ARTERIOVENOUS-MALFORMATIONS OF THE BASAL GANGLIA REGION - RATIONALE FOR SURGICAL-MANAGEMENT

Surgical indications for arteriovenous malformations (AVMs) arising at the region of the basal ganglia are questionable and the majority of cases are considered inoperable. Albeit not free from risks of morbidi ty and mortality, the treatment of choice is usually radiosurgery for small lesions, and embolization plus radiosurgery for larger lesions. Nevertheless, some lesions may be amenable for surgical resection due to their favorable location. Eighteen cases of such AVMs were selected for a direct approach in our series. Seventeen cases were classified as Spetzler and Martin [22] grade III, and one case was a grade V. Ten patients were males and eight females. The mean age was 28.3 years (r anged from 2 to 43 years). Sixteen patients had had previous hemorrhag ic events prior to hospital admission. Eleven patients had pre-operati ve well stablished neurological deficits, and seven patients although symptomatic had a normal neurological exam at admission. Fifteen patie nts had their AVMs completely resected. Among the eleven patients with previous neurological deficts nine had no change in their pre-operati ve condition and two experienced postoperative neurological worsening. In the long-term follow-up six patients had a complete recovery and f ive recovered only partially. Among the seven patients whose neurologi cal examination was normal pre-operatively five remained unchanged, on e had a transient motor deficit, and one died due to a thalamic venous infarction and massive bleeding into the thalamus. The anatomical kno wledge and the precise localization of the arteriovenous malformation through the aid of neuroimage studies has provided the means to classi fy these AVMs and plan operative strategies for some small selected ca ses with relatively low morbidity.