Surgical Techniques for Arteriovenous Malformations in Functional Areas: Focus on the Superior Temporal Gyrus

概要

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Direct surgical intervention of arteriorvenous malformations (AVMs) in functional areas has been ac-cepted as a standard mode of treatment. However, safe and successful intervention requires that such factors as exact location, size, vascular supply, and drainage be considered. Importantly, surgical tech-niques must be individualized to each patient, based on hemodynamic anatomy of the AVM. This paper discusses AVMs in the superior temporal lobe, which have a complex neuronal anatomy and circulato-ry system; the authors present 22 patients with AVMs of various sizes and describe the surgical tech-niques specific for the indicated location. Surgical procedures adhered to the following principles: 1) avoid brain tissue removal; 2) preserve microcirculation; 3) maintain circulation of the isolated major draining vein to access the AVM core; 4) compartmental isolation; and 5) preservation of functional area cortex covering the AVM. All patients underwent total resection except one, who had a subtotal resection. Neurological and occupational recovery was remarkable except for partial hemianesthesia in one patient; two patients are still in rehabilitation. This is the first description of a direct surgical ap-proach to AVMs in the superior temporal gyrus, where management is challenging because the lesions may extend elsewhere, such as to Brocas and Wernickes areas. The results suggest that the procedure is promising.