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Cerebrovascular and
Tumor Neurosurgery

Dr. Mika Niemela
ื“"ืจ ืžื™ืงื” ื ื™ืžืœื”. ื ื™ืชื•ื—ื™ ื›ืœื™ ื“ื ืžื•ื—ื™ื™ื: ืžืคืจืฆื•ืช (ืื ื•ืจื™ื–ืžื•ืช) ื•ืคื’ืžื™ื ืขื•ืจืงื™ื™ื-ื•ืจื™ื“ื™ื™ื (AVM). ื ื•ื™ืจื•ื›ื™ืจื•ืจื’ื™ืช ื’ื™ื“ื•ืœื™ ืžื•ื—. ืงื•ืจื•ืช ื—ื™ื™ื. 0
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1. ื“"ืจ ืžื™ืงื” ื ื™ืžืœื”. ื ื™ืชื•ื—ื™ ื›ืœื™ ื“ื ืžื•ื—ื™ื™ื: ืžืคืจืฆื•ืช (ืื ื•ืจื™ื–ืžื•ืช) ื•ืคื’ืžื™ื ืขื•ืจืงื™ื™ื-ื•ืจื™ื“ื™ื™ื (AVM). ื ื•ื™ืจื•ื›ื™ืจื•ืจื’ื™ืช ื’ื™ื“ื•ืœื™ ืžื•ื—. ืงื•ืจื•ืช ื—ื™ื™ื. 0

ื“"ืจ ืื ื˜ื•ืŸ ื˜ื™ื˜ื•ื‘, MD, ืžืจืื™ื™ืŸ ืืช ื”ื ื•ื™ืจื•ื›ื™ืจื•ืจื’ ื”ื ื•ื“ืข ืขืœ ื”ืคืจืงื˜ื™ืงื” ื”ืงืœื™ื ื™ืช ืฉืœื•.

ืื ื—ื ื• ืื—ื“ ืžืžืจื›ื–ื™ ื”ื ื•ื™ืจื•ื›ื™ืจื•ืจื’ื™ื” ื”ืžื•ื—ื™ืช ื•ื”ืฉื“ืจืชื™ืช ื”ืคืขื™ืœื™ื ื‘ื™ื•ืชืจ ื‘ืื™ืจื•ืคื”.
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2. ืื ื—ื ื• ืื—ื“ ืžืžืจื›ื–ื™ ื”ื ื•ื™ืจื•ื›ื™ืจื•ืจื’ื™ื” ื”ืžื•ื—ื™ืช ื•ื”ืฉื“ืจืชื™ืช ื”ืคืขื™ืœื™ื ื‘ื™ื•ืชืจ ื‘ืื™ืจื•ืคื”.

ืžื•ืžื—ื” ืžื•ื‘ื™ืœ ื‘ื ื•ื™ืจื•ื›ื™ืจื•ืจื’ื™ื” ืฉืœ ื›ืœื™ ื“ื ืžื•ื—ื™ื™ื ื•ื’ื™ื“ื•ืœื™ ืžื•ื—, ื“"ืจ ืžื™ืงื” ื ื™ืžืœื”, MD, ืžืกื‘ื™ืจ ืขืœ ื”ืขื‘ื•ื“ื” ื”ืžืงื™ืคื” ืฉืœ ื”ืžื—ืœืงื” ืœื ื•ื™ืจื•ื›ื™ืจื•ืจื’ื™ื” ื‘ืžืจื›ื– ื”ืจืคื•ืื™ ืื•ื ื™ื‘ืจืกื™ื˜ืช ื”ืœืกื™ื ืงื™. ื”ื•ื...

ืžื“ื•ืข ืžืคืจืฆื•ืช ืžื•ื—ื™ื•ืช ืžืชืคื•ืฆืฆื•ืช? ืกื™ื›ื•ืŸ ืœื”ืชืคื•ืฆืฆื•ืช ืฉืœ ืžืคืจืฆืช ืชื•ืš-ื’ื•ืœื’ื•ืœืชื™ืช ืงื˜ื ื” ื•ื“ื•ืคืŸ ื“ืงื”. 2
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3. ืžื“ื•ืข ืžืคืจืฆื•ืช ืžื•ื—ื™ื•ืช ืžืชืคื•ืฆืฆื•ืช? ืกื™ื›ื•ืŸ ืœื”ืชืคื•ืฆืฆื•ืช ืฉืœ ืžืคืจืฆืช ืชื•ืš-ื’ื•ืœื’ื•ืœืชื™ืช ืงื˜ื ื” ื•ื“ื•ืคืŸ ื“ืงื”. 2

ื“"ืจ ืื ื˜ื•ืŸ ื˜ื™ื˜ื•ื‘, MD, ืžืกืคืง ืชื•ื‘ื ื•ืช ืงืจื™ื˜ื™ื•ืช ืขื‘ื•ืจ ืžื˜ื•ืคืœื™ื ื•ืžืฉืคื—ื•ืช ื”ืžื‘ืงืฉื™ื ืœื”ื‘ื™ืŸ ืืช ื”ืื‘ื—ื ื” ื”ื—ืžื•ืจื” ื”ื–ื•.

ืขื“ 6% ืžื›ืœืœ ื”ืื•ื›ืœื•ืกื™ื™ื” ืกื•ื‘ืœื™ื ืžืื ื•ืจื™ื–ืžื•ืช ืžื•ื—ื™ื•ืช ืœื ืžืคื•ืฆืฆื•ืช. ื’ื•ืจืžื™ ืกื™ื›ื•ืŸ ืœืงืจืข ืฉืœ ืžืคืจืฆืช ืชื•ืšึพื’ื•ืœื’ื•ืœืชื™ืช. 3
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4. ืขื“ 6% ืžื›ืœืœ ื”ืื•ื›ืœื•ืกื™ื™ื” ืกื•ื‘ืœื™ื ืžืื ื•ืจื™ื–ืžื•ืช ืžื•ื—ื™ื•ืช ืœื ืžืคื•ืฆืฆื•ืช. ื’ื•ืจืžื™ ืกื™ื›ื•ืŸ ืœืงืจืข ืฉืœ ืžืคืจืฆืช ืชื•ืšึพื’ื•ืœื’ื•ืœืชื™ืช. 3

ืžื•ืžื—ื” ืžื•ื‘ื™ืœ ื‘ื ื•ื™ืจื•ื›ื™ืจื•ืจื’ื™ื” ืฉืœ ื›ืœื™ ื“ื ืžื•ื—ื™ื™ื, ื“"ืจ ืžื™ืงื” ื ื™ืžืœื”, MD, ืžืกื‘ื™ืจ ืืช ื”ืคืชื•ืคื™ื–ื™ื•ืœื•ื’ื™ื” ื•ื’ื•ืจืžื™ ื”ืกื™ื›ื•ืŸ ืœืงืจืข ืฉืœ ืžืคืจืฆืช ืžื•ื—ื™ืช. ื”ื•ื ืžืคืจื˜ ื›ื™ืฆื“ ื“ืœืงืช ืžื—ืœื™ืฉื”...

ื˜ื™ืคื•ืœ ื‘ืื ื•ืจื™ื–ืžื” ืžื•ื—ื™ืช. ืžื”ื“ืง, ืกืœื™ืœ, ืื• ืกื˜ื ื˜? ื›ื™ืฆื“ ืœื‘ื—ื•ืจ ืืช ื”ื˜ื™ืคื•ืœ ื”ื˜ื•ื‘ ื‘ื™ื•ืชืจ ืœืื ื•ืจื™ื–ืžื” ืชื•ืš-ื’ื•ืœื’ื•ืœืชื™ืช? 4
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5. ื˜ื™ืคื•ืœ ื‘ืื ื•ืจื™ื–ืžื” ืžื•ื—ื™ืช. ืžื”ื“ืง, ืกืœื™ืœ, ืื• ืกื˜ื ื˜? ื›ื™ืฆื“ ืœื‘ื—ื•ืจ ืืช ื”ื˜ื™ืคื•ืœ ื”ื˜ื•ื‘ ื‘ื™ื•ืชืจ ืœืื ื•ืจื™ื–ืžื” ืชื•ืš-ื’ื•ืœื’ื•ืœืชื™ืช? 4

