SURGICAL-MANAGEMENT OF ARTERIOVENOUS-MALFORMATIONS IN THE REGION OF THE VENTRICULAR TRIGONE

THE RESULTS IN the surgical management of 26 patients with arterioveno us malformations intimately related to the trigone of the lateral vent ricle are presented. Three operative approaches were used in the serie s, including a transtemporal route through the inferior or middle temp oral gyrus (15 patients), an interhemispheric approach (8 patients), a nd a transcortical parieto-occipital approach (3 patients). The surgic al approach was chosen on the basis of the relationship of the arterio venous malformation to the trigone, the presence and location of assoc iated hematoma, and preoperative neurological deficits. This report em phasizes the use of surgical adjuncts that are instrumental in the man agement of these challenging lesions, including magnetic resonance ima ging for precise localization and operative planning, preoperative emb olization to obliterate deep arterial supply, and intraoperative ultra sound and angiography to aid in localization and to document complete excision of the arteriovenous malformation before closure. The results of the management of these 26 patients are as follows: 21 had no or m inor neurological deficits and were able to resume premorbid activitie s; 2 had a fair result, being independent but unable to resume their p remorbid occupation; 2 had a poor result and were dependent as the res ult of an incapacitating neurological deficit; and 1 died.