Surgical Approach to Arteriovenous Malformation of the Medial Temporal Lobe

Abstract

We report three cases of arteriovenous malformation (AVM) of the medial temporal lobe and the surgical approaches used. The AVM was fed by the anterior choroidal artery (AChA) in two cases (Cases 1 and 2) and by the posterior cerebral artery in one (Case 3). The trans-Sylvian approach was first used for cerebrospinal fluid aspiration to retract the brain in all cases, and for confirming the feeding arteries to prevent premature bleeding from the AVM in Cases 1 and 2. In Case 1, a corticotomy was then made in the fusiform gyrus via the subtemporal approach to avoid the development of speech disturbance and visual field defects, while in Cases 2 and 3, a cortical incision was made in the middle temporal gyrus because visual field defects were preoperatively present. Cases 1 and 2 achieved good recoveries, but Case 3 suffered postoperative speech disturbance and died of rebleeding from a recurrent AVM fed by the AChA 22 months after the operation. This AVM was not demonstrated on the postoperative angiograms. We emphasize the usefulness of the combination of trans-Sylvian and subtemporal approaches for this lesion, because the feeding arteries are easily identified and retraction of the temporal lobe is alleviated. A corticotomy in the fusiform gyrus is also recommended to avoid the development of not only visual field defects but also aphasia.