Artikel
Treatment of tentorial AVMs with an emphasis on surgical strategy
Die Behandlung tentorieller Fisteln mit dem Schwerpunkt operative Strategie
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Autoren
Veröffentlicht: | 23. April 2004 |
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Gliederung
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Objective
Tentorial arteriovenous malformations (AVMs) are uncommon lesions associated with an aggressive natural history. Controversy exists regarding their optimal treatment. We present our series of tentorial AVMs treated by embolization and subsequent surgical resection during a 6-year period and address the current controversies.
Methods
Between 1996 and 2003 the senior author operated on 5 males (44-70yo), 1 female (51yo) with a tentorial AVM. In five patients preoperative intraarterial embolization led to partial occlusion of the AVM. In one case it was unsuccessful. The microsurgical resection was carried out by using a subtemporal approach in each case. According to the pathological angioarchitecture, cauterization of the feeding arteries was performed in a specific chronological order.
Results
Postoperatively all patients had an excellent outcome. Surgical disconnection of the feeding arteries and the venous drainage was accomplished in all cases. In 3 individuals a large ectatic vein was additionally resected. Angiographic follow-up between 1 week and 2 years showed complete obliteration of the tentorial AVMs.
Conclusions
Patients treated by a combination of embolization and surgery can have a good outcome. Extensive nidal resection completely obliterates the tentorial AVM.