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[Total removal through the ventricle in 2 cases of pallidocaudal arteriovenous abnormalities under deep hypotension]
Insights
Surgical removal of arteriovenous malformations (AVMs) in the pallido-caudal region is feasible. Deep hypotension and the operative microscope facilitated successful AVM resection with no neurological deficits in two patients.
Area of Science:
- Neurosurgery
- Neuroradiology
- Vascular Neurology
Context:
- Arteriovenous malformations (AVMs) in the pallido-caudal region present unique surgical challenges.
- Precise pre-operative imaging is crucial for planning surgical approaches to deep-seated AVMs.
- The anterior perforated space arteries are key feeding vessels for these AVMs.
Purpose:
- To investigate the utility of advanced angiographic techniques in evaluating AVMs.
- To determine the feasibility of surgical AVM resection via the lateral ventricle.
- To assess the safety and efficacy of deep hypotension during AVM surgery.
Summary:
- Two cases of AVMs in the pallido-caudal area, supplied by anterior perforated space arteries, were studied.
- Angiography, angiotomography with pneumoencephalography, and hypotension angiography were employed.
- Surgical removal through the lateral ventricle was deemed possible and successfully performed using a retrograde technique under deep hypotension and operative microscopy.
Impact:
- Demonstrates a successful surgical strategy for challenging AVMs.
- Highlights the benefits of deep hypotension and operative microscopy in AVM resection.
- Confirms positive patient outcomes with no additional neurological deficits post-surgery.
Abstract:
Two cases of A.V.M. situated in the pallido-caudal area and directly nourrished by the anterior perforated space arteries have been investigated using three angiographic techniques: selective internal carotid angiography, angiotomography including pneumoencephalography and angiography under deep hypotension at 30 mm Hg (mean pressure) induced by sodium nitroprusside. These investigations led to the conclusion that the A.V.M. could be removed through the lateral ventricle. Both were radically removed using the retrograde technique under deep hypotension and the operative microscope. Both patients are alive without additional neurological deficit.