Skip to main content
Erschienen in: Neurosurgical Review 2/2005

01.04.2005 | Original Article

Microsurgery for cerebral arteriovenous malformation management: a Siberian experience

verfasst von: Alexei L. Krivoshapkin, Evstafy G. Melidy

Erschienen in: Neurosurgical Review | Ausgabe 2/2005

Einloggen, um Zugang zu erhalten

Abstract

Cerebral vascular malformations remain among the most difficult neurosurgical entities to treat. We report a retrospective study of the outcome in 95 consecutive patients with angiographically revealed arteriovenous malformations (AVMs). Fifty-four patients underwent microsurgical total AVM removal (group I). Forty-one patients who refused open surgery (group II) were managed either by endovascular embolisation (16 cases), radiosurgery (three) or followed up with medical treatment for their symptoms. In the first group pretreatment with the non-selective β-blocker propranolol before surgery, the current neuronavigation techniques, intraoperative embolisation and AVM nidus colouring in high flow AVM were used for total microsurgical excision of the lesions. All AVM patients but one survived microsurgery. The mortality rate was 1.8% for group I. Six patients with grade IV–V AVM developed new temporal neurological symptoms following surgery. Four of them recovered completely in 3–6 weeks; two patients remained with mild persistent monoparesis and with homonymous hemianopsia postoperatively. In ten of 13 epileptic patients surgery produced a cure. No patient re-bled following surgery. No postoperative normal perfusion pressure breakthrough occurred. In the second group ten patients (24%) developed intracerebral haemorrhages, six of ten patients demonstrated progressive seizures. The mortality rate in group II totalled 17% over 6 years. Microsurgical management approaches must consider preoperative correction of impaired cerebral autoregulation, neuronavigation for preoperative planning and intraoperative orientation, intraoperative embolisation and dying of the nidus for large high-flow AVMs.
Literatur
1.
Zurück zum Zitat Al-Rhodan N, Sundt T, Piepgras D, Nichols D, Rufenacht D, Stevens L (1993) Occlusive hyperaemia: a theory for the haemodynamic complications following resection of intracerebral arteriovenous malformations. J Neurosurg 78:167–175 Al-Rhodan N, Sundt T, Piepgras D, Nichols D, Rufenacht D, Stevens L (1993) Occlusive hyperaemia: a theory for the haemodynamic complications following resection of intracerebral arteriovenous malformations. J Neurosurg 78:167–175
2.
Zurück zum Zitat Barrow DL (1999) Surgical management of arteriovenous malformations of the brain. In: Tindall GT, Cooper PR, Barrow DL (eds) The practice of neurosurgery, vol II. Williams & Wilkins, Baltimore, pp 2173–2210 Barrow DL (1999) Surgical management of arteriovenous malformations of the brain. In: Tindall GT, Cooper PR, Barrow DL (eds) The practice of neurosurgery, vol II. Williams & Wilkins, Baltimore, pp 2173–2210
3.
Zurück zum Zitat Bishop CCR, Powell S, Rutt D, Browse NL (1986) Transcranial Doppler measurement of middle cerebral artery blood flow velocity: a validation study. Stroke 17:913–915 Bishop CCR, Powell S, Rutt D, Browse NL (1986) Transcranial Doppler measurement of middle cerebral artery blood flow velocity: a validation study. Stroke 17:913–915
4.