ืžื•ืžื—ื” ืžื•ื‘ื™ืœ ื‘ื ื•ื™ืจื•ื›ื™ืจื•ืจื’ื™ื” ืฉืœ ื›ืœื™ ื“ื ืžื•ื—ื™ื™ื, ื“"ืจ ืžื™ืงื” ื ื™ืžืœื”, MD, ืžืกื‘ื™ืจ ื›ื™ืฆื“ ืœื‘ื—ื•ืจ ืืช ื”ื˜ื™ืคื•ืœ ื”ืžื™ื˜ื‘ื™ ื‘ืžืคืจืฆืช ืžื•ื—ื™ืช. ื”ื•ื ืžืคืจื˜ ืืช ื”ื’ื•ืจืžื™ื ื”ืงืจื™ื˜ื™ื™ื ื‘ื”ื—ืœื˜ื”...

ืžื•ืžื™ื ื•ืจื™ื“ื™ื™ื ืžื•ื—ื™ื™ื. ืžืชื™ ืœื˜ืคืœ ื‘ืงื‘ืจื•ืžื”? ืžืชื™ ืœื”ืžืฉื™ืš ื‘ืžืขืงื‘? 5
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6. ืžื•ืžื™ื ื•ืจื™ื“ื™ื™ื ืžื•ื—ื™ื™ื. ืžืชื™ ืœื˜ืคืœ ื‘ืงื‘ืจื•ืžื”? ืžืชื™ ืœื”ืžืฉื™ืš ื‘ืžืขืงื‘? 5

ืžื•ืžื—ื” ืžื•ื‘ื™ืœ ื‘ืžืœืคื•ืจืžืฆื™ื•ืช ืžืขืจื•ืช ืžื•ื—ื™ื•ืช, ื“"ืจ ืžื™ืงื” ื ื™ืžืœื”, MD, ืžืกื‘ื™ืจ ื›ื™ืฆื“ ืœื”ื—ืœื™ื˜ ื‘ื™ืŸ ื˜ื™ืคื•ืœ ืœืžืขืงื‘ ืขื‘ื•ืจ ืงื•ื•ืจื ื•ืžื•ืช ืžื•ื—ื™ื•ืช. ื”ื•ื ืžืคืจื˜ ืืช ื”ื’ื•ืจืžื™ื ื”ืงืจื™ื˜ื™ื™ื ื”ืžืฉืคื™ืขื™ื ืขืœ...

ื”ืžื ื’ื™ื•ืžื” ืžืขืจืชื™ืช ืžื•ื—ื™ืช. ืกื™ื›ื•ื ื™ ื“ื™ืžื•ื. 
 ืื™ื–ื• ื”ืžื ื’ื™ื•ืžื” ืžืขืจืชื™ืช ืขืœื•ืœื” ืœื“ืžื? 
 6
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7. ื”ืžื ื’ื™ื•ืžื” ืžืขืจืชื™ืช ืžื•ื—ื™ืช. ืกื™ื›ื•ื ื™ ื“ื™ืžื•ื. ืื™ื–ื• ื”ืžื ื’ื™ื•ืžื” ืžืขืจืชื™ืช ืขืœื•ืœื” ืœื“ืžื? 6

ืžื•ืžื—ื” ืžื•ื‘ื™ืœ ื‘ื ื•ื™ืจื•ื›ื™ืจื•ืจื’ื™ื” ืฉืœ ื›ืœื™ ื“ื ืžื•ื—ื™ื™ื, ื“"ืจ ืžื™ืงื” ื ื™ืžืœื”, MD, ืžืกื‘ื™ืจ ืืช ื”ืกื™ื›ื•ื ื™ื ืœื“ื™ืžื•ื ืžืื ื’ื™ื•ืžื” ืžืขืจืชื™ืช ื‘ืžื•ื—. ื”ื•ื ืžืคืจื˜ ื›ื™ืฆื“ ื”ืกื™ื›ื•ืŸ ืœื“ื™ืžื•ื ืชืœื•ื™ ื‘ืžื™ืงื•ื...

