Resection of lateral temporal lobe arteriovenous malformations

Cerebral arteriovenous malformations (AVMs) can be formidable lesions to treat. There are four modalities available for treatment: expectant management, radiosurgery, embolization, and microsurgery. In order to make a decision about treatment, the surgeon must consider the natural history of the lesion versus the rate of treated morbidity and mortality. Characteristics of temporal lobe AVMs such as their location, the potential for deep-seated arterial feeders and deep venous drainage, increase the risk of early clinical onset, hemorrhage, and overall morbidity and mortality (Fleetwood and Steinberg; Lancet 359:863-873, 3) and provide an additional challenge to surgeons attempting to remove the lesion while preserving eloquent local structures.

In this paper, we demonstrate our technique for the microsurgical resection of lateral temporal lobe AVMs. In order to maximize access to the lesion for safe resection, a large craniotomy is utilized, with the malformation separated from the MCA feeding arteries and underlying cortex, with care taken not to compromise en passage vessels. The entire nidus is resected and intraoperative angiography confirms appropriate resection.

Microsurgical resection remains an important part of the treatment paradigm for temporal lobe AVMs. In appropriately selected patients, this can be done with minimal morbidity.