Zurück zum Zitat Deruty R, Pelissou Guyotat I, Amat D, Mottolese C, Bascoulergue Y, Turjman F, Gerard JP (1996) Complications after multidisciplinary treatment of cerebral arteriovenous malformations. Acta Neurochir 138:119–131 Deruty R, Pelissou Guyotat I, Amat D, Mottolese C, Bascoulergue Y, Turjman F, Gerard JP (1996) Complications after multidisciplinary treatment of cerebral arteriovenous malformations. Acta Neurochir 138:119–131
5.
Zurück zum Zitat Eldridge PR (1996) Image directed surgery. In: Palmer JD (ed) Neurosurgery 96. Manual of neurosurgery. Churchill Livingstone, New York, pp 166–171 Eldridge PR (1996) Image directed surgery. In: Palmer JD (ed) Neurosurgery 96. Manual of neurosurgery. Churchill Livingstone, New York, pp 166–171
6.
Zurück zum Zitat Fabrikant JI, Levy RP, Steinberg GK (1992) Charged-particle radiosurgery for intracranial vascular malformations. Neurosurg Clin N Am 3:99–139 Fabrikant JI, Levy RP, Steinberg GK (1992) Charged-particle radiosurgery for intracranial vascular malformations. Neurosurg Clin N Am 3:99–139
7.
Zurück zum Zitat Fisher WS (1995) Therapy of AVMs: a decision analysis. Clin Neurosurg 42:294–312 Fisher WS (1995) Therapy of AVMs: a decision analysis. Clin Neurosurg 42:294–312
8.
Zurück zum Zitat Giller CA (1991) A bedside test for cerebral autoregulation using transcranial Doppler ultrasound. Acta Neurochir 108:7–14 Giller CA (1991) A bedside test for cerebral autoregulation using transcranial Doppler ultrasound. Acta Neurochir 108:7–14
9.
Zurück zum Zitat Greenberg MS (1994) Vascular malformations. In: Handbook of neurosurgery, 3rd edn. Greenberg Graphics, Lakeland, Fla, pp 753–761 Greenberg MS (1994) Vascular malformations. In: Handbook of neurosurgery, 3rd edn. Greenberg Graphics, Lakeland, Fla, pp 753–761
10.
Zurück zum Zitat Hamilton MG, Spetzler RF (1994) The prospective application of a grading system for arteriovenous malformations. Neurosurgery 34:2–7 Hamilton MG, Spetzler RF (1994) The prospective application of a grading system for arteriovenous malformations. Neurosurgery 34:2–7
11.
Zurück zum Zitat Holland MC, Holland EC, Martin NA (1999) Clinical presentation and diagnostic evaluation of intracranial arteriovenous malformations. In: Tindall GT, Cooper PR, Barrow DL (eds) The practice of neurosurgery, vol. II. Williams & Wilkins, Baltimore, pp 2155–2171 Holland MC, Holland EC, Martin NA (1999) Clinical presentation and diagnostic evaluation of intracranial arteriovenous malformations. In: Tindall GT, Cooper PR, Barrow DL (eds) The practice of neurosurgery, vol. II. Williams & Wilkins, Baltimore, pp 2155–2171
12.
Zurück zum Zitat Humphreys RP (1995) Surgical management of arteriovenous malformations in children. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques. Indications, methods and results. Saunders, Philadelphia, pp 1197–1203 Humphreys RP (1995) Surgical management of arteriovenous malformations in children. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques. Indications, methods and results. Saunders, Philadelphia, pp 1197–1203
13.
Zurück zum Zitat Irikura K, Morri S, Miyasaka Y, Yamada M, Tokiwa K, Yada K (1996) Impaired autoregulation in an experimental model of chronic cerebral hypoperfusion in rats. Stroke 27:1399–1404 Irikura K, Morri S, Miyasaka Y, Yamada M, Tokiwa K, Yada K (1996) Impaired autoregulation in an experimental model of chronic cerebral hypoperfusion in rats. Stroke 27:1399–1404
14.
Zurück zum Zitat Kelly PJ (1999) Stereotactic craniotomy. In: Tindall GT, Cooper PR, Barrow DL (eds) The practice of neurosurgery, vol. III. Williams & Wilkins, Baltimore, pp 3193–3212 Kelly PJ (1999) Stereotactic craniotomy. In: Tindall GT, Cooper PR, Barrow DL (eds) The practice of neurosurgery, vol. III. Williams & Wilkins, Baltimore, pp 3193–3212
