Microsurgical resection of cervical spinal arteriovenous malformation: the pial resection technique

We present the case of a 26-year-old female patient who had two episodes of sudden, left, upper and lower extremity paresthesias and weakness, which resolved completely after 5 months. After recovery, she presented for evaluation. Imaging demonstrated a C3-C6 intra- and extra-axial arteriovenous malformation (AVM) with spinal cord compression and edema. A spinal angiogram showed arterial feeders arising from both vertebral arteries and from the right ascending pharyngeal artery. The AVM had been partially embolized after her first bleeding episode. She underwent C3-C6 laminoplasty and microsurgical resection of the AVM. After locating the main arterial feeders and draining veins, the malformation was resected using the pial resection technique. A postoperative spinal angiogram demonstrated gross total resection. Video used with permission from Barrow Neurological Institute. The video can be found here: http://youtu.be/JbbIwCTUsuI.