Multimodal Flow-Assisted Resection of Brain AVMs.

Area of Science:

• Neurosurgery
• Vascular Neurology

Background:

• Brain arterio-venous malformations (bAVMs) present complex surgical challenges.
• Effective intraoperative monitoring is crucial for successful bAVM resection.

Purpose of the Study:

• To evaluate a multimodal flow-assisted approach for bAVM surgery.
• To assess the efficacy and safety of combining indocyanine green video-angiography (ICG-VA), micro-flow probe flowmetry, and temporary arterial clipping tests.

Main Methods:

• Retrospective analysis of 27 patients undergoing bAVM resection.
• Utilized ICG-VA for angio-architecture visualization and surgical guidance.
• Employed micro-flow probe flowmetry and temporary arterial clipping tests for intraoperative assessment.

Main Results:

• The multimodal approach facilitated adaptable surgical strategies based on AVM characteristics.
• ICG-VA and flowmetry were valuable for pre-operative planning.
• Flowmetry proved superior to ICG-VA in detecting residual bAVMs during the final resection stage.

Conclusions:

• The multimodal flow-assisted approach is a feasible, safe, and reliable method for bAVM surgery.
• This technique achieves high rates of complete resection with low morbidity.
• It empowers surgeons to optimize technique based on intraoperative findings.