Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

J Vis Exp. 2017 Oct 20:(128):55522. doi: 10.3791/55522.

Abstract

Arteriovenious malformations (AVMs) are associated with significant morbidity and mortality, and have a rupture risk of ~3% per year. Treatment of AVMs must be tailored specifically to the lesion, with surgical resection being the gold standard for small, accessible lesions. Pre-operative embolization of AVMs can reduce nidal blood flow and remove high-risk AVM features such as intranidal or venous aneurysms, thereby simplifying a challenging neurosurgical procedure. Herein, we describe our approach for the staged endovascular embolization and open resection of AVMs, and highlight the advantages of having a comprehensively trained neurovascular surgeon leading a multi-disciplinary clinical team. This includes planning the craniotomy and resection to immediately follow the final embolization stage, thereby using a single session of anesthesia for aggressive embolization, and rapid resection. Finally, we provide a representative case of a 22-year-old female with an unruptured right frontal AVM diagnosed during a seizure workup, who was successfully treated via staged embolizations followed by open surgical resection.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Embolization, Therapeutic / methods*
  • Female
  • Humans
  • Intracranial Arteriovenous Malformations / pathology
  • Intracranial Arteriovenous Malformations / surgery*
  • Neurosurgical Procedures / methods*
  • Treatment Outcome
  • Young Adult