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Journal of Korean Neurosurgical Society 1972;1(1): 27-38.
Clinical Observation and Surgical Treatment of Cerebral Arterioveous Malformations.
Jin Un Song, Young Keun Lee, Chang Rak Choi, Joon Kee Kang, Jang Sung Song, Choon Jang Lee, Yoong Soo Ha
Department of Neurosurgery, Catholic Medical Collge, Korea.
We have experienced 19 patients of the cerebral arteriovenous malformation with subarachnoid hemorrhage, who were admitted to the Presbyterian Hospital, Daegu from January 1966 to July 1968, and to the Catholic Medical Center, Seoul from August 1968 to August 1971. All of the patients, who have the cerebral arteriovenous malformation, were proved by cerebral angiography. Since the site of lesions were considered to have close relation to the neurologic deficit and the result of surgery, various analysis of the clinical manifestations and the cerebral angiographic findings were attempted. Of the 19 patients, surgery was performed on 12 patients and its results were analyzed correlating to various types of surgical procedure. Following are the results. 1. From January 1966 to August 1971, there were 100 cases of cerebral vascular anomalies which were proved by cerebral angiography. Among the 100 cases, there were 71 intracranial aneurysms, 19 cerebral arteriovenous malformations, one cavernous angioma, 2 telangiectasis, 5 cerebral rete mirabile, and s Sturge Weber-Dimitris disease. The ratio of arteriovenous malformatons to aneurysms was 1: 3.7. 2. Age distribution of the bleeding arteriovenous malformations was ranged from 8 to 54, and 42 per cent of them were in the third decade. 73 percent of the group had bleeding from the cerebral arteriovenous malformation before the age of 40. The ratio of male to female was 1.9:1. 3. The parietal region was most commonly involved by the malformations. There were 8 parietal lesion, 4 temoroparietal lesions, one temporal lesion, one occipital lesion, and one tela chorioidea lesion. Simultaneous involvement of the both hemispheres occurred in one case. In lesions involving the cerebral hemisphere, there was a predominance of the left side. 4. In the past history, convulsive seizure was recorded in two cases and recurrent hemorrhages were reported in two. One patient was recorded to have suffered fourth hemorrhage and the other have sufferd third hemorrhge. 5. Meningeal irritation signs were most frequently observed in bleeding arteriovenous malformations. The incidence of weakness of extremities was higher in lesions involving the parietal area. Unconsciousness was occurred in 6 patients at the onset of symptom, of which transient loss of consciousness was seen in 3 patients. Transient hypertension at the onset was observed in two patients. 6. The feeding arteries of the malformations were most frequently seen from the middle cerebral artery and the draining veins from the malformations were into the superior sagittal sinus and internal cerebral vein in many cases. It was evident that the carotid artery of the sites of arteriovenous malformations was markedly dilated in 5 patients. 7. Ligation of the vessels feeding the arteriovenous malformations was carried out in 8 patients. One patient had neurologic deficit after the operation. Evacuation of intracerebral hematoma, resection of the anomaly or carotid ligation were carried out in 4 patients. Of the 12 patients who underwent various types of surgery, there was one death after evacuation of a large intracereral hematoma. 8. In our opinion, the ligation of feeding artery a choice of procedure to reduce the incidence of rebleeding, if the resection of the lesion was considered to have operative risk by the location of malformations.
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