Surgical Removal of Giant Basal Ganglia Arteriovenous Malformations through the Extended Transsylvian Approach Following Preoperative Embolization —Two Case Reports—

Abstract

A 12-year-old boy and a 22-year-old male presented with sudden onset of consciousness disturbance with right-sided hemiparesis and aphasia due to massive intracerebral hemorrhage from giant striocapsular arteriovenous malformations (AVMs). Angiography revealed giant AVMs located at the left basal ganglia in both patients. Large frontotemporal craniotomies were performed following staged embolization of the feeding arteries. Through an extended transsylvian approach, the lesions were totally excised with confirmation using intraoperative digital subtraction angiography. The patients showed a transient postoperative worsening of symptoms, but recovered to their preoperative status at discharge. Motor functions of the right upper and lower extremities were graded 4/5 in both patients. These cases demonstrate that combined use of preoperative embolization and intraoperative angiography allows some giant deep AVMs to be resected with encouraging results. © 1995, The Japan Neurosurgical Society. All rights reserved.