Microsurgery for 67 intracranial arteriovenous malformations less than 3 cm in diameter

View More View Less
  • 1 The Neurological Institute, Columbia-Presbyterian Medical Center, New York, New York
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

✓ The surgical outcome in a series of small arteriovenous malformations (AVM's) that might have been considered optimal for radiosurgery is reviewed. In a total microsurgical series of 360 patients, 67 (19%) underwent resection of AVM's less than 3 cm in largest diameter, regardless of location. Many of these lesions (45%) were in locations that might be considered surgically inaccessible such as the thalamus, brain stem, medial hemisphere, and paraventricular regions. Complete angiographic obliteration of the AVM by microsurgical technique was accomplished in 63 patients (94%) with a surgical morbidity of 1.5% and no operative mortality. Patients with hemispheric AVM's had a cure rate of 100% and no neurological morbidity. Stereotactically guided craniotomy was used in 14 patients (21%) to locate and resect deep or concealed malformations. The results from five major radiosurgery centers treating similar-sized AVM's are analyzed. The authors' surgical results compare favorably with those from radiosurgery centers which, in their opinion, supports the conclusion that microneurosurgery is superior to radiosurgery, except for a small percentage of lesions that are truly inoperable on the basis of inaccessibility.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address reprint requests to: Michael B. Sisti, M.D., The Neurological Institute, 710 West 168th Street, Room 431, New York, New York 10032.
  • 1.

    Betti OO, , Munari C, & Rosier R: Stereotactic radiosurgery with the linear accelerator: treatment of arteriovenous malformations. Neurosurgery 24:311321, 1989 Betti OO, Munari C, Rosier R: Stereotactic radiosurgery with the linear accelerator: treatment of arteriovenous malformations. Neurosurgery 24:311–321, 1989

    • Search Google Scholar
    • Export Citation
  • 2.

    Brown RD Jr, , Wiebers DO, & Forbes G, et al: The natural history of unruptured intracranial arteriovenous malformations. J Neurosurg 68:352357, 1988 Brown RD Jr, Wiebers DO, Forbes G, et al: The natural history of unruptured intracranial arteriovenous malformations. J Neurosurg 68:352–357, 1988

    • Search Google Scholar
    • Export Citation
  • 3.

    Colombo F, , Benedetti A, & Pozza F, et al: Linear accelerator radiosurgery of cerebral arteriovenous malformations. Neurosurgery 24:833840, 1989 Colombo F, Benedetti A, Pozza F, et al: Linear accelerator radiosurgery of cerebral arteriovenous malformations. Neurosurgery 24:833–840, 1989

    • Search Google Scholar
    • Export Citation
  • 4.

    Drake CG: Arteriovenous malformations of the brain. The options for management. N Engl J Med 309:308310, 1983 Drake CG: Arteriovenous malformations of the brain. The options for management. N Engl J Med 309:308–310, 1983

    • Search Google Scholar
    • Export Citation
  • 5.

    Garrido E, & Stein B: Removal of an arteriovenous malformation from the basal ganglion. J Neurol Neurosurg Psychiatry 41:992995, 1978 Garrido E, Stein B: Removal of an arteriovenous malformation from the basal ganglion. J Neurol Neurosurg Psychiatry 41:992–995, 1978

    • Search Google Scholar
    • Export Citation
  • 6.

    Heros RC, & Korosue K: Radiation treatment of cerebral arteriovenous malformations. N Engl J Med 323:127129, 1990 Heros RC, Korosue K: Radiation treatment of cerebral arteriovenous malformations. N Engl J Med 323:127–129, 1990

    • Search Google Scholar
    • Export Citation
  • 7.

    Heros RC, , Korosue K, & Deibold PM: Surgical excision of cerebral arteriovenous malformations: late results. Neurosurgery 26:570578, 1990 Heros RC, Korosue K, Deibold PM: Surgical excision of cerebral arteriovenous malformations: late results. Neurosurgery 26:570–578, 1990

    • Search Google Scholar
    • Export Citation
  • 8.

    Kjellberg RN, , Hanamura T, & Davis KR, et al: Bragg-peak proton-beam therapy for arteriovenous malformations of the brain. N Engl J Med 309:269274, 1983 Kjellberg RN, Hanamura T, Davis KR, et al: Bragg-peak proton-beam therapy for arteriovenous malformations of the brain. N Engl J Med 309:269–274, 1983

    • Search Google Scholar
    • Export Citation
  • 9.

