Neurosurgery and Neurology Department, Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil; Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Neurosurgery and Neurology Department, Santa Casa de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil.
World Neurosurg. 2022 Oct;166:168. doi: 10.1016/j.wneu.2022.07.149. Epub 2022 Aug 9.
Sylvian arteriovenous malformations (sAVMs) are rare and account for approximately 8%-11% of all intracranial arteriovenous malformations (AVMs). Because of their proximity to eloquent structures such as the motor speech center, insular cortex, and internal capsule, microsurgical resection of sAVMs remains a challenge. Several classifications have already been suggested for sAVMs, such as Sugita and Yasargil. It is well established that for low-grade AVMs, results of the microsurgical resection are excellent and tend to favor surgery, but in high-grade AVM, a multimodal assessment is necessary for formulating treatment strategies. In Video 1, we demonstrate the surgical resection of a ruptured sylvian temporal AVM. This AVM was localized in the superior surface of the temporal lobe, and its nidus was just beneath the cortical surface of this lobe. Because it was 5.1 cm at its largest diameter, had a deep drainage vein, and was localized adjacent to the Wernicke area, we classified it as a Spetzler-Martin grade IV AVM. Despite the high-grade AVM, microsurgical treatment was the choice in this ruptured AVM and there was no increase in morbidity.
大脑中 Sylvian 动静脉畸形（sAVM）较为罕见，约占颅内动静脉畸形（AVM）的 8%-11%。由于其毗邻运动言语中枢、岛叶皮质和内囊等重要结构，sAVM 的显微切除仍然是一个挑战。目前已经提出了几种 sAVM 的分类方法，如 Sugita 和 Yasargil 分类法。已经明确的是，对于低级别 AVM，显微切除的效果非常好，倾向于手术治疗，但对于高级别 AVM，则需要进行多模态评估来制定治疗策略。在视频 1 中，我们展示了一例破裂的大脑中 Sylvian 颞叶 AVM 的手术切除。该 AVM 位于颞叶的上表面，其病灶刚好位于该叶的皮质表面下方。由于其最大直径为 5.1cm，有一条深部引流静脉，且位于 Wernicke 区附近，我们将其分类为 Spetzler-Martin 分级 IV 级 AVM。尽管该 AVM 为高级别，但在本例破裂的 AVM 中，我们选择了显微手术治疗，且并未增加发病率。
