title: Surgical management of Spetzler-Martin grade V AVM.
abstract: The surgical management of giant arteriovenous malformations (AVMs) has been complicated and fraught with considerable risk. We retrospectively analysed seven patients with giant AVMs classified into Spetzler-Martin Grade V between 1993 and 1999. Six of seven surgical cases presented with haemorrhagic episodes and the other single case developed progressive neurological deficits. Four out of seven surgical cases developed haemorrhagic complications during surgery or postoperatively. This resulted in poor outcomes in two of four cases. The other five cases recovered well from surgery. Although no morbidity was found after preoperative embolisation in this series, incomplete embolisation did not decrease the rate of haemorrhagic complication. Nonhaemorrhagic complications of a new focal neurological deficit occurred in three cases, one case in hemiparesis and two cases in quadrant hemianopsia. This resulted in surgical injury of white matter pathway where deep feeders such as the lenticulostriate arteries or wedge shape nidus were evident. Successful removal of giant AVM depends on not only stepwise obliteration of AVM but also successful management of the deep feeders that may reside in white matter pathways. Preoperative embolisation should target inaccessible deep feeders.
authors.affiliation: Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan. huji@nij.twmu.ac.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ujiie
authors.forename: Takashi
authors.initials: T
authors.lastname: Higa
authors.forename: Motohiro
authors.initials: M
authors.lastname: Hayashi
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Tamano
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Muragaki
authors.forename: Tomokatsu
authors.initials: T
authors.lastname: Hori
mesh_terms: D000328:Adult; D002543:Cerebral Hemorrhage / Q000473:pathology / Q000601:surgery; D003131:Combined Modality Therapy; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000473:pathology* / Q000601:surgery* / Q000628:therapy; D007431:Intraoperative Complications / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000473:pathology; D011300:Preoperative Care; D016634:Radiosurgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult