title: Surgical treatment of Spetzler-Martin grade III to V cerebral arteriovenous malformations: 10 years experience in Kyoto University.
abstract: Cerebral arteriovenous malformations (AVMs) are abnormal connections between arteries and veins leading to arteriovenous shunting with nidus formation. This study reviewed the clinical outcomes of surgical treatment for AVMs of Spetzler-Martin grades III to V in our institute. In addition, we summarized the technical aspects of surgical treatment for cerebral AVMs. Our development of the surgical modality for high-grade AVMs included intraoperative digital subtraction cerebral angiography, non-stick bipolar forceps, magnetic resonance tractography, and indocyanine green videoangiography. Excellent outcomes were obtained, but about 40% of all patients with AVMs could not receive surgical treatment. Multimodality approach including Onyx embolization may extend the surgical indications.
authors.affiliation: Department of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. ytakagi@kuhp.kyoto-u-ac.jp
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Takagi
authors.forename: Jun C
authors.initials: JC
authors.lastname: Takahashi
authors.forename: Kazumichi
authors.initials: K
authors.lastname: Yoshida
authors.forename: Akira
authors.initials: A
authors.lastname: Ishii
authors.forename: Nobuo
authors.initials: N
authors.lastname: Hashimoto
authors.forename: Susumu
authors.initials: S
authors.lastname: Miyamoto
mesh_terms: D000293:Adolescent; D000328:Adult; D015901:Angiography, Digital Subtraction / Q000295:instrumentation / Q000379:methods; D020771:Anterior Cerebral Artery / Q000601:surgery; D002533:Cerebral Angiography / Q000295:instrumentation / Q000379:methods; D002648:Child; D003131:Combined Modality Therapy; D038524:Diffusion Magnetic Resonance Imaging; D004564:Electrocoagulation / Q000295:instrumentation / Q000379:methods; D004621:Embolization, Therapeutic; D004867:Equipment Design; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007208:Indocyanine Green; D002538:Intracranial Arteriovenous Malformations / Q000145:classification* / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000601:surgery; D009460:Neurologic Examination; D038361:Neuronavigation / Q000295:instrumentation / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology; D016634:Radiosurgery / Q000295:instrumentation / Q000379:methods; D013525:Surgical Instruments; D020535:Video-Assisted Surgery / Q000295:instrumentation / Q000379:methods; D055815:Young Adult
chemical_list: D007208:Indocyanine Green