Use of Laser in Arteriovenous Malformation Surgery

Arteriovenous malformation surgery is particularly demanding owing to the need to control bleeding of small, deep white matter vessels during and after removal of the nidus; this is probably one of the most critical moments of arteriovenous malformation surgery. The aim of this article is to describe a useful technique based on the use of tweezers to temporarily stop the blood flow followed by coagulation with the thulium laser.

Surgery was performed in 20 patients with unruptured cerebral arteriovenous malformations. In each case, the superficial feeder vessels were easily coagulated with nonstick bipolar tips. The finer and deeper feeder vessels were coagulated with use of tweezers and thulium laser.

All patients were treated successfully. Optimal intraoperative hemostasis was achieved.

Results were good with no postoperative complications. Our results could encourage a more standardized use of the described technique.