Microsurgical Resection of Cerebral Arteriovenous Malformations

Huh, Jae Taeck

Abstract

The treatment of cerebral arteriovenous malformations is concerned primarily with eliminating the substantial risk of potentially lethal intracranial hemorrhage. The surgical technique chosen aims to resect the AVM without removing or damaging brain tissue and interfering with microcirculation. The selection of the technical modalities is based on the presence of preoperative neurological deficits or an intracerebral hematoma, and the relationship of the AVM to the functionally important area. There is, however, controversy regarding the inherent risk of surgery involving AVM's, especially those with large parenchymal hemorrhage, those in the functional area, those with medially located draining veins, and those with a combination of these factors. This report illustrates the need for surgical decision making on a case-by-case basis. In this report three different technical modalities were used to resect AVM's. First, in cases involving an AVM of the ventricular trigone, the author advocated the direct transcortical parieto-occipital approach using a microsurgical technique based on knowledge of the anatomic architecture and hemodynamics of AVM's. Second, a small AVM in the left frontal opecular area was stereotactically resected using the transsulcal approach, with minimal resultant brain retraction or damage. Third, resection of a medium-sized AVM in which there was a massive life-threatening parenchymal hemorrhage involved multi-stage surgery. These results suggest that a successful selection of technical modalities can help to minimize complications and improve outcome.