Concurrent anatomic hemispherectomy and thalamic arteriovenous malformation resection

Excerpt

Arteriovenous malformations (AVMs) may present with hemorrhage, neurologic deficits, or seizure. Recent studies have found that of patients with AVMs, approximately 33 % have seizures, and of those patients with seizures, approximately 75 % have generalized tonic–clonic (GTC) seizures [4, 5]. In a recent study, seizure occurrence was associated with male gender, age <65 years, AVM size greater than 3 cm, and temporal lobe locations [5]. Complete obliteration of AVMs was associated with freedom from disabling seizure [5]. AVMs can be treated through microsurgical resection, embolization, radiosurgery, or a combination of these modalities. Deep location, size, and location in eloquent cortex are three factors which may limit surgical resection as they increase surgical morbidity significantly [11]. The high morbidity of surgical treatment for thalamic AVMs renders them often treated by stereotactic radiosurgery (SRS). A recent study found angiographic obliteration in 55 % of patients undergoing stereotactic radiosurgery with a 13 % rate of permanent radiation-related neurologic deficit; outcome with radiosurgery was linked to age of patient, AVM volume, and AVM location [12]. …