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Serebral AVM'lerde Sınıflamaların Önemi, Temel Hastane Deneyimi

GİRİŞ ve AMAÇ: Serebral Arteriovenöz malformasyonlar nöroşirürji pratiğinde sık karşılaşılan vasküler hastalıklardır. Bu vasküler hastalıklarda cerrahi veya endovasküler yaklaşımlar gibi alternatif tedavi yöntemlerinin uygulanma endikasyonları halen tartışmalıdı.Serebral AVM tedavisinde konservatif, endovasküler, radyocerrahi ve mikrocerrahi gibi çeşitli yöntemler kullanılmaktadır. Başarılı klinik sonuçlar elde edebilmek için hangi hastada hangi tedavi yönteminin seçileceğine karar vermek en önemli adımdır. GEREÇ ve YÖNTEM: Günümüzde Spetzler Martin skalası, AVM cerrahi uygunluğu veya cerrahi riskleri öngörmek amacıyla yaygın olarak kullanılan basit ve pratik bir skaladır. Tedavi seçimini belirlemede yeterli olup olmadığı tartışılsa da halen uygun cerrahi kararı Spetzler Martin skalası zemininde verilmektedir. Çalışmamızda kliniğimizde 2009 ve 2016 yılları arasında cerrahi tedavi yapılan Spetzler Martin 3. derece olan 9 hasta değerlendirilmiştir. BULGULAR: Genellikle rüptüre veya semptomatik AVM tanısı olan hastalarda mümkünse mikrocerrahi yöntemler tedavi için kullanılır. TARTIŞMA ve SONUÇ: Cerrahi tedavinin mümkün olmadığı hastalarda ise radyocerrahi gibi farklı tedavi yöntemleri uygulanabilir. Devam eden tartışmalara rağmen biz klinik çalışmamızda, bilinenin aksine cerrahi tedavi uygulanan 3. derece AVM hastalarının tedavisinde başarılı sonuçlar elde edilebileceğini sunduk.

The Effectiviness of The Classification on The Cerebral AVM's, A Basic Hospital Experience

INTRODUCTION: Cerebral arteriovenous malformation (AVM) is a common vascular disease in neurosurgery, and the indication for alternative treatments remains controversial. Cerebral AVM’s have different alternative treatments as conservative, endovascular, radiosurgery and microsurgical excision. Microsurgical excision is safer and may be best choice for appropriate patients. The grading scale of Spetzler Martin has been the most widely used scale to predict the operability and surgical risks of AVMs because of its ease, simplicity and practicality. Careful selection of patients and planning of surgery are crucial for the good outcomes. Developed AVM grading scales like help to predict the safety of treatment, but it doesn’t eliminate the need for careful preoperative planning. Despite having validated predictive value, SM grading system may be somewhat too simplistic for many occasions, and additional scales have been proposed. The objective of this abstract is to briefly discuss these aspects about AVM’s SM Grade III for a decision of surgery. Contrary to common belief, we have good outcomes in SM Grade III patients with the microsurgery. METHODS: We studied 9 cases of SM Grade III AVM’s received surgical resection at our institution between 2010 and 2016. Spetzler-Martin grading system was used to classify the patients who underwent surgical treatment. Neurological outcome was assassed preoperative and postoperative with the Modified Rankin Scale. RESULTS: Decision for the surgery and the role of neurosurgeon should be given by a neurovascular team. But it is not limited with the team, also the patient has a main role for the decision of treatment options. DISCUSSION and CONCLUSION: With careful patient selection, even high grade lesions, particularly those that have ruptured, may be good candidates for microsurgical treatment

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