SURGICAL VIDEO Multimodality Treatment of a Temporal Grade II Arteriovenous Malformation: Operative Video Gary Rajah, MD, Arianne Boylan, MD, Mathew Schreckinger, MD, Leonardo Rangel-Castilla, MD Department of Neurosurgery, Wayne State School of Medicine, Wayne State University, Detroit, Michigan We present a 42-yr-old male with no past medical history Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/ who presented to the emergency room with new onset of opx124 seizures. On examination, he was alert and oriented but drowsy, mildly aphasic, and no focal deficits. Imaging demon- strated a ruptured posterior left temporal grade II arteriovenous COMMENT malformation (AVM). After informed patient consent, the his is an excellent video illustrating the comprehensive management patient underwent cerebral angiography with an awake, super- T of a ruptured left temporal arteriovenous malformation (AVM) in selective Wada test prior to embolization. The AVM was then a young patient. The angiogram showed a superficial Spetzler-Martin successfully embolized with Onyx liquid embolic material. He Grade I AVM. The authors perform selective microexploration followed then underwent stereotactic left temporal parietal craniotomy, by selective WADA testing that demonstrates that the AVM is not hematoma evacuation, and microsurgical resection of AVM. in eloquent territory and that the feeders are not en passant. Partial A postoperative cerebral angiogram demonstrated gross total embolization is performed with Onyx mainly to act as a localizer resection. The patient was neurologically intact at his most recent during surgery. The microsurgical video clearly highlights the principles clinical follow-up. The patient consented to the publication this of microsurgical resection of AVM: preservation of the draining vein, clean bloodless arachnoid dissection, using the hematoma as a primary video. dissection plane, isolation and disconnection of AVM arterial feeders, circumferential pial dissection, and the use of indocyanine green angiog- raphy pre- and post-resection. Disclosure Sabareesh K. Natarajan The authors have no personal, financial, or institutional interest in any of the Elad I. Levy drugs, materials, or devices described in this article. Buffalo, New York OPERATIVE NEUROSURGERY VOLUME 14 | NUMBER 3 | MARCH 2018 | 317 Downloaded from https://academic.oup.com/ons/article-abstract/14/3/317/3835263 by Ed 'DeepDyve' Gillespie user on 16 March 2018
Operative Neurosurgery – Oxford University Press
Published: Mar 1, 2018
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