A Study on the Treatment of Intracranial arteriovenous ?Malformation

J Korean Neurol Assoc > Volume 6(1); 1988 > Article

Journal of the Korean Neurological Association 1988;6(1): 41-48.

두개강내 동정맥기형 치료에 관한 연구

노재규, 김종성

서울대학교 신경과.

A Study on the Treatment of Intracranial arteriovenous ?Malformation

Jae Kyu Roh, M.D., Jong Sung Kim, M.D.

Department of Neurology, College of Medicine, Seoul National University

Abstract

We reviewed forty five cases of intracranial arteriovenous malformation (AVM) who were admitted in Seoul National University Hospital within recent 7 years; thirty one patients revealed intracerebral hemorrhage and fourteen patients showed seizure or progressived focal neurologic deficit as an initial presentation. To evaluate the natural history of AVM after initial hemorrhage, out of these 45 cases, we selected 22 cases who were, operated or not, observed naturally for at least 1 year. To know the post operative course, we also selected 18 cases who were operated on. Thses two groups were compared with respect to the mortality, morbidity, frequency of rebleeding or seizure, which were 9%, 27%, 55%, 27%, in the former, and 0%, 17%, 0%, and 28% in the latter. Among the 14 patients whose initial presentation was not intracranial bleeding, 9 had seizure, 5 had progressive focal neurologic deficit, and 4 had both. During the follow-up period (average 5 years), only one patient had intracranial bleeding. Seizures in this group were relatively well controlled by regular antiepileptic regimen. Out of the 2 cases who were operated for seizure control, one had considerable degree of neurologic deficit after operation. From above evidences, we tentatively conclude that the AVM with initial bleeding should be better operated on if accessible, whereas the AVM without initial bleeding should be best managed conservatively. For a more definite conclusion, large, radomized controlled studies should be done again which, however, may meet ethical problems.