실비안 열 뇌동정맥 기형에 대한 일차적인 수술적 치료의 결과

Abstract

Objects Arteriovenous malformations that involve the sylvian fissure are difficult to remove surgically. Many surgeons label this AVMs inoperable, because the branches of the MCA are areteries of passage and the margins between the AVM and insular cortex may be ill defined. The authors reviewed their surgical experience with 12 patients having insular AVMs to determine the incidence of operative morbidity. Patients and Methods Nine patients(75%) of all twelve patients were diagnosed as sylvian AVMs by radiologic findings(brain CT and MRI and angiography), and three(25%) by intraopertive biopsy findings. Seven patients experienced intracerebral hemorrhage(58%), three(25%) had seizures, and four(33%) had headaches. Preoperatively, four patients(33%) were normal neurologically and eight patients(66%) had neurological deficits. Six (50%) of twelve sylvian AVMs were located in the dominant hemisphere. The size of the nidus ranged from 1 to 27㎤. Results Complete removal of the AVM was documented by postoperative angiography in every case. Seizures were reduced or eliminated and headaches were relieved in all affected patients. within 3 month, all patients were functioning independently with no new neurological deficits. All eight patients who had had preoperative neurological deficits improved postoperatively. Conclusions With low postoperative morbidity, the outcome was excellent in all patients. the authors thus recommend microsurgery as the primary treatment for sylvian AVMs.