Challenging traditional beliefs: microsurgery for arteriovenous malformations of the basal ganglia and thalamus.
OBJECTIVE
Arteriovenous malformations of the basal ganglia and thalamus are often managed with radiosurgery or observation, without consideration of microsurgery. Given the devastating effects of hemorrhage from these lesions, the accumulating evidence that they bleed more frequently than their lobar counterparts should prompt more creative thinking regarding their management.


METHODS
A review of the endovascular, microsurgical, and radiosurgical literature for arteriovenous malformations of the basal ganglia and thalamus was performed, with close attention to surgical approaches, obliteration rates, and procedure-related complications.


RESULTS
A complete resection rate of 91% and a mortality rate of 2.4% were found across surgical series of these lesions. These contrast with a 69% rate of complete obliteration and a 5.3% mortality rate (from latency-period hemorrhage) found when compiling results across the radiosurgical literature.


CONCLUSIONS
Given an appropriate surgical corridor of access, often afforded by incident hemorrhage, arteriovenous malformations of the basal ganglia and thalamus should be considered for microsurgical extirpation with preoperative embolization. In experienced hands, this approach presents an expeditious and definitive opportunity to eliminate the risk of subsequent hemorrhage and resultant morbidity and mortality.
Gross
Bradley A
BA
Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA.
Duckworth
Edward A M
EA
Getch
Christopher C
CC
Bendok
Bernard R
BR
Batjer
H Hunt
HH
D001479:Basal Ganglia / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000601:surgery*; D008866:Microsurgery / Q000379:methods* / Q000639:trends; D019635:Neurosurgical Procedures / Q000379:methods* / Q000639:trends*; D011859:Radiography; D013788:Thalamus / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods* / Q000639:trends*