Temporal lobe arteriovenous malformations: Surgical management and outcome

Abstract

Temporal lobe arteriovenous malformations (AVMs) represent a subgroup of intracranial AVMs with particular characteristics and management issues. We performed a retrospective analysis of 24 consecutive patients with temporal lobe AVMs treated with surgical excision. Factors such as location, size, arterial feeders, venous drainage, and clinical follow-up were recorded for each. Results were compared with those of 132 patients with nontemporal lobe AVMs surgically treated over the same time period. Sixteen of the temporal AVMs were located in the convexity, six in the mesotemporal region, and two were predominantly intraventricular. The mode of presentation was seizure in 11 patients, hemorrhage in 7, headache in 4, and 2 were asymptomatic. Patients with convexity AVMs more commonly presented with seizures, whereas patients with mesotemporal or intraventricular AVMs were more likely to present with hemorrhage. One patient with subarachnoid hemorrhage from a basilar artery aneurysm died. Postoperatively, 2 patients (8.3%) had a new hemiparesis and dysphasia, 1 (4%) had a new dysphasia and hemianopsia, and 3 others (13%) were left with an isolated superior quadrant field deficit. Lasting surgical morbidity other than isolated field deficit was 13% for patients with temporal AVMs and 15% for those with nontemporal AVMs. Temporal lobe AVMs may be successfully resected using a direct microsurgical approach with limited morbidity and excellent prognosis for recovery. Most of the deficits relating to AVM hemorrhage and those of the immediate postoperative period improved significantly over the subsequent few months.