medigraphic.com
Instituto Nacional de Neurología y Neurocirugía

2006, Number 1

<< Back Next >>

Arch Neurocien 2006; 11 (1)

Microsurgical technique for the resection of encephalic arteriovenous malformation

Nathal E

Language: Spanish
References: 45
Page: 29-40
PDF size: 208.08 Kb.


ABSTRACT

The arteriovenous malformations of the brain (AVMs),are the most commonly recognized of the vascularmalformations because of their clínical and therapeuticalimplications. Even when there are many papers in theliterature about the surgical technique, most of themlack of a detailed and systematic description of themicrotechnique. This point is a matter of concernspecially for young neurosurgeons in training, becauseonly a few neurosurgical centers have enough numberof patients with AVMs to get a theoretical and practicalconcept to deal with such a cases.In this work, it is presented a detailed description ofthe microsurgical technique based on the acronym“ACADEV”. This acronym includes all the stepsnecessaries to assure an effective treatment of an AVMas follows: A= angioarchitecture, C=craniotomy,A=attack (peripheral attack), D=dissection (circum-ferencial), E=extensive coagulation of feeders and, V=vein(s) of drainage. In addition, a special remarks aremade about our surgical results, the proper surgicalintrumentation and another special tips according tothe surgical experience of the author.


REFERENCES

  1. Zhao J, Wang S, Li J, Qi W, Sui D, Zhao Y. Clinical characteristicsand surgical results of patients with cerebral arteriovenousmalformations. Surg Neurol 2005;63:156-61; discussion 161.

  2. Wallace RC, Bourekas EC. Brain arteriovenous malformations.Neuroimaging Clin N Am 1998;8:383-99.

  3. Kubalek R, Moghtaderi A, Klisch J, Berlis A, Quiske A,Schumacher M. Cerebral arteriovenous malformations: influenceof angioarchitecture on bleeding risk. Acta Neurochir (Wien)2003;145:1045-52; discussion 1052.

  4. Todaka T, Hamada J, Kai Y, Morioka M, Ushio Y. Analysis ofmean transit time of contrast medium in ruptured andunruptured arteriovenous malformations: a digital subtractionangiographic study. Stroke 2003;34:2410-4.

  5. Spetzler RF, Martin NA. A proposed grading system forarteriovenous malformations. J Neurosurg 1986;65:476-83.

  6. Lawton MT. Spetzler-Martin Grade III arteriovenousmalformations: surgical results and a modification of the gradingscale. Neurosurgery 2003;52:740-748; discussion 748-9.

  7. De Oliveira E, Tedeschi H, Raso J. Comprehensive managementof arteriovenous malformations. Neurol Res 1998;20:673-83.

  8. Krivoshapkin AL, Melidy EG. Microsurgery for cerebralarteriovenous malformation management: a siberian expe-rience. Neurosurg Rev 2005;28:124-30.

  9. Morgan MK, Rochford AM, Tsahtsarlis A, Little N, Faulder KC.Surgical risks associated with the management of grade I andII brain arteriovenous malformations. Neurosurgery 2004;54:832-7; discussion 837-9.

  10. Davis C. Grade IV and V arteriovenous malformations. JNeurosurg 20003;99:440; author reply 440-1.

  11. Dhandapani SS. Grade IV and V arteriovenous malformations.J Neurosurg 2003; 99:438-9.

  12. Ferch RD, Morgan MK. High-grade arteriovenous malformationsand their management. J Clin Neurosci 2002;9:37-40.

  13. Heros RC. Spetzler-Martin grades IV and V arteriovenousmalformations. J Neurosurg 2003;98:1-2.

  14. Hongo K, Koike G, Isobe M, Watabe T, Morota N, Nakagawa H.Surgical resection of cerebral arteriovenous malformationcombined with pre-operative embolisation. J Clin Neurosci2000;7 Suppl 1:88-91.

  15. Soderman M, Andersson T, Karlsson B, Wallace MC, Edner G.Management of patients with brain arteriovenous malformations.Eur J Radiol 2003;46:195-205.

  16. Zhao J, Wang C, Wang S, Li J, Sui D, Zhao Y. Combination ofintraoperative embolization with surgical resection for treatmentof giant cerebral arteriovenous malformation. Chin Med J (Engl)1999;112:273-7.

  17. Kato Y, Sano H, Kanaoka N, Imai F, Katada K, Kanno T. Successfulresection of arteriovenous malformations in eloquent areasdiagnosed by surface anatomy scanning and motor evokedpotential. Neurol Med Chir (Tokyo) 1998;38 Suppl:217-21.

  18. Spetzler RF, Wilson CB, Weinstein P, Mehdorn M, Townsend J,Telles D. Normal perfusion pressure breakthrough theory. ClinNeurosurg 1978;25:651-72.

