SURGERY FOR CEREBRAL ARTERIOVENOUS MALFORMATION - RISKS RELATED TO LENTICULOSTRIATE ARTERIAL SUPPLY

The aim of this study was to compare complications of surgery in arter iovenous malformations (AVMs) supplied by the middle cerebral artery ( MCA) with and without a lenticulostriate arterial contribution. Ninety -two consecutive surgical resections of AVMs with an angiographically demonstrated MCA supply were performed between January 1989 and July 1 996. Ten of these cases had a significant lenticulostriate arterial co ntribution. The cases were graded according to the Spetzler-Martin cla ssification. There were no deaths and 4.3% of cases developed new majo r neurological deficit by the 3-month follow-up examination. All cases had angiographically confirmed obliteration of the AVM. There were no complications in 16 patients with Spetzler-Martin Grade I AVMs, one c ase of complications in 40 patients with Grade II AVMs, eight case of complications in 26 patients with Grade III AVMs, and seven cases of c omplications in 10 patients with Grade IV and V AVMs. The supply of bl ood from lenticulostriate branches was associated with complications i n eight of the 10 cases. The effect of the presence of a lenticulostri ate arterial supply was most apparent in cases of Grade III AVMs: comp lications were experienced in three of 20 patients whose AVMs were not supplied by the arteries and in five of six patients whose AVMs were fed by the lenticulostriate arteries. This difference is significant ( p < 0.0001). The conclusions drawn from this study are that for Grade III AVMs, the presence of a lenticulostriate arterial supply can be co nsidered a factor predictive of an increased risk of surgical complica tions.