Arteriovenous malformations (AVM) of the brain are one of several causes of a spontaneous intracerebral hemorrhage. Unlike the more common spontaneous hypertensive hemorrhage or ruptured aneurysm, the presence of AVM often is heralded by recurrent headaches or seizures prior to rupture. The importance of recognizing these "warning" symptoms has increased recently as new microsurgical techniques allow the resection of AVMs prior to their rupture even from areas previously considered inoperable and the use of stereotaxic radiation eliminated the need for surgery in many instances.
The surgical resection of these lesions has attained even greater significance recently since it has been recognized that, in addition to a life-threatening intracerebral hemorrhage, a dementia-like syndrome, thought to be caused by the pulsatile force of the AVM, relative ischemia of the normal brain in the vicinity caused by the shunting of blood through the AVM, or both, add to the total disability over a period of years.
Figure 1
Figure 1 - Single, superficial venous drainage. Preoperative (left) and postoperative (right) angiograms.
The new aggressive approach to the treatment adopted at The Barnabas Health Institute of Neurology and Neurosurgery has been directed not only to AVMs located in the "silent areas, but also to those located in critical areas of the brain. Our experience, along with that of others who have adopted a similar approach, indicates that resectioning of an AVM from a vital area can be accomplished with no mortality and little or no additional morbidity.
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