뇌동정맥기형의 임상적 고찰

Abstract

We analyzed 62 cases of intracranial AVM treated in the department of neurosurgery of Soonchunhyang University Hospital during the period from January 1984 to May 1994. The results are summarized as follows: 1) The ratio of male to female was 1.58 : 1 and 44 cases(71%) were distributed under the age of forty, with a peak incidence in the 2nd and 4th decade. 2) Forty five patients(72.6%) experienced symptoms due to spontaneous intracerebral/intraventricular hemorrhage, and the next most common symptom was seizure in 9 patients(14.5%) 3) Intracerebral hemorrhage(ICH) was the most common cause of symptoms, constituting 90.4% of intracranial hemorrhage. Among the patients with intracerebral hemorrhage, the size of AVM nidus was less than 3cm in 70.2%, between 3cm to 6cm in 27.7%, and over 6cm in 2.1%, respectively. 4) Ten(58%) of the patients presenting with over 30cc of ICH had the AVM located in the eloquent area. 5) The most common location of AVM was the supratentorial subcortical region, especially the parietal lobe(33.9%). 6) Forty five patients were managed surgically, and the operative mortality was 2.2% and significant morbidity, 24.4%. 7) As for surgical intervention, total excision of AVM was carried out in 33(73.3%), partial excision in 10(22.2%), and only arterial feeder clipping in 2(4.4%). The lower the Spetzler grade of AVM, the better the surgical result and the postoperative outcome. 8) Postoperative neurological deterioration was noticed in 3 of 33 cases(9%) in the group of total excision of AVM, and their causes were cerebral edema and normal perfusion pressure break-through. 9) The clinical outcome of surgical management for AVM was superior than that of conservative treatment(p<0.01).