Elsevier

Surgical Neurology

Volume 66, Issue 1, July 2006, Pages 50-55
Surgical Neurology

Vascular-AVM
Retrospective analysis of the surgically treated temporal lobe arteriovenous malformations with focus on the visual field defects and epilepsy

https://doi.org/10.1016/j.surneu.2005.12.017Get rights and content

Abstract

Background

Authors investigate the surgical outcomes of the temporal lobe arteriovenous malformation (AVM) with focus on the visual field deficit and seizure.

Methods

Between 1981 and 2004, we experienced 294 cases of intracranial AVMs. Among the 294 cases, 45 (15.3%) were located in the temporal lobe. Twenty-six of the 45 cases underwent microsurgical excisions of the AVMs.

Results

The male-female ratio of 26 surgically treated temporal lobe AVMs was 15:11. The mean age was 34.2 years, ranging from 7 to 63 years. The sites of lesion were classified as polar in 1, dorsal in 2, laterobasal in 15, and mediobasal in 8. The initial symptoms were hemorrhage in 22 and epilepsy in 4 cases. Arteriovenous malformations were totally removed in all 26 patients and there was no surgical mortality. The visual field deficits were identified in 17 of 22 patients with hemorrhage. Massive hematoma cases that needed emergency operation were 5. Visual field deficits improved in only 2 of the 5 patients after surgery. Among the 7 quadrantanopia patients, 3 resulted in hemianopia after surgery. Seven of 22 hemorrhage patients had history of epilepsy. Although one patient had new postoperative epilepsy, the medical controls of the seizure were good in all 8 patients. Four patients underwent AVM excision for epilepsy without hemorrhage. In two patients, seizures disappeared after surgery. The other two patients had typical psychomotor seizures after the total excision of AVMs.

Conclusions

Improvement of visual field deficit due to hematoma was difficult in most cases. Emergency craniotomy for global neurological deterioration due to massive hematoma had improved the visual field deficit in two cases. Although the outcome of seizure associated with hemorrhage was acceptable, the postoperative intractable seizures would remain in cases with epilepsy without hemorrhage. Intraoperative electrocorticography might be requisite for nonruptured temporal lobe AVM cases with 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.

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