A gentleman aged 38
years presented with a 5 years history of a feeling off epigastric discomfort
followed by automatic movements lasting for 10 minutes followed by complete
recovery. He had no memory of the episode. He was diagnosed as a case of complex
partial seizures which were poorly controlled with medication.
CT scan of the head
showed a lesion in the right temporal lobe of the brain(yellow arrows).
MRI brain also revealed
an Arterio-venous malformation in the right temporal lobe(yellow arrows)
Digital Subtraction Angiography
showed that the malformation was fed by branches from the middle cerebral
artery with veins draining towards the surface and into the depth.
The AV malformation
was completely removed by microsurgical technique. During surgery multiple
tortuous arterialized veins were fed by right first part of the middle cerebral
artery. It was drained by two veins, one over the brain surface and the other
towards its lower surface.
Post-operative CT
scan of head showed surgical changes and the cavity left after removal of the AVM
(yellow dots)
The patient recovered
well and was discharged intact on long term anti-epileptic medication.
Right Tempolar lobe AVM. Did you preoperative embolize the AVM ?
ReplyDeleteGreat work in such challenging case.
Dr TOmasz Skaba
Hello,
ReplyDeleteI will be grateful to accept me as a member of Indian Neurosurgery Forum.
Thank you in advance.
Kindly regards,
Dr Tomasz Skaba
Specialist in Neurosurgery
Poland.
Categorization of temporal AVMs into subtypes can assist with surgical planning and also standardize reporting. Lateral AVMs are the easiest to expose surgically, with circumferential access to feeding arteries and draining veins at the AVM margins. Basal AVMs require a subtemporal approach, often with some transcortical dissection through the inferior temporal gyrus. Medial AVMs are exposed tangentially with an orbitozygomatic craniotomy and transsylvian dissection of anterior choroidal artery and posterior cerebral artery feeders in the medial cisterns. Medial AVMs posterior to the cerebral peduncle require transcortical approaches through the temporooccipital gyrus. Sylvian AVMs require a wide sylvian fissure split and differentiation of normal arteries, terminal feeding arteries, and transit arteries. Ventricular AVMs require a transcortical approach through the inferior temporal gyrus that avoids the Meyer loop. Surgical results with temporal lobe AVMs are generally good, and classifying them does not offer any prediction of surgical risk.
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