoms included cerebral hemorrhage in 32 cases, seizures in 10 cases, headache in 6 cases, neurological dysfunction in 14 cases, and the left 3 cases were diagnosed in health examination. According to Spetzler-Martin grades, there were 7 cases in Grade Ⅰ, 20 in Grade Ⅱ, 23 in Grade Ⅲ, 10 in Grade Ⅳ and 5 in Grade Ⅴ. The diameter of nidi ranged from 2 to 7 cm (on average of 3.50 cm). The lesions were located in the surface of cerebral cortex (31 cases) and deep brain (34 cases), including frontal lobe (19 cases), temporal lobe (12 cases), parietal lobe (16 cases), occipital lobe (9 cases), cerebellum (3 cases), basal ganglia (2 cases) and lateral cleft (4 cases). Feeding arteries included anterior cerebral artery (ACA) and its branches in 11 cases, middle cerebral artery (MCA) in 29 cases, posterior cerebral artery (PCA) in 15 cases, both ACA and MCA in 2 cases, both ACA and PCA in 5 cases, and vertebral artery (VA) in 3 cases. There were superficial vein drainage in 29 cases, deep vein drainage in 15 cases, and both superficial and deep vein drainage in 21 cases. All of those patients underwent surgical resections, including simple excisions in 45 cases and excisions combined with evacuation of hematoma in 20 cases. Among all of those operations, 6 were performed through single-frontal approach, 3 orbitozygomatic approach, 2 transcortical approach, 8 frontal-parietal approach, 10 pterional approach, 3 subtemporal approach, 4 temporal-parietal approach, 7 single-parietal approach, 7 interhemispheric approach, 8 parietal-occipital approach, 3 suboccipital approach, and 4 transcortical-transventricular approach.  Results Among these patients, 4 cases (6.15%) had undergone prior endovascular embolization. Total resection was obtained in 60 cases (92.31%) and 5 cases (7.69%) took postoperative stereotactic radiosurgery. On discharge, modified Rankin Scale (mRS) scores were 0 in 21 cases (32.31%), 1 in 23 cases (35.38%), 2 in 9 cases (13.85%), 3 in 7 cases (10.77%), 4 in 3 cases (4.62% ) and 5 in 2 cases (3.08% ). During the follow-up (12 months on average), 6 patients got good recovery, while 3 patients presented with limb weakness, one visual field defect, 2 aphasia, one underwent ventriculoperitoneal shunt (VPS) due to hydrocephalus, 2 newly occurred seizures, and 2 deaths (one died of respiratory failure after one year, and the other was agnogenic).  Conclusions Microsurgical resection of AVMs is highly efficient and can be undertaken with low rates of mortality. Adequate patient selection and careful preoperative planning are essential to improve the prognosis of patients with complicated AVM lesions.

DOI: 10.3969/j.issn.1672-6731.2015.04.008