脳循環動態よりみた脳動静脈奇形の手術適応

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The cerebral hemodynamic study was performed in 45 cases with the arteriovenous malformation (AVM) of the brain before and after the operation. The volume of the AVM, the relative shunt rate through the AVM and the regional cerebral blood flow values (rCBF values) were measured and the hemodynamic results were compared with clinical and radiological findings. Based on our study, the indication for surgical treatment of the AVM was discussed.<BR>The examination before the operation was carried out in all cases. No correlations between rCBF values and volume of the AVM were found except in the special cases which had hyperemic foci near the very large AVM. In cases with abnomally low rCBF values, various neurological deficits were frequently noticed and the intracerebral hematoma and the internal hydrocephalus were also frequently combined with. Furthermore, such neurological deficits and neuroradiological abnormality were occurred after the episode of the bleeding from the AVM. In cases with normal rCBF values, almost all cases had not any neurological deficits and showed normal radiological figures.<BR>The study after the total removal of the AVM were performed in 18 cases. In 5 out of 6 cases which were examined within 4 weeks after the operation, rCBF value swere abnormally low. However, in those whichwere studied after 4 weeks or more since the operation, rCBF values signified the hemodynamic correlation between before and after the operation, patients with normal rCBF values maintained their values after the operation, while those with abnormally low rCBF values showed abnormally low levels even 3 months after the operation.<BR>These facts indicated that the circulatory disturbance in patients with the AVM was due to the presence of the intracerebral hematoma or the internal hydrocephalus following subarachnoid hemorrhage from the lesion and if it had occurred, the recovery of the circulatory condition delayed after the operation. From these hemodynamic results, we concluded that the purpose of surgical treatment for the AVM is to prevent the bleeding from the AVM which may cause the circulatory disturbance. Furthermore, it is not possible to clinically detect wherether the hemorrhage from the AVM have occurred or not at present. therefore, surgical treatment should be considered in all cases with the AVM of the brain.<BR>But in practical standpoints, surgical treatment can be justified only when the operation is safe enough not to cause further neurological deterioration.
The Japanese Society on Surgery for Cerebral Strokeの論文

脳循環動態よりみた脳動静脈奇形の手術適応

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