    Küne Z: Surgery of arteriovenous malformations in the speech and motor-sensory regions. J Neurosurg 40:293303, 1974 Küne Z: Surgery of arteriovenous malformations in the speech and motor-sensory regions. J Neurosurg 40:293–303, 1974

    • Search Google Scholar
    • Export Citation
  • 10.

    Levy RP, , Fabrikant JI, & Frankel KA, et al: Stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of intracranial arteriovenous malformations in childhood and adolescence. Neurosurgery 24:841852, 1989 Levy RP, Fabrikant JI, Frankel KA, et al: Stereotactic heavy-charged-particle Bragg peak radiosurgery for the treatment of intracranial arteriovenous malformations in childhood and adolescence. Neurosurgery 24:841–852, 1989

    • Search Google Scholar
    • Export Citation
  • 11.

    Lindquist C, & Steiner L: Stereotactic radiosurgical treatment of malformations of the brain, in Lunsford LD (ed): Modern Stereotactic Neurosurgery . Boston: Martinus Nijhoff, 1988, pp 491505 Lindquist C, Steiner L: Stereotactic radiosurgical treatment of malformations of the brain, in Lunsford LD (ed): Modern Stereotactic Neurosurgery. Boston: Martinus Nijhoff, 1988, pp 491–505

    • Search Google Scholar
    • Export Citation
  • 12.

    Lunsford LD, , Flickinger J, & Coffey RJ: Stereotactic gamma knife radiosurgery: initial North American experience in 207 patients. Arch Neurol 47:169175, 1990 Lunsford LD, Flickinger J, Coffey RJ: Stereotactic gamma knife radiosurgery: initial North American experience in 207 patients. Arch Neurol 47:169–175, 1990

    • Search Google Scholar
    • Export Citation
  • 13.

    Lunsford LD, , Kondziolka D, & Flickinger JC, et al: Stereotactic radiosurgery for arteriovenous malformations of the brain. J Neurosurg 75:512524, 1991 Lunsford LD, Kondziolka D, Flickinger JC, et al: Stereotactic radiosurgery for arteriovenous malformations of the brain. J Neurosurg 75:512–524, 1991

    • Search Google Scholar
    • Export Citation
  • 14.

    Ogilvy CS: Radiation therapy for arteriovenous malformations: a review. Neurosurgery 26:725735, 1990 Ogilvy CS: Radiation therapy for arteriovenous malformations: a review. Neurosurgery 26:725–735, 1990

    • Search Google Scholar
    • Export Citation
  • 15.

    Ondra SL, , Troupp H, & George ED, et al: The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment. J Neurosurg 73:387391, 1990 Ondra SL, Troupp H, George ED, et al: The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment. J Neurosurg 73:387–391, 1990

    • Search Google Scholar
    • Export Citation
  • 16.

    Sisti MB, , Solomon RA, & Stein BM: Stereotactic craniotomy in the resection of small arteriovenous malformations. J Neurosurg 75:4044, 1991 Sisti MB, Solomon RA, Stein BM: Stereotactic craniotomy in the resection of small arteriovenous malformations. J Neurosurg 75:40–44, 1991

    • Search Google Scholar
    • Export Citation
  • 17.

    Solomon RA, & Stein BM: Interhemispheric approach for the surgical removal of thalamocaudate arteriovenous malformations. J Neurosurg 66:345351, 1987 Solomon RA, Stein BM: Interhemispheric approach for the surgical removal of thalamocaudate arteriovenous malformations. J Neurosurg 66:345–351, 1987

    • Search Google Scholar
    • Export Citation
  • 18.

    Solomon RA, & Stein BM: Management of arteriovenous malformations of the brain stem. J Neurosurg 64:857864, 1986 Solomon RA, Stein BM: Management of arteriovenous malformations of the brain stem. J Neurosurg 64:857–864, 1986

    • Search Google Scholar
    • Export Citation
  • 19.

    Solomon RA, & Stein BM: Surgical management of arteriovenous malformations that follow the tentorial ring. Neurosurgery 18:708715, 1986 Solomon RA, Stein BM: Surgical management of arteriovenous malformations that follow the tentorial ring. Neurosurgery 18:708–715, 1986

    • Search Google Scholar
    • Export Citation
  • 20.

