Vascular-AVMRetrospective analysis of the surgically treated temporal lobe arteriovenous malformations with focus on the visual field defects and epilepsy
Introduction
Temporal lobe AVMs account for 12% to 16% of intracranial AVMs [1], [2], [8], [13]. Common clinical symptoms of the temporal lobe AVM are visual field deficits due to the hemorrhage and seizure. From the retrospective analysis of surgically treated temporal lobe AVMs, we will discuss the surgical effects on the temporal lobe AVM with focus on the visual field deficits and seizure.
Section snippets
Materials and methods
Between 1981 and 2004, we experienced 294 cases of intracranial AVMs at the Department of Neurosurgery, Kyushu University Graduate School of Medical Sciences and the Department of Neurosurgery, Aso Iizuka Hospital. Among the 294 cases, 45 were located in the temporal lobe. The microsurgical excisions of the AVMs were performed in 26 cases: 22 cases with ruptured AVMs and 4 nonruptured cases presented by epilepsy. Surgical indication was limited to symptomatic patients with Spetzler and Martin
Results
The incidence of the temporal lobe AVM in our series was 15.3% (45/294) of all intracranial AVMs. Twenty-six patients underwent surgical excision of the temporal lobe AVMs (Table 1). The male-female ratio was 15:11. The mean age was 34.2 years, ranging from 7 to 63 years. The AVM locations were classified as polar in 1, dorsal in 2, laterobasal in 15 (2 anterior and 13 posterior), and mediobasal in 8 (4 anterior and 4 posterior). The initial symptoms for the diagnosis were hemorrhage in 22
Case 16
A 25-year-old woman suddenly had seizure with loss of consciousness for the first time. A couple of days later, she visited a nearby hospital. Brain CT showed a small hematoma in the left temporal lobe. She did not show any neurological deficits. Cerebral angiography revealed a left temporal lobe AVM of less than 3 cm in diameter (Fig. 1A and B). She planed to undergo radiosurgery after the embolization. She was hospitalized in the Department of Interventional Neuroradiology for the
Discussion
Temporal lobe AVM accounts for 12% to 16% of intracranial AVMs [1], [2], [8], [13]. In our series, it was 15.3%. Seizures have been reported to be more common presenting symptoms of temporal lobe AVM patients, occurring in 46% of patients, compared with the incidence of 24% in nontemporal AVM patients [8]. In our series, history of epilepsy was obtained in 14 (31.1%) of 45 cases. The incidence of epilepsy as an initial symptom at diagnosis was 7 (15.6%). About half of the nonruptured temporal
Conclusion
Improvement of visual field deficit due to hematoma is difficult in most cases with ruptured temporal lobe AVM. Deterioration due to the operative procedure should be avoided. Although the outcome of seizure associated with hemorrhage is acceptable, the postoperative intractable seizures can remain after the complete total excision of AVMs particularly in cases with seizure without hemorrhage. Intraoperative ECoG monitoring might be requisite for nonruptured AVM patients with seizure.
References (16)
- et al.
The natural history of unruptured intracranial arteriovenous malformations
J Neurosurg
(1988) Cerebral arteriovenous malformations: considerations for and experience with surgical treatment in 166 cases
Clin Neurosurg
(1979)- et al.
“Tangential” resection of medial temporal lobe arteriovenous malformations with the orbitozygomatic approach
Neurosurgery
(2004) - et al.
Outcome with respect to epileptic seizures
- et al.
Results of multimodality treatment for 141 patients with brain arteriovenous malformations and seizures: factors associated with seizure incidence and seizure outcomes
Neurosurgery
(2002) - et al.
Emergency craniotomy for intraparenchymal massive hematoma after embolization of supratentorial arteriovenous malformations
Neurosurgery
(2003) - et al.
Complications of complete surgical resection of AVMs of the brain
- et al.
Temporal lobe arteriovenous malformations: surgical management and outcome
Surg Neurol
(1996)