  19. Yoshimoto T, Kayama T, Suzuki J. Treatment of cerebralarteriovenous malformation. Neurosurg Rev 1986;9:279-85.

  20. Rhoton AL Jr. Operative techniques and instrumentation forneurosurgery. Neurosurgery 2003;53:907-34.

  21. Sugita K. Microsurgical Atlas. Berlin, Springer-Verlag, 1985.

  22. O’Laoire SA. Microsurgical treatment of arteriovenousmalformations in critical areas of the brain. Br J Neurosurg1995;9:347-60.

  23. Sato S, Kodama N, Sasaki T, Matsumoto M, Ishikawa T. Perinidaldilated capillary networks in cerebral arteriovenous mal-formations. Neurosurgery 2004;54:163-8; discussion 168-70.

  24. Hashimoto H, lida J, Hironaka Y, Sakaki T. Surgical managementof cerebral arteriovenous malformations with intraoperative digitalsubtraction angiography. J Clin Neurosci 2000;7 Suppl 1:33-5.

  25. Pietila TA, Stendel R, Jansons J, Schilling A, Koch HC, BrockM. The value of intraoperative angiography for surgical treatmentof cerebral arteriovenous malformations in eloquent brain areas.Acta Neurochir (Wien) 1998;140:1161-5.

  26. Yanaka K, Matsumaru Y, Okazaki M, Noguchi S, Asakawa H,Anno I, et al. Intraoperative angiography in the surgical treatmentof cerebral arteriovenous malformations and fistulas. ActaNeurochir (Wien) 2003;145:377-82; discussion 382-3.

  27. Gaspar L. Radiosurgery for AVMs: evaluating the risks andbenefits. J Neurosurg 1995;83:381-2.

  28. Lasjaunias P, Manelfe C, Terbrugge K, Lopez Ibor L.Endovascular treatment of cerebral arteriovenousmalformations. Neurosurg Rev 1986;9:265-75.

  29. Nataf F, Merienne L, Schlienger M. Radiosurgery for largecerebral arteriovenous malformations. Neurochirurgie2001;47:298-303.

  30. Pollock BE, Gorman DA, Brown PD. Radiosurgery forarteriovenous malformations of the basal ganglia, thalamus,and brainstem. J Neurosurg 2004;100:210-4.

  31. Pollock BE, Meyer FB: Radiosurgery for arteriovenousmalformations. J Neurosurg 2004;101:390-2.

  32. Valavanis A, Yasargil MG. The endovascular treatment of brainarteriovenous malformations. Adv Tech Stand Neurosurg1998;24:131-214.

  33. Heros RC, Korosue K, Diebold PM. Surgical excision of cerebralarteriovenous malformations: late results. Neurosurgery1990;26:570-7; discussion 577-8.

  34. Kiris T, Sencer A, Sahinbas M, Sencer S, Imer M, Izgi N. Surgical results in pediatric Spetzler-Martin grades I-III intracranialarteriovenous malformations. Childs Nerv Syst 2005;21:69-74.

  35. Nussbaum ES, Heros RC, Camarata PJ. Surgical treatment ofintracranial arteriovenous malformations with an analysis of cost-effectiveness. Clin Neurosurg 1995;42:348-69.

  36. Pikus HJ, Beach ML, Harbaugh RE. Microsurgical treatment ofarteriovenous malformations: analysis and comparison withstereotactic radiosurgery. J Neurosurg 1998;88:641-6.

  37. Da Pian R, Pasqualin A, Scienza R. Surgical treatment ofsupratentorial arteriovenous malformations. Minerva Med 1986;77:1175-85.

  38. Hashimoto N. Microsurgery for cerebral arteriovenousmalformations: a dissection technique and its theoreticalimplications. Neurosurgery 2001;48:1278-81.

  39. Stein BM, Solomon RA. Surgical approaches to posterior fossaarteriovenous malformations. Clin Neurosurg 1991;37:353-71.

  40. Stein BM, Wolpert SM. Arteriovenous malformations of the brain.II: Current concepts and treatment. Arch Neurol 1980;37:69-75.

  41. Suzuki J, Onuma T, Kayama T. Surgical treatment of intracranialarteriovenous malformation. Neurol Res 1982;4:191-207.

  42. Yamada S, Brauer F, Dayes L, Yamada S. Surgical techniquesfor arteriovenous malformations in functional areas: focus onthe superior temporal gyrus. Neurol Med Chir (Tokyo) 1998;38Suppl:222-6.

  43. Yamada S, Brauer FS, Knierim DS. Direct approach toarteriovenous malformations in functional areas of the cerebralhemisphere. J Neurosurg 1990;72:418-25.

  44. Yasargil MG, Jain KK, Antic J, Laciga R. Arteriovenousmalformations of the splenium of the corpus callosum:microsurgical treatment. Surg Neurol 1976;5:5-14.

  45. Yasargil MG, Jain KK, Antic J, Laciga R, Kletter G. Arteriovenousmalformations of the anterior and the middle portions of thecorpus callosum: microsurgical treatment. Surg Neurol1976;5:67-80.




2020     |     www.medigraphic.com