15.
Zurück zum Zitat Kjellberg RN, Manchola IF, De-Salles AA, Foo TK, Ackerman RH, Candia GT (1993) Arteriovenous malformation hemodynamics: a transcranial Doppler. Neurosurgery 33:556–562 Kjellberg RN, Manchola IF, De-Salles AA, Foo TK, Ackerman RH, Candia GT (1993) Arteriovenous malformation hemodynamics: a transcranial Doppler. Neurosurgery 33:556–562
16.
Zurück zum Zitat Lobato RD, Perez C, Rivas JJ, et al (1988) Clinical, radiological, and pathological spectrum of angiographically occult intracranial vascular malformations. Analysis of 21 cases and review of the literature. J Neurosurg 68:518–531 Lobato RD, Perez C, Rivas JJ, et al (1988) Clinical, radiological, and pathological spectrum of angiographically occult intracranial vascular malformations. Analysis of 21 cases and review of the literature. J Neurosurg 68:518–531
17.
Zurück zum Zitat Luessenhop AJ, Rosa L (1984) Cerebral arteriovenous malformations: indications for and results of surgery, and the role of intravascular techniques. J Neurosurg 60:14–22 Luessenhop AJ, Rosa L (1984) Cerebral arteriovenous malformations: indications for and results of surgery, and the role of intravascular techniques. J Neurosurg 60:14–22
18.
Zurück zum Zitat Morgan MK, Sundt TM Jr (1989) The case against staged operative resection of cerebral arteriovenous malformations. Neurosurgery 25:429–436 Morgan MK, Sundt TM Jr (1989) The case against staged operative resection of cerebral arteriovenous malformations. Neurosurgery 25:429–436
19.
Zurück zum Zitat Nussbaum ES, Heros RC, Camarata PJ (1995) Surgical treatment of intracranial arteriovenous malformations with an analysis of cost-effectiveness. Clin Neurosurg 42:348–369 Nussbaum ES, Heros RC, Camarata PJ (1995) Surgical treatment of intracranial arteriovenous malformations with an analysis of cost-effectiveness. Clin Neurosurg 42:348–369
20.
Zurück zum Zitat Ojemann RG, Crowell RM, Ogilvy CS (1995) Surgical management of cavernous angiomas of the nervous system. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques. Indications, methods and results. Saunders, Philadelphia, pp 1183–1196 Ojemann RG, Crowell RM, Ogilvy CS (1995) Surgical management of cavernous angiomas of the nervous system. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques. Indications, methods and results. Saunders, Philadelphia, pp 1183–1196
21.
Zurück zum Zitat Pasqualin D, Scienza R, Cioffi F (1991) Treatment of cerebral arteriovenous malformations with a combination of preoperative embolization and surgery. Neurosurgery 29:358–368 Pasqualin D, Scienza R, Cioffi F (1991) Treatment of cerebral arteriovenous malformations with a combination of preoperative embolization and surgery. Neurosurgery 29:358–368
22.
Zurück zum Zitat Patterson RH (1995) Surgical management of arteriovenous malformations of the brain. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques. Indications, methods and results. Saunders, Philadelphia, pp 1177–1182 Patterson RH (1995) Surgical management of arteriovenous malformations of the brain. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques. Indications, methods and results. Saunders, Philadelphia, pp 1177–1182
23.
Zurück zum Zitat Pertuiset B, Ancri D, Artuis F (1985) Shunt induced hemodynamic disturbances in supratentorial arteriovenous malformations. J Neuroradiol 12:165–178 Pertuiset B, Ancri D, Artuis F (1985) Shunt induced hemodynamic disturbances in supratentorial arteriovenous malformations. J Neuroradiol 12:165–178
