57. 段階的 feeder clipping を意図した摘出困難な optico-chiasmal, hypothalamic AVM

概要

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A case of optico-chiasmal, hypothalamic arteriovenous malformation (AVM) operated on with feeder clipping was reported. <BR>Case: A 21-year-old male with an attack of subarachnoid hemorrhage was admitted to our clinic on August 28, 1983. Neuroradiological examinations disclosed AVM at the suprasellar and hypothalamic regions. Superselective angiography using a micro-balloon-catheter clearly showed fine feeding arteries arising from the bilateral internal carotid artery and the right posterior communicating artery. The first feeder clipping was performed one month later. Operative findings were optico-chiasmal, hypothalamic AVM. Postoperative angiography showed decreased blood supply from the ICA, but increased blood supply from the posterior circulation. Although the postoperative course was uneventful, the second feeder clipping will be performed against the feeders from the posterior circulation. <BR>Feeder clipping is often elected as the alternative treatment for AVM that is not amenable to direct excision. Graded feeder clipping may be a better procedure than one-step clipping because of its safety and effectiveness in reducing the blood supply to the lesion. <BR>Superselective angiography using a micro-balloon-catheter is quite useful not only for determining the feeding arteries precisely, but also for evaluating the hemodynamics of AVMs.
The Japanese Society on Surgery for Cerebral Strokeの論文