ืคื™ืกื˜ื•ืœื” ืขื•ืจืงื™ืช-ื•ืจื™ื“ื™ืช ื“ื•ืจืืœื™ืช ื‘ืžื•ื—. BDAVF. ืžื”ืŸ ืืคืฉืจื•ื™ื•ืช ื”ื˜ื™ืคื•ืœ? 7
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8. ืคื™ืกื˜ื•ืœื” ืขื•ืจืงื™ืช-ื•ืจื™ื“ื™ืช ื“ื•ืจืืœื™ืช ื‘ืžื•ื—. BDAVF. ืžื”ืŸ ืืคืฉืจื•ื™ื•ืช ื”ื˜ื™ืคื•ืœ? 7

ื ื•ื™ืจื•ื›ื™ืจื•ืจื’ ืžื•ื— ื•ื›ืœื™ ื“ื ืžื•ื‘ื™ืœ, ื“"ืจ ืžื™ืงื” ื ื™ืžืœื”, MD, ืžืกื‘ื™ืจ ื›ื™ืฆื“ ืœื‘ื—ื•ืจ ืืช ื”ื˜ื™ืคื•ืœ ื”ืžื™ื˜ื‘ื™ ืœืคืชื™ื—ืช ืขื•ืจืง-ื•ืจื™ื“ ื“ื•ืจืืœื™ ื‘ืžื•ื— (BDAVF). ื‘ื—ื™ืจืช ื”ื˜ื™ืคื•ืœ ืชืœื•ื™ื” ื‘ืžื™ืงื•ื ื”ืคืชื™ื—ื”...

ื“ื™ืžื•ื ืชื•ืš-ืžื•ื—ื™. ื˜ื™ืคื•ืœ ื•ืคืจื•ื’ื ื•ื–ื” ืฉืœ ื“ื™ืžื•ื ืžื•ื—ื™. 8
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9. ื“ื™ืžื•ื ืชื•ืš-ืžื•ื—ื™. ื˜ื™ืคื•ืœ ื•ืคืจื•ื’ื ื•ื–ื” ืฉืœ ื“ื™ืžื•ื ืžื•ื—ื™. 8

ืžื•ืžื—ื” ืžื•ื‘ื™ืœ ืœื“ื™ืžื•ื ืชื•ืš-ืžื•ื—ื™, ื“"ืจ ืžื™ืงื” ื ื™ืžืœื”, MD, ืžืกื‘ื™ืจ ืืช ื”ืชืคืงื™ื“ ื”ืงืจื™ื˜ื™ ืฉืœ ืžื ื™ืขื” ื‘ืชื•ืฆืื•ืช ื“ื™ืžื•ื ืžื•ื—ื™. ื”ื•ื ืžื“ื’ื™ืฉ ื›ื™ ื˜ื™ืคื•ืœ ื‘ื™ืชืจ ืœื—ืฅ ื“ื ื”ื•ื...

ื˜ื™ืคื•ืœ ื‘ื’ื™ื“ื•ืœื™ ืžื•ื— ื‘ืขื™ื“ืŸ ื”ืจืคื•ืื” ื”ืžื•ืชืืžืช ืื™ืฉื™ืช. ื›ื™ืฆื“ ืœื”ืฉื™ื’ ืืช ื”ืคืจื•ื’ื ื•ื–ื” ืืจื•ื›ืช ื”ื˜ื•ื•ื— ื”ื˜ื•ื‘ื” ื‘ื™ื•ืชืจ? 9
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10. ื˜ื™ืคื•ืœ ื‘ื’ื™ื“ื•ืœื™ ืžื•ื— ื‘ืขื™ื“ืŸ ื”ืจืคื•ืื” ื”ืžื•ืชืืžืช ืื™ืฉื™ืช. ื›ื™ืฆื“ ืœื”ืฉื™ื’ ืืช ื”ืคืจื•ื’ื ื•ื–ื” ืืจื•ื›ืช ื”ื˜ื•ื•ื— ื”ื˜ื•ื‘ื” ื‘ื™ื•ืชืจ? 9

ื“"ืจ ืื ื˜ื•ืŸ ื˜ื™ื˜ื•ื‘, MD, ืกื•ืงืจ ืืกื˜ืจื˜ื’ื™ื•ืช ื˜ื™ืคื•ืœื™ื•ืช ืœื’ื™ื“ื•ืœื™ ืžื•ื— ืฉืคื™ืจื™ื ื•ืžืžืื™ืจื™ื ื›ืื—ื“.

ื’ืœื™ื•ื‘ืœืกื˜ื•ืžื”. ื’ืœื™ื•ืžื” ื‘ื“ืจื’ื” ื’ื‘ื•ื”ื”. ื›ื™ืฆื“ ืืคืฉืจื•ื™ื•ืช ื”ื˜ื™ืคื•ืœ ื”ืฉืชืคืจื• ืœืื—ืจื•ื ื”? 10
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11. ื’ืœื™ื•ื‘ืœืกื˜ื•ืžื”. ื’ืœื™ื•ืžื” ื‘ื“ืจื’ื” ื’ื‘ื•ื”ื”. ื›ื™ืฆื“ ืืคืฉืจื•ื™ื•ืช ื”ื˜ื™ืคื•ืœ ื”ืฉืชืคืจื• ืœืื—ืจื•ื ื”? 10

ืžื•ืžื—ื” ืžื•ื‘ื™ืœ ื‘ื ื•ื™ืจื•ื›ื™ืจื•ืจื’ื™ื” ื•ื‘ื˜ื™ืคื•ืœ ื‘ื’ื™ื“ื•ืœื™ ืžื•ื—, ื“"ืจ ืžื™ืงื” ื ื™ืžืœื”, MD, ืžืกื‘ื™ืจ ืขืœ ื”ื˜ื™ืคื•ืœ ื”ืžื•ื“ืจื ื™ ื‘ื’ืœื™ื•ื‘ืœืกื˜ื•ืžื”. ื”ื•ื ืžืคืจื˜ ื›ื™ืฆื“ ื˜ื›ื ื™ืงื•ืช ื ื™ืชื•ื—ื™ื•ืช ื”ืชืงื“ืžื• ืขื ื›ืœื™ื ื›ืžื• ื ื™ื•ื•ื˜...

ืงืจืข ืฉืœ ืžืคืจืฆืช ืžื•ื—ื™ืช ื‘ื’ื‘ืจ ื‘ืŸ 45. ืชื™ืื•ืจ ืžืงืจื” ืงืœื™ื ื™. 11
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12. ืงืจืข ืฉืœ ืžืคืจืฆืช ืžื•ื—ื™ืช ื‘ื’ื‘ืจ ื‘ืŸ 45. ืชื™ืื•ืจ ืžืงืจื” ืงืœื™ื ื™. 11

ืžื•ืžื—ื” ืžื•ื‘ื™ืœ ื‘ื ื•ื™ืจื•ื›ื™ืจื•ืจื’ื™ื” ืฉืœ ื›ืœื™ ื“ื ืžื•ื—ื™ื™ื, ื“"ืจ ืžื™ืงื” ื ื™ืžืœื”, MD, ืžืกื‘ื™ืจ ื›ื™ืฆื“ ืœื˜ืคืœ ื‘ืžืคืจืฆืช ืžื•ื—ื™ืช ืฉื”ืชืคื•ืฆืฆื”. ื”ื•ื ืžืคืจื˜ ืžืงืจื” ืงืœื™ื ื™ ืฉืœ ื’ื‘ืจ ืžืขืฉืŸ ื‘ืŸ...