24.
Zurück zum Zitat Pikus HJ, Beach ML, Harbaugh RE (1998) Microsurgical treatment of arteriovenous malformations: analysis and comparison with stereotactic radiosurgery. J Neurosurg 88:641–646 Pikus HJ, Beach ML, Harbaugh RE (1998) Microsurgical treatment of arteriovenous malformations: analysis and comparison with stereotactic radiosurgery. J Neurosurg 88:641–646
25.
Zurück zum Zitat Purdy PD, Batjer HH, Samson DS (1999) Intracranial arteriovenous malformation endovascular treatment. In: Tindall GT, Cooper PR, Barrow DL (eds) The practice of neurosurgery, vol. II. Williams & Wilkins, Baltimore, pp 2261–2270 Purdy PD, Batjer HH, Samson DS (1999) Intracranial arteriovenous malformation endovascular treatment. In: Tindall GT, Cooper PR, Barrow DL (eds) The practice of neurosurgery, vol. II. Williams & Wilkins, Baltimore, pp 2261–2270
26.
Zurück zum Zitat Ratnatunga C, Adiseshiah M (1990) Increase in middle cerebral artery velocity on breath holding: a simplified test of cerebral perfusion reserve. Eur J Vasc Surg 4:519–523 Ratnatunga C, Adiseshiah M (1990) Increase in middle cerebral artery velocity on breath holding: a simplified test of cerebral perfusion reserve. Eur J Vasc Surg 4:519–523
27.
Zurück zum Zitat Reichert KW II, Lewis AI, Tew JM Jr (1995) Surgical management of thalamic–basal ganglia vascular malformation. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques. Indications, methods and results, 3rd edn. Saunders, Philadelphia, pp 1501–1521 Reichert KW II, Lewis AI, Tew JM Jr (1995) Surgical management of thalamic–basal ganglia vascular malformation. In: Schmidek HH, Sweet WH (eds) Operative neurosurgical techniques. Indications, methods and results, 3rd edn. Saunders, Philadelphia, pp 1501–1521
28.
Zurück zum Zitat Ringelstein EB, Sievers C, Ecker S, Schneider PA, Otis SM (1988) Noninvasive assessment of CO2-induced cerebral vasomotor response in normal individuals and patients with internal carotid artery occlusion. Stroke 19:963–969 Ringelstein EB, Sievers C, Ecker S, Schneider PA, Otis SM (1988) Noninvasive assessment of CO2-induced cerebral vasomotor response in normal individuals and patients with internal carotid artery occlusion. Stroke 19:963–969
29.
Zurück zum Zitat Samson D, Ditmore QM, Beyer CW Jr (1981) Intravascular use of isobutyl-2-cyanoacrylate. I. Treatment of intracranial arteriovenous malformations. Neurosurgery 8:43–51 Samson D, Ditmore QM, Beyer CW Jr (1981) Intravascular use of isobutyl-2-cyanoacrylate. I. Treatment of intracranial arteriovenous malformations. Neurosurgery 8:43–51
30.
Zurück zum Zitat Sekhon LHS, Mrgan MK, Spence I (1997) Normal perfusion pressure breakthrough: the role of capillaries. J Neurosurg 86:519–524 Sekhon LHS, Mrgan MK, Spence I (1997) Normal perfusion pressure breakthrough: the role of capillaries. J Neurosurg 86:519–524
31.
Zurück zum Zitat Spetzler RF, Martin NA (1986) Proposed grading system for arteriovenous malformations. J Neurosurg 65:476–483PubMed Spetzler RF, Martin NA (1986) Proposed grading system for arteriovenous malformations. J Neurosurg 65:476–483PubMed
32.
Zurück zum Zitat Spetzler RF, Wilson CB, Weinstein P, et al (1978) Normal perfusion pressure breakthrough theory. Clin Neurosurg 25:651–672 Spetzler RF, Wilson CB, Weinstein P, et al (1978) Normal perfusion pressure breakthrough theory. Clin Neurosurg 25:651–672
33.
