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Revista chilena de neuro-psiquiatría

versión On-line ISSN 0717-9227


ORTIZ, Armando et al. Surgical Resection of Medial Hemispheric Arteriovenous Malformation . Rev. chil. neuro-psiquiatr. [online]. 2002, vol.40, n.1, pp.76-87. ISSN 0717-9227.

Cerebral arteriovenous malformations (AVMs) are a major challenge for the neurosurgeon. Regardless of the treatment chosen, complete obliteration is the goal. An interesting and complex group are AVMs located on or next to the medial surface of the cerebral hemispheres. This group tends to be replaced by distal branches of major arteries (anterior, posterior and middle cerebral arteries), making endovascular treatment difficult. On the other hand, they are not large, and resection complications in a time period are limited. This article presents 12 cases of surface or deep medial AVMs, 8 male and 4 female. Average age is 30, ranging from 16 to 50 years old. Clinical symptoms were hemorrhage in 8 cases and convulsive syndrome in 4. Complete exeresis was achieved in all cases, corroborated by angiography. A second intervention was needed for complete deafferentation in 5 patients, with no increase in morbidity. Eighty percent of the cases showed no incapacitating neurological deficit. One parapeduncular case was left with a slight hemiparesis, and a paracaudal case with minor bradypsychia. The campimetric deficit of one patient who began with parieto-occiptal hemorrhaging remained unchanged after surgery. Both cases treated through lower temporal transulci resulted in hemianopia. There was no mortality. While our results were satisfactory, we believe an analysis of each individual case and, above all, the local situation of each work group should determine the risk factors, and decisions made should be made based on that reality. The use of interventionist neuroradiology brings about a significant improvement in the analysis and discussion of this controversial pathology, and undoubtedly optimizes treatment of these patients

Palabras clave : arteriovenous malformation; intracerebral hemorrhage; late-onset epilepsy.

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