Resection of Right Frontal Arteriovenous Malformation: 3-Dimensional Operative Video

Resection of Right Frontal Arteriovenous Malformation: 3-Dimensional Operative Video SURGICAL VIDEO Resection of Right Frontal Arteriovenous Malformation: 3-Dimensional Operative Video William T. Couldwell, MD, PhD Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy090 Correspondence: William T. Couldwell, MD, PhD, Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N Medical Dr, Salt Lake City, UT 84132. E-mail: neuropub@hsc.utah.edu The video demonstrates resection of a Grade II demonstrates careful microsurgical dissection on the Spetzler-Martin unruptured, medium-sized arteriovenous AVM/brain interface, with selective interruption of feeding malformation (AVM). A young woman presented with arteries circumferentially. The lesion was removed after headaches and seizures. The right frontal lesion measured ligation of the large superficial draining vein. Postoper- 4.5 cm in largest dimension and had superficial venous ative day 1 and 1-yr angiography demonstrated complete drainage. Partial Onyx embolization, primarily of the resection. The patient’s symptoms abated after resection. anterior cerebral feeding arteries, was performed. Bone This case is presented with a waiver of informed consent removal for exposure allowed identification of inden- as per the Institutional Review Board. tation from the large superficial draining vein. The video KEY WORDS: Arteriovenous malformation, Feeding arteries, Microsurgical dissection Operative Neurosurgery 0:1, 2018 DOI:10.1093/ons/opy090 Received, December 7, 2017. Accepted, March 26, 2018. Disclosure he authors have presented an operative video showing the surgical treatment of a young woman with a Spetzler-Martin grade II AVM, The author has no personal, financial, or institutional interest in any of the in particular the key principles and steps of AVM surgery. This is a classic drugs, materials, or devices described in this article. case of a supratentorial, wedge-shaped lesion. As it presented unruptured, the lesion may have been considered for observation in this era; however, COMMENTS her young age tilts the decision toward resection. The operative video, which is quite bloodless, shows the benefit of preoperative embolization. he authors present a video illustrating the management of a Spetzler- However, the benefit of embolization should always be weighed against Martin grade 2 AVM of the right frontal lobe. The details and steps its non-trivial risks. of resection are well presented. I raise the question, however, of the need for preoperative embolization for this straightforward AVM. Visish M. Srinivasan Akash J. Patel Carlos A. David Burlington, Massachusetts Houston, Texas OPERATIVE NEUROSURGERY VOLUME 0 | NUMBER 0 | 2018 | 1 Downloaded from https://academic.oup.com/ons/advance-article-abstract/doi/10.1093/ons/opy090/4967787 by Ed 'DeepDyve' Gillespie user on 12 July 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Operative Neurosurgery Oxford University Press

Resection of Right Frontal Arteriovenous Malformation: 3-Dimensional Operative Video

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Publisher
Oxford University Press
Copyright
Copyright © 2018 by the Congress of Neurological Surgeons
ISSN
