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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
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Contralateral Transfalcine Approach to Deep Parasagittal Arteriovenous Malformations-Technical Note
Ivo Peto1, Mohsen Nouri2, Jeffrey Katz3
1Department of Neurosurgery and Brain Repair, University of South Florida, Morsani College of Medicine, Tampa, Florida, USA; Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, New York, USA.
World Neurosurgery
|August 14, 2020
Summary
The contralateral transfalcine approach offers a safe and effective method for resecting deep arteriovenous malformations (AVMs). This technique minimizes brain retraction, preserving neurological function in patients with AVMs near eloquent areas.
Area of Science:
- Neurosurgery
- Cerebrovascular Surgery
- Surgical Neurology
Background:
- Deep medial frontal and parietal arteriovenous malformations (AVMs) present surgical challenges due to limited access and the risk of neurological deficits.
- Minimizing brain retraction is crucial when operating near eloquent cortical areas to prevent inadvertent neurologic damage.
Observation:
- The contralateral transfalcine approach was utilized in 5 cases for deep-seated parasagittal AVM resection.
- The unaffected hemisphere was positioned in a gravity-dependent manner during the surgical procedures.
Findings:
- Complete resection of AVMs was achieved in all 5 patients.
- No permanent major neurologic deficits were observed postoperatively.
- The approach provided superior visualization of arterial feeders and allowed early control of parenchymal feeders while minimizing brain retraction.
Implications:
- The contralateral transfalcine approach is a valuable technique for managing deep-seated AVMs in eloquent brain regions.
- This method helps cerebrovascular surgeons avoid neurological deficits by minimizing normal brain retraction.