    Stein BM: Arteriovenous malformations of the medial cerebral hemisphere and the limbic system. J Neurosurg 60:2331, 1984 Stein BM: Arteriovenous malformations of the medial cerebral hemisphere and the limbic system. J Neurosurg 60:23–31, 1984

    • Search Google Scholar
    • Export Citation
  • 21.

    Stein BM: General techniques for surgical removal of arteriovenous malformations, in Wilson CB, & Stein BM (eds): Intracranial Arteriovenous Malformations . Baltimore: Williams & Wilkins, 1984, pp 143155 Stein BM: General techniques for surgical removal of arteriovenous malformations, in Wilson CB, Stein BM (eds): Intracranial Arteriovenous Malformations. Baltimore: Williams & Wilkins, 1984, pp 143–155

    • Search Google Scholar
    • Export Citation
  • 22.

    Stein BM, , Mohr JP, & Sisti MB: Is radiosurgery all that it appears to be? Arch Neurol 48:1920, 1991 (Letter) Stein BM, Mohr JP, Sisti MB: Is radiosurgery all that it appears to be? Arch Neurol 48:19–20, 1991 (Letter)

    • Search Google Scholar
    • Export Citation
  • 23.

    Steinberg GK, , Fabrikant JI, & Marks MP, et al: Stereotactic heavy-charged-particle Bragg-peak radiation for intracranial arteriovenous malformations. N Engl J Med 323:96101, 1990 Steinberg GK, Fabrikant JI, Marks MP, et al: Stereotactic heavy-charged-particle Bragg-peak radiation for intracranial arteriovenous malformations. N Engl J Med 323:96–101, 1990

    • Search Google Scholar
    • Export Citation
  • 24.

    Steiner L: Radiosurgery in cerebral arteriovenous malformations, in Fein JM, & Flamm ES (eds): Cerebrovascular Surgery . New York: Springer-Verlag, 1984, Vol 4, pp 11611215 Steiner L: Radiosurgery in cerebral arteriovenous malformations, in Fein JM, Flamm ES (eds): Cerebrovascular Surgery. New York: Springer-Verlag, 1984, Vol 4, pp 1161–1215

    • Search Google Scholar
    • Export Citation
  • 25.

    Steiner L: Treatment of arteriovenous malformations by radiosurgery, in Wilson CB, & Stein BM (eds): Intracranial Arteriovenous Malformations . Baltimore: Williams & Wilkins, 1984, pp 295313 Steiner L: Treatment of arteriovenous malformations by radiosurgery, in Wilson CB, Stein BM (eds): Intracranial Arteriovenous Malformations. Baltimore: Williams & Wilkins, 1984, pp 295–313

    • Search Google Scholar
    • Export Citation
  • 26.

    Steiner L, , Leksell L, & Forster DMC, et al: Stereotactic radiosurgery in intracranial arterio-venous malformations. Acta Neurochir Suppl 21:195209, 1974 Steiner L, Leksell L, Forster DMC, et al: Stereotactic radiosurgery in intracranial arterio-venous malformations. Acta Neurochir Suppl 21:195–209, 1974

    • Search Google Scholar
    • Export Citation
  • 27.

    Steiner L, & Lindquist CH: Radiosurgery in cerebral arteriovenous malformation, in Tasker RR (ed): Neurosurgery: State of the Art Reviews. Stereotactic Surgery . Philadelphia: Hanley & Belfus, 1987, Vol 2, pp 329335 Steiner L, Lindquist CH: Radiosurgery in cerebral arteriovenous malformation, in Tasker RR (ed): Neurosurgery: State of the Art Reviews. Stereotactic Surgery. Philadelphia: Hanley & Belfus, 1987, Vol 2, pp 329–335

    • Search Google Scholar
    • Export Citation
  • 28.

    Wascher TM, & Spetzler RF: Radiosurgery of arteriovenous malformations. J Neurosurg 76:10451046, 1992 (Letter) Wascher TM, Spetzler RF: Radiosurgery of arteriovenous malformations. J Neurosurg 76:1045–1046, 1992 (Letter)

    • Search Google Scholar
    • Export Citation

Metrics