Microsurgery For Arteriovenous Malformation (the Report Of 109 Cases)

Objective: To evaluate the effect of microneurosurgery excision of AVM treatment by analysis 109 cases of AVM patients.Methods: All the 109 patients underwent microneurosurgery. 26 patients who were considered the possibility of AVM by the CT scan examination before operation, underwent emergency operation, and were discovered the AVM disease during the surgery by microscope exploration. 24 cases of the 26 patients underwent the AVM excision at the first time, 1 case was excised part of the AVM focus, and 1 case was just cleaned up the hematoma without the AVM excision. The other 83 cases underwent selective operation after more sufficient preoperative examination. The microscope of the surgery was the M520 OH3 type made by Leica Microsystems company in Germany. The 109 patients'clinical data was summarized and analysised retrospectively.Results: Only 2 cases of 109 patients were affirmed the remains of focus during the surgery(1 case was excised part of the AVM focus, and 1 case was just cleaned up the hematoma without the AVM excision). The other 107 cases were considered reaching the standard of"entirely excision under the microscope". 72 cases underwent iconography reexamination after operation. During the 72 cases, 36 cases only underwent DSA reexamination, 33 cases only underwent MR scan reexamination, and 3 cases underwent both DSA and MR scan reexamination. The result of the reexamination showed that, 68 cases didn't found the evidence of the remains of focus, and the rate of entirely excision was 94.4%(68/72). 4 cases were found the remains of focus who had underwent the emergency operation, and 1 of them underwent the partly excision, the other 3 patients were considered had entirely excision during the operation and were found the remains of focus after operation by iconography reexamination. 63 cases of 109 patients were fine by the time of leaving hospital, and 27 cases were mild deformity, 16 cases were serious deformity, 3 cases were death. The rate of fine after surgery was 82.6%. Comparing with the emergency operation and selective operation, the fine rate of emergency operation was 57.7%, and the fine rate of selective operation was 90.4%. 3 cases of death during hospital were underwent emergency operation. 1 case was just cleaned up the hematoma without the AVM excision, and the cause of death was rehaemorrhagia after operation. 2 cases underwent a long time of hernia of brain, and the cause of death was brainstem function failure. The average time from morbidity to death was 9 days. The fine rate of 109 cases after operation associated with S-M classification was: 100% of Grade I, 84.6% of Grade II, 85.7% of Grade III, 76.0% of Grade IV, 33.3% of Grade V, 77.8% of Grade VI. 50 cases of 109 patients had follow-up visit. The rate was 47.2%. The time of follow-up visit was 1 month to 209 months, the average was 48.3 months. 30 cases(60%) got 5 points of GOS, 10 cases(20%) got 4 points of GOS, 7 cases(14%) got 3 points of GOS, and 3 cases(6%) got 1 points of GOS. There were 3 cases death during the time of follow-up visit. 1 case was death of intracranial infection, 1 cases was in the state of unconsciousness, because of the cerebral infarction after surgery, and finally dead of complication, 1case was death of intracranial hematoma , because of the blood coagulation function failure after operation. The 50 patients didn't have AVM rehaemorrhagia.Conclusions: 1.The AVM excision surgery can prevent rehaemorrhagia effectively. With the correct operation indications, ample knowledge of microdissection and adept skill of microsurgery , the effect of microneurosurgery treatment of AVM is satisfactory. 2.The MRI and DSA examination have significant meaning in diagnosing and directing the operation of AVM. The preoperative iconography examination of AVM should be comprehensive and particularity, so that we could analysis the information, evaluate and establish the surgery project. 3.Whether or not do the surgery for AVM patients should be evaluated synthetically according to the risk of autogenous hemorrhage and the risk of surgery. 4.The improving of microsurgery technique and the summarize of surgery experience have a significant effect for improving the prognosis of AVM patients. 5.In brainstem AVM patients, the ones who are appropriate for surgery should be done as soon as possible, when stanching bleeding, we should prefer pressing with hematischetic material to the using of bipolar electrocoagulation.