Ultrasound guided microsurgical resection of cerebral arteriovenous malformations

Microsurgical excision of intracranial arteriovenous malformations (AVMs) remains a surgical challenge that requires neurosurgical experience as well as neurosurgical tools. Advances in medical devices widen the range of tools that can be used to ensure patients' safety and procedural integrity. There is limited data published regarding the role of intraoperative ultrasound to ensure proper cerebral arteriovenous malformation excision.

Patients who underwent ultrasound-assisted microsurgical excision of cerebral arteriovenous malformations were reviewed in a single center from 2021 through 2024. Patients' clinical, radiological, and intraoperative data were retrieved and analyzed.

Twenty patients were included in the study. All lesions were in the cerebral regions. The study included 20 patients, 11 (55%) of whom were males and the patients' ages ranged from 5 to 55 years. Sixteen patients (80%) presented with headache, 13 patients (65%) with seizures, 8 patients (40%) with syncope, 2 patients (10%) with vomiting, and 6 patients (30%) with weakness.Thirteen patients (65%) had intracranial hemorrhage (ICH) on presentation. For all cases, intraoperative ultrasound (IOUS) was successful in confirming total resection of the lesion. In 13 cases that involved an intracerebral hematoma took place, the hematoma was visualized easily with grey-scale B-mode ultrasound, as well as its relation to the nidus was clearly delineated.

Intraoperative ultrasonography is a useful, cost-effective, and non-invasive tool for guiding through cerebral arteriovenous malformation microsurgical excision.