[Surgical indication to deep-seated arteriovenous malformation].

The natural history of cerebral arteriovenous malformation (AVN) is still a subject of dispute. In the case of deep seated AVM ruptures, the problem is more serious because the hemorrhages often give rise to severe disability or death, depending on their location. Total extirpation of the nidus is fundamentally the best choice for treatment of AVM. It is never acceptable, however, to allow a persistent post operative deficit. Forty-seven cases of deep AVM were encountered in the Tokyo Jikei University Hospital. Total extirpation of the nidus was successful in 32 cases, while no surgery was undertaken in 15. Up to the present time we have taken three risk factors into condition in judging the indications for deep seated AVM surgery: the size of the nidus, the position of the nidus, and the pattern of demarcation around nidus, as shown on CT scan. When the nidus is bordered by a hemorrhage, cyst, or ventricular wall, dissection of the nidus is facilitated and injury to adjacent brain tissue is minimized, and this is why we included profound demarcation around the nidus as the third factor. We then determined grade of risk with respect to each factor, and counted a risk score in each case. The long-term result was judged by the response to questionnaires. Of the 15 patients who did not undergo surgery, four died on account of rebleeding. The longer the patient having deep AVM survived, the more likely the occurrence of fatal rebleeding. Of the 32 patients operated on, two died immediately after surgery, while 23 survived in an improved state or without any aggravated neurological deficit.(ABSTRACT TRUNCATED AT 250 WORDS)