脳動静脈奇形の多角的治療戦略の現状 脳動静脈奇形の治療戦略 外科治療

Abstract

We retrospectively analyzed clinical courses and outcomes of cerebral arteriovenous malformations in 214 patients (3-79 years old) admitted to our institute between January 1987 and March 2000 in order to determine their natural history and therapeutic outcomes. The cerebral arteriovenous malformations were located in the cerebral hemisphere in 142, basal ganglia-thalamus in 19, cerebellum in 24, corpus callosum in 13, brainstem in 6, and others in 10 (Spetzler & Martin Grade I, 17; II, 44; III, 81; IV, 57; V, 13; and VI, 2). The initial presentation was hemorrhage in 121, seizure in 40, ischemia in 21, headache in 18, and asymptomatic in 14. The annual re-bleeding risk was 11.9% in 121 cases with hemorrhagic onset, and the annual bleeding risk was 3.2% in 93 cases with non-hemorrhagic onset. Bleeding risks between initial treatment and complete obliteration of the lesion were 9.7% and 11.4% in hemorrhagic and non-hemorrhagic groups. In 129 cases who suffered from hemorrhage, total extirpation was achieved in 97 and complete obliteration was obtained in 109 in combination with transarterial embolization and/or radiosurgery. In 85 cases without hemorrhage, complete obliteration was obtained in 55 cases. Surgical morbidity and mortality were 5.8% and 0.6%. Clinical outcome was excellent/good in 141 (92%) out of 154 cases who received surgical treatments, in 18 (86%) out of 21 cases who received radiosurgery, and in 23 (59%) out of 39 cases who received partial transarterial embolization or observation. Cerebral arteriovenous malformations should be treated considering their relatively high re-bleeding risks in hemorrhagic cases and treatment-related bleeding risks.