49. 全摘出困難なAVMの外科的治療
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In has been believed for a long time that total nidus removal is the best method of surgical treatment for intracranial arteriovenous malformation. Ordinary procedures are as follows : first, clipping of the feeding arteries, then nidus stripping and finally cutting off the draining veins. So that operative brain damage was significant, and this was one reason to avoid total removal of deepseated arteriovenous malformations. There have been many cases of this disorder in which total extirpation is difficult, and they have been dealt with by feeder clipping, often in vain. We suppose that the main aim of arteriovenous malformation surgery should be changed to draining vein obstruction. For this purpose it is neccessary to use a different route of invasion and/or divided operation, serial CAG during the operation and bipolar coagulation of nidus vessels. After many experiences, we knew that when serial CAG showed no visualization of the nidus, it became possible to obstruct the main draining vein. If all drainers were obstructed and revealed any abnormal bulging or hemorrhage from the nidus, they might be rendered harmless by thrombosis in a short time. Thus, nidus stripping is of no use.<BR>Practically, at first, every feeding artery and draining vein except the main drainer are obstructed. Then, the main drainer can be temporarily clipped when the nidus is invisible by serial CAG. After observation of the nidus for about 30 minutes for abnormal local bulging or hemorrhage, permanent obstruction of the main drainer is performed. This is the entire procedure.<BR>If residual arteriovenous malformation is revealed postoperatively, the second operation must be planned in the same way, and usually almost all nidus vessels are thrombosed and treatment is quite easy, according to our experiences. We have successfully treated many cases of arteriovenous malformation by this method and believe in its usefulness.
- The Japanese Society on Surgery for Cerebral Strokeの論文
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- 49. 全摘出困難なAVMの外科的治療
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