Surgical treatment of arteriovenous malformations of the striatothalamocapsular region

Abstract

Sixteen patients with arteriovenous malformations (AVM's) located in the striatothalamocapsular region were treated microsurgically at the Hau Shan Hospital, Shanghai. These AVM's had a tendency to bleed intracerebrally and typically presented with hemiplegia, hemianesthesia, and hemianopsia. Angiographically the lesions were primarily located in the triangle of Reil. Postoperative outcome was not as good as that of AVM's in other locations, but the operation may have prevented the risk of further hemorrhage. This report details the operative technique used and the clinical course in this group of patients.

Gamma Knife Radiosurgery in the Management of Arteriovenous Malformations of the Basal Ganglia Region of the Brain

“…These problems may present serious obstacles to complete microsurgical excision in a single operation, so that a second operation is required for radical surgical removal in 17 ± 25 % of reported cases [5,8,9]. The angioma remnant leaves operated patients with a continuing risk of post-microsurgical bleeding/rebleeding, an occurrence which is reported in 4.5 % ± 12.5 % of cases [5,8,12,13]. Finally, clinical series published in the last 5 years report permanent morbidity and post-operative mortality rates of 11 % ± 31 % and 3 % ± 5.5 %, respectively [1,4,5,11].…”

“…Due to the greater frequency of haemorrhages, patients with BGAVMs present serious clinical and neurological conditions before treatment (in 58.3 % ± 77.3 % of cases) [1,11,28] much more often than patients with AVMs in other areas of the brain (44.9 %) [30]. However, a higher probability of improvement in neurological deficits is also reported for treated BGAVMs (35.7 % ± 75 %) [1,3,5,9,12,28], irrespective of the combination of therapies used, compared with clinical series of AVMs in other locations (18.2 % ± 37 %) [18,30,33,56,68]. In our study, 46 % of patients with BGAVMs showed neurological improvement at the latest clinical examination, compared with only 14 % of those with cortical AVMs ( Table 5).…”

“…Decidedly encouraging results were reported in a few selected cases of angiomas superficially located on the head of the caudate nucleus-thalamus, adjacent to the ventricular system [13, 22 ± 24], or else laterally in the region of the insula, adjacent to the sylvian cistern [25]. However, it is not always possible to achieve radical excision of AVMs with microsurgery; angiography shows remnants of angiomas in 3 % ± 18 % of cases [1,5,8,13], with a consequent risk of post-microsurgical bleeding documented in 4.5 % ± 12.5 % of operated patients [5,8,12,13]. Furthermore, the rates of permanent morbidity and post-operative mortality (12.5 % ± 27 % and 6 % ± 12.5 %, respectively) are by no means negligible [8,9,12,13], even in recently published studies, which report permanent sequelae in 11 % ± 31 % of cases [1,4,5,11].…”

Retinocephalic vascular malformation: case report

“…9± 11 Most of the reports of successful surgical treatment of lesions in the striothalamocapsular areas have been of small AVMs and almost all of these patients presented with intracerebral or intraventricular haemorrhage. 10,11 Moreover, as suggested by Solomon and Stein the natural history of lesions in this area is not known 10 . A conservative`wait and watch' attitude was adopted in our patient because of (a) large size, (b) location in a critical area, (c) the patient was well preserved neurologically (the blindness could not have been reversed by intervention) and (d) the natural history of AVMs in this location is unknown.…”

Cerebral Arteriovenous Malformations

“…Other surgeons have been more aggressive with these thalamic and basal ganglia parenchymal lesions, and good results have been reported frequently. 70,103,108,121,124…”