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Titolo:
Surgical resection of cerebral arteriovenous malformation combined with pre-operative embolisation
Autore:
Hongo, K; Koike, G; Isobe, M; Watabe, T; Morota, N; Nakagawa, H;
Indirizzi:
Aichi Med Univ, Dept Neurol Surg, Nagakute, Aichi 48011, Japan Aichi Med Univ Nagakute Aichi Japan 48011 g, Nagakute, Aichi 48011, Japan
Titolo Testata:
JOURNAL OF CLINICAL NEUROSCIENCE
, volume: 7, anno: 2000, supplemento:, 1
pagine: 88 - 91
SICI:
0967-5868(200009)7:<88:SROCAM>2.0.ZU;2-6
Fonte:
ISI
Lingua:
ENG
Soggetto:
PERFUSION-PRESSURE BREAKTHROUGH; MULTIDISCIPLINARY TREATMENT; BASAL GANGLIA; MANAGEMENT; COMPLICATIONS;
Keywords:
arteriovenous malformation; pre-operative embolisation; microsurgery; overload phenomenon;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
17
Recensione:
Indirizzi per estratti:
Indirizzo: Hongo, K Shinshu Univ, Sch Med, Dept Neurosurg, Asahi 3-1-1, Matsumoto, Nagano 3908621, Japan Shinshu Univ Asahi 3-1-1 Matsumoto Nagano Japan 390862121, Japan
Citazione:
K. Hongo et al., "Surgical resection of cerebral arteriovenous malformation combined with pre-operative embolisation", J CL NEUROS, 7, 2000, pp. 88-91

Abstract

To assess the importance of pre-operative embolisation, 27 cases of cerebral artriovenous malformation (AVM) treated in this Institute between July 1994 and October 1998 were analysed. The patients' ages ranged from 3 to 70 years (average 36.9) with a follow-up period of 1-41 months (average 19.2). The patient presented with haemorrhage in 21 cases and seizure in five. In21 of 27 cases, surgical resection of a nidus was performed, gamma knife therapy was applied in three and conservative therapy was chosen in three. Of 21 cases treated surgically, total removal was achieved in 19 cases and aresidual nidus was seen in one (a large basal ganglia AVM). In the remaining case, postoperative angiography was not available. Pre-operative embolisation followed by surgical resection of the nidus was performed in seven cases In which there was a large AVM. A volume index was calculated to indicate the size of the nidus using X x Y x Z, where X is the maximum diameter (cm) of the nidus on the lateral angiogram, Y is the diameter (cm) perpendicular to X and Z is the maximum diameter (cm) on the anteroposter or angiogram. The index averaged 45.9 for the cases in which pre-operative embolisation was performed, while it was 5.6 in the cases without embolisation. Pre-operative embolisation was performed to reduce the nidus flow as much as possible, to prevent overload to the surrounding structures. At surgery, the nidus was resected from the surrounding tissue and care was taken not to enter the nidus. Postoperatively, the systolic blood pressure was maintained at 90-100 mmHg for several days in the intensive care unit. The results wereexcellent in 15 cases, good in three (hemiparesis due to the initial haemorrhage remained in all three), fair in one (a patient with a severe subarachnoid haemorrhage). TWO patients died (acute pulmonary oedema and severe meningitis). Minor postoperative bleeding or oozing was seen In three cases. In conclusion, reducing the shunt flow through a nidus in a step-wise fashion with pre-operative embolisation of a targe AVM seems to be quite helpfulin preventing postoperative haemodynamic overload to the surrounding brain. It is also important not tb enter the nidus when it is removed at surgery. This helps to prevent intraoperative and/or postoperative bleeding, and led to successful total removal of the nidus with a good postoperative course. (C) 2000 Harcourt Publishers Ltd.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 20/09/20 alle ore 07:40:50