Nagata Shinji, Morioka Takato, Matsukado Koichiro, Natori Yoshihoro, Sasaki Tomio
Department of Neurosurgery, Kyushu University Graduate School of Medical Sciences, Fukuoka 812-8582, Japan.
Surg Neurol. 2006 Jul;66(1):50-5; discussion 55. doi: 10.1016/j.surneu.2005.12.017.
Authors investigate the surgical outcomes of the temporal lobe arteriovenous malformation (AVM) with focus on the visual field deficit and seizure.
Between 1981 and 2004, we experienced 294 cases of intracranial AVMs. Among the 294 cases, 45 (15.3%) were located in the temporal lobe. Twenty-six of the 45 cases underwent microsurgical excisions of the AVMs.
The male-female ratio of 26 surgically treated temporal lobe AVMs was 15:11. The mean age was 34.2 years, ranging from 7 to 63 years. The sites of lesion were classified as polar in 1, dorsal in 2, laterobasal in 15, and mediobasal in 8. The initial symptoms were hemorrhage in 22 and epilepsy in 4 cases. Arteriovenous malformations were totally removed in all 26 patients and there was no surgical mortality. The visual field deficits were identified in 17 of 22 patients with hemorrhage. Massive hematoma cases that needed emergency operation were 5. Visual field deficits improved in only 2 of the 5 patients after surgery. Among the 7 quadrantanopia patients, 3 resulted in hemianopia after surgery. Seven of 22 hemorrhage patients had history of epilepsy. Although one patient had new postoperative epilepsy, the medical controls of the seizure were good in all 8 patients. Four patients underwent AVM excision for epilepsy without hemorrhage. In two patients, seizures disappeared after surgery. The other two patients had typical psychomotor seizures after the total excision of AVMs.
Improvement of visual field deficit due to hematoma was difficult in most cases. Emergency craniotomy for global neurological deterioration due to massive hematoma had improved the visual field deficit in two cases. Although the outcome of seizure associated with hemorrhage was acceptable, the postoperative intractable seizures would remain in cases with epilepsy without hemorrhage. Intraoperative electrocorticography might be requisite for nonruptured temporal lobe AVM cases with epilepsy.
作者研究颞叶动静脉畸形（AVM）的手术结果，重点关注视野缺损和癫痫。
1981年至2004年间，我们共收治294例颅内AVM。在这294例中，45例（15.3%）位于颞叶。45例中的26例接受了AVM的显微手术切除。
26例接受手术治疗的颞叶AVM患者中，男女比例为15:11。平均年龄为34.2岁，范围从7岁至63岁。病变部位分类为极区1例，背侧2例，外侧基底15例，内侧基底8例。初始症状为出血22例，癫痫4例。所有26例患者的AVM均被完全切除，无手术死亡病例。22例出血患者中有17例出现视野缺损。需要急诊手术的大量血肿病例有5例。5例患者中术后仅有2例视野缺损得到改善。7例象限盲患者中，3例术后导致偏盲。22例出血患者中有7例有癫痫病史。虽然有1例患者术后出现新的癫痫，但所有8例患者的癫痫药物控制良好。4例患者因癫痫而非出血接受AVM切除。2例患者术后癫痫消失。另外2例患者在AVM完全切除后出现典型的精神运动性癫痫。
大多数情况下，因血肿导致的视野缺损难以改善。因大量血肿导致全面神经功能恶化而行急诊开颅手术的2例患者视野缺损得到改善。虽然与出血相关的癫痫结果尚可接受，但无出血的癫痫病例术后仍会存在顽固性癫痫。对于无破裂的颞叶AVM合并癫痫病例，术中皮层脑电图检查可能是必要的。
