51. 脳動静脈奇形の治療結果と摘出困難な脳動静脈奇形へのアプローチ

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The therapeutic results of our 104 cases of cerebral arteriovenous malformation (AVM) during an 18-year period were reported. At the first admission, 73 patients were operated on and 21 were treated conservatively. One patient died immediately without surgery.<BR>Four of the 21 conservatively treated patients were readmitted for rebleeding and one of them died. The three others were successfully treated by a total removal, silicone-ball embolization and carotid ligation, respectively. The latter patient died latter at the third admission due to repeated bleeding.<BR>Fifty of the 73 operated AVMs were doing well by successful total removal of the AVMs, and three AVMs could be totally removed at the second admission for rebleeding after previous palliative surgery. As the AVMs were thought to be large with a high shunt flow, staged operations were performed in the three cases. One of two cases with partial ligation of the feeding arteries resulted in repeated bleeding after the surgery and the other died of rebleeding.<BR>Fatal cases after direct surgery were restricted to large, deep-seated medial parietooccipital AVMs, which could not be managed without severe difficulties because they had multiple blood supplies from the anterior, middle and posterior cerebral circulation. These AVMs need preoperative, deliberative discussion.<BR>For five AVMs that were larger or difficult to reach and resect, we app lied with good result silicone-ball embolization in two, alon alpha embolization in one and fibrinogen-thrombin chemical thrombolizations in two. These patients are doing well with no rebleeding. The carotid artery or feeding artery ligation method is not recommended from our experiences with cases of rebleeding.
The Japanese Society on Surgery for Cerebral Strokeの論文

51. 脳動静脈奇形の治療結果と摘出困難な脳動静脈奇形へのアプローチ

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