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Grade 4 Temporal Arteriovenous Malformation: 2-Dimensional Operative Video
Benjamin K Hendricks1, Robert F Spetzler1
1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Operative Neurosurgery (Hagerstown, Md.)
|November 24, 2019
Summary
Surgical resection of complex brain arteriovenous malformations (AVMs) is challenging but feasible. This case highlights successful AVM removal in an eloquent region, preventing rehemorrhage risk.
Area of Science:
- Neurosurgery
- Vascular Neurology
Background:
- Arteriovenous malformations (AVMs) carry a significant annual rupture risk (2-4%).
- Surgery in eloquent brain regions poses high risks, necessitating careful consideration.
- Hemorrhage events can alter the operability of AVMs, potentially enabling intervention.
Purpose of the Study:
- To demonstrate the surgical principles for resecting a complex Spetzler-Martin grade 4 AVM.
- To illustrate the management of AVMs in eloquent brain regions with deep venous drainage.
- To showcase the successful complete resection of a challenging temporal lobe AVM.
Main Methods:
- Microdissection using microscissors for arachnoid plane delineation.
- Circumdissection and disconnection of the AVM nidus.
- Identification and management of draining veins and feeding arteries.
Main Results:
- Complete resection of the Spetzler-Martin grade 4 AVM was confirmed postoperatively via angiography.
- The surgical approach successfully addressed the deep venous drainage and eloquent location.
- The patient underwent successful surgical intervention to mitigate rehemorrhage risk.
Conclusions:
- Complex AVMs in eloquent brain regions can be surgically resected.
- Careful surgical technique, including microdissection and nidus disconnection, is crucial for successful AVM removal.
- Intervention following hemorrhage can be a viable strategy to prevent recurrent bleeding from previously inoperable AVMs.
