Barrow D L, Dawson R
Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia.
Neurosurgery. 1994 Dec;35(6):1046-54. doi: 10.1227/00006123-199412000-00005.
The results in the surgical management of 26 patients with arteriovenous malformations intimately related to the trigone of the lateral ventricle are presented. Three operative approaches were used in the series, including a transtemporal route through the inferior or middle temporal gyrus (15 patients), an interhemispheric approach (8 patients), and a transcortical parieto-occipital approach (3 patients). The surgical approach was chosen on the basis of the relationship of the arteriovenous malformation to the trigone, the presence and location of associated hematoma, and preoperative neurological deficits. This report emphasizes the use of surgical adjuncts that are instrumental in the management of these challenging lesions, including magnetic resonance imaging for precise localization and operative planning, preoperative embolization to obliterate deep arterial supply, and intraoperative ultrasound and angiography to aid in localization and to document complete excision of the arteriovenous malformation before closure. The results of the management of these 26 patients are as follows: 21 had no or minor neurological deficits and were able to resume premorbid activities; 2 had a fair result, being independent but unable to resume their premorbid occupation; 2 had a poor result and were dependent as the result of an incapacitating neurological deficit; and 1 died.
本文报告了26例与侧脑室三角区密切相关的动静脉畸形患者的手术治疗结果。该系列采用了三种手术入路，包括经颞下回或颞中回的经颞入路（15例患者）、经半球间入路（8例患者）和经皮质顶枕入路（3例患者）。手术入路根据动静脉畸形与三角区的关系、相关血肿的存在及位置以及术前神经功能缺损情况来选择。本报告强调了手术辅助手段在处理这些具有挑战性病变中的应用，包括用于精确定位和手术规划的磁共振成像、用于闭塞深部动脉供血的术前栓塞，以及术中超声和血管造影，以辅助定位并在关闭切口前记录动静脉畸形的完全切除情况。这26例患者的治疗结果如下：21例无神经功能缺损或仅有轻微神经功能缺损，能够恢复病前活动；2例效果尚可，能够独立生活但无法恢复病前工作；2例效果不佳，因严重神经功能缺损而需要依赖他人；1例死亡。
