You Take the Low Road: Differential Outcomes After Tangential and Transcortical Approaches to Medial Temporal Brain Arteriovenous Malformations

被引：1

作者：

Scherschinski, Lea ^{[1
]}

Srinivasan, Visish M. ^{[1
]}

Karahalios, Katherine ^{[1
]}

Garcia, Joseph H. ^{[2
]}

Koester, Stefan W. ^{[1
]}

Jubran, Jubran H. ^{[1
]}

Benner, Dimitri ^{[1
]}

Winkler, Ethan A. ^{[1
]}

Catapano, Joshua S. ^{[1
]}

Labib, Mohamed A. ^{[1
]}

Graffeo, Christopher S. ^{[1
]}

Lawton, Michael T. ^{[1
]}

机构：

[1] St Josephs Hosp, Barrow Neurol Inst, Dept Neurosurg, Phoenix, AZ 85013 USA

[2] Univ Calif San Francisco, Dept Neurosurg, San Francisco, CA USA

来源：

WORLD NEUROSURGERY | 2023年 / 173卷

关键词：

Brain arteriovenous malformation; Cerebrovascular; Medial; Orbitozygomatic; Tangential; Temporal lobe; Transcortical; MONTREAL COGNITIVE ASSESSMENT; VISUAL-FIELD DEFECTS; QUALITY-OF-LIFE; SELECTIVE AMYGDALOHIPPOCAMPECTOMY; NEUROPSYCHOLOGICAL OUTCOMES; TELEPHONE INTERVIEW; LOBE; EPILEPSY; RESECTION; SURGERY;

D O I：

10.1016/j.wneu.2023.02.005

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

-OBJECTIVE: Microsurgical resection of medial temporal brain arteriovenous malformations (AVMs) is typically conducted through 2 approaches: the orbitozygomatic-tangential and subtemporal-transcortical. Relative in-dications and outcomes for these techniques have not been formally compared.METHODS: The cerebrovascular database of a quater-nary center was reviewed for patients with medial tem-poral AVMs treated between January 1, 1997, and July 31, 2021. Demographic characteristics, lesion characteristics, surgical approaches, and outcomes were retrospectively analyzed and compared. Postoperative outcome testing was performed using the Montreal Cognitive Assessment and Global Quality of Life Scale.RESULTS: Fifty-nine patients were assessed. Mean (standard deviation) age was 31 (18) years; 30 (51%) patients were male. Of the AVMs, 29 (49%) were left-sided and 30 (51%) were right-sided. The tangential approach was selected in 20 (34%) cases, whereas the transcortical technique was preferred in 39 (66%). Improved modified Rankin Scale status was significantly associated with the tangential resection technique both in the early post-operative period (P = 0.02) and at last follow-up (P = 0.01). Differences between the tangential and transcortical approaches were not significant with respect to new postoperative deficits (5/20 [25%] vs. 12/39 [31%], P = 0.87) or the presence of residual AVM on follow-up angiography (1/20 [6%] vs. 5/39 [14%], P = 0.65).CONCLUSIONS: The orbitozygomatic-tangential strategy was associated with favorable functional and quality-of -life outcomes after medial temporal AVM resection. These benefits are likely to be attributable to minimization of temporal retraction, avoidance of brain transgression, and avoidance of traction on the vein of Labbe, rendering the orbitozygomatic-tangential approach the preferred op-tion for cases that are anatomically amenable to either strategy.

引用

页码：E81 / E90

页数：10