Pai Balaji, Nagaraj Nagarjun Maulyavantham, Hegde Sathyaranjandas
Bangalore Medical College and Research Institute, Department of Neurosurgery, Bangalore, India.
Turk Neurosurg. 2019;29(2):164-170. doi: 10.5137/1019-5149.JTN.22071-17.2.
To describe the authors' experiences with surgical excision of cerebral arteriovenous malformations (AVMs) using temporary proximal artery clipping to reduce intraoperative bleeding and excision time.
Temporary proximal artery clipping was employed by the authors during surgery on 14 patients with cerebral AVMs in a public-sector institution. Seven AVMs were situated in eloquent areas like the sensory, motor, and speech areas and the other seven were located in non-eloquent areas. Four patients each were classified as Spetzler grades 2 and 4 while three patients each were classified as grades 3 and 5. A large craniotomy flap was fashioned to enable access to the proximal feeding arteries along with the AVM. After wide dural opening, the proximal feeding arteries were first approached. The proximal middle cerebral artery was approached by opening the proximal sylvian cistern, an interhemispheric approach was employed for the distal anterior cerebral artery, and a subtemporal route was used for the P2 portion of the posterior cerebral artery. After placing a temporary aneurysm clip on the proximal feeding artery, excision of the AVM was performed, employing the basic principles of AVM excision.
Total excision of the AVM was achieved in all cases. There were no instances of cerebral infarction or neurological deficits attributable to temporary clipping of the proximal artery. There was no mortality in this series.
Temporary proximal artery clipping helps in surgical excision by reducing intraoperative bleeding and resection time.
描述作者使用临时近端动脉夹闭术切除脑动静脉畸形（AVM）以减少术中出血和切除时间的经验。
作者在一家公共部门机构对14例脑AVM患者进行手术时采用了临时近端动脉夹闭术。7例AVM位于感觉、运动和语言等功能区，另外7例位于非功能区。4例患者为Spetzler 2级和4级，3例患者为3级和5级。制作一个大的开颅皮瓣，以便能够接近近端供血动脉和AVM。广泛打开硬脑膜后，首先处理近端供血动脉。通过打开近端侧裂池处理大脑中动脉近端，采用半球间入路处理大脑前动脉远端，采用颞下入路处理大脑后动脉P2段。在近端供血动脉上放置临时动脉瘤夹后，按照AVM切除的基本原则进行AVM切除。
所有病例均实现了AVM的完全切除。没有因临时夹闭近端动脉而导致脑梗死或神经功能缺损的情况。本系列无死亡病例。
临时近端动脉夹闭术通过减少术中出血和切除时间有助于手术切除。