Zurück zum Zitat Spetzler RF, Martin NA, Carter LP (1987) Surgical management of AVMs by staged embolization and operative excision. J Neurosurg 67:17–28 Spetzler RF, Martin NA, Carter LP (1987) Surgical management of AVMs by staged embolization and operative excision. J Neurosurg 67:17–28
34.
Zurück zum Zitat Spetzger U, Krombach G, Reinges MT, Gilsbach JM, Schmidt T (1997) Navigational microneurosurgery: experience with the EasyGuide Neuro. Medica Mundi 48:28–33 Spetzger U, Krombach G, Reinges MT, Gilsbach JM, Schmidt T (1997) Navigational microneurosurgery: experience with the EasyGuide Neuro. Medica Mundi 48:28–33
35.
Zurück zum Zitat Steinberg GK, Chang SD, Levy RP, Marks MP, Frankel K, Marcellus M (1996) Surgical resection of large incompletely treated intracranial arteriovenous malformations following stereotactic radiosurgery. J Neurosurg 84:920–928 Steinberg GK, Chang SD, Levy RP, Marks MP, Frankel K, Marcellus M (1996) Surgical resection of large incompletely treated intracranial arteriovenous malformations following stereotactic radiosurgery. J Neurosurg 84:920–928
36.
Zurück zum Zitat Vinuela F, Dion JE, Duckwiler G, et al (1991) Combined endovascular embolization and surgery in the management of cerebral arteriovenous malformations: experience with 101 cases. J Neurosurg 75:856–864 Vinuela F, Dion JE, Duckwiler G, et al (1991) Combined endovascular embolization and surgery in the management of cerebral arteriovenous malformations: experience with 101 cases. J Neurosurg 75:856–864
37.
Zurück zum Zitat Yamamoto Y, Coffey RJ, Nichols DA, Shaw EG (1995) Interim report on the radiosurgical treatment of cerebral arteriovenous malformations. The influence of size, dose, time, and technical factors on obliteration rate. J Neurosurg 83:832–837 Yamamoto Y, Coffey RJ, Nichols DA, Shaw EG (1995) Interim report on the radiosurgical treatment of cerebral arteriovenous malformations. The influence of size, dose, time, and technical factors on obliteration rate. J Neurosurg 83:832–837
38.
Zurück zum Zitat Yamamoto M, Jimbo M, Hara M, Saito I, Mori K (1996) Gamma knife radiosurgery for arteriovenous malformations: long-term follow-up results focusing on complications occurring more than 5 years after irradiation. Neurosurgery 38:906–914 Yamamoto M, Jimbo M, Hara M, Saito I, Mori K (1996) Gamma knife radiosurgery for arteriovenous malformations: long-term follow-up results focusing on complications occurring more than 5 years after irradiation. Neurosurgery 38:906–914
39.
Zurück zum Zitat Young WL, Kader A, Prohovnik I, Ornstein E, Fleischer LH, Ostapkovich N, Jackson LD, Stein BM (1993) Neurosurgery 32:491–496 Young WL, Kader A, Prohovnik I, Ornstein E, Fleischer LH, Ostapkovich N, Jackson LD, Stein BM (1993) Neurosurgery 32:491–496
40.
Zurück zum Zitat Zhao JZ, Wang C, Wang S, Li JS, Sui DL, Zhao YL (1999) Combination of intraoperative embolization with surgical resection for treatment of giant cerebral arteriovenous malformation. Chin Med J 112:273–277 Zhao JZ, Wang C, Wang S, Li JS, Sui DL, Zhao YL (1999) Combination of intraoperative embolization with surgical resection for treatment of giant cerebral arteriovenous malformation. Chin Med J 112:273–277
Metadaten
Titel
Microsurgery for cerebral arteriovenous malformation management: a Siberian experience
verfasst von
Alexei L. Krivoshapkin
Evstafy G. Melidy
Publikationsdatum
01.04.2005
Erschienen in
Neurosurgical Review / Ausgabe 2/2005
Print ISSN: 0344-5607
Elektronische ISSN: 1437-2320
DOI
https://doi.org/10.1007/s10143-004-0375-0

Weitere Artikel der Ausgabe 2/2005

Neurosurgical Review 2/2005 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.