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Parafalcine and midline arteriovenous malformations: surgical strategy, techniques, and outco

Authors
 Yong Bae Kim  ;  William L. Young  ;  Michael T. Lawton 
Citation
 JOURNAL OF NEUROSURGERY, Vol.114(4) : 984-993, 2011 
Journal Title
JOURNAL OF NEUROSURGERY
ISSN
 0022-3085 
Issue Date
2011
MeSH
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Craniotomy ; Embolization, Therapeutic ; Female ; Follow-Up Studies ; Humans ; Infant ; Intracranial Arteriovenous Malformations/complications ; Intracranial Arteriovenous Malformations/pathology ; Intracranial Arteriovenous Malformations/surgery* ; Male ; Middle Aged ; Neurosurgical Procedures/methods* ; Radiosurgery ; Treatment Outcome ; Vascular Surgical Procedures/methods* ; Young Adult
Keywords
arteriovenous malformation ; anterior interhemispheric approach ; posterior interhemispheric approach ; transcallosal approach ; microsurgery ; resection
Abstract
OBJECT: Parafalcine arteriovenous malformations (AVMs) have a midline plane in common, but differ in their location (anterior, middle, or posterior) and depth (superficial or deep). Surgical management varies with AVM location and depth in terms of patient position, head position, craniotomy, and surgical approach. This study examined surgical strategies, patient outcomes, and regional factors influencing results.

METHODS: Patients with AVMs located on the medial surface of the cerebral hemisphere were identified retrospectively from a consecutive, single-neurosurgeon series that is registered prospectively as part of the UCSF Brain Arteriovenous Malformation Study Project. During a 12-year period, 443 patients with AVMs were treated surgically. Of these 443 patients, 132 (30%) had parafalcine AVMs, which were distributed in zones as follows: superficial-anterior, 25 (18.9%); superficial-middle, 26 (19.7%); superficial-posterior, 39 (29.5%); deep-anterior, 25 (18.9%); deep-posterior, 17 (12.9%). Five different surgical strategies were used depending on AVM zone.

RESULTS: Complete AVM resection was achieved in 123 (93.2%) of 132 patients. Overall, neurological condition improved in 74 patients (56.1%) and remained unchanged in 41 patients (31.1%). Neurological condition deteriorated in 12 patients (9.1%), and 5 patients (3.8%) died. Patients with AVMs in the superficial-middle zone had the highest rate of neurological deterioration (26.9%).

CONCLUSIONS: Parafalcine AVMs lie on a midline surface that, when exposed with a bilateral craniotomy across the superior sagittal sinus and a wide opening of the interhemispheric fissure, makes them superficial. However, unlike convexity AVMs, which are approached perpendicularly, parafalcine AVMs are approached tangentially. Gravity retraction is useful with deeply located AVMs (those in the deep-anterior and deep-posterior zones), because it widens the interhemispheric fissure and accesses deep arterial feeding vessels from the anterior and posterior cerebral arteries. Surgical risks were increased in the superficial-middle zone, which is likely explained by the proximity of sensorimotor cortex. The authors' regional classification of parafalcine AVMs may serve as a guide to surgical planning.
Full Text
http://thejns.org/doi/full/10.3171/2010.12.JNS101297
DOI
10.3171/2010.12.JNS101297
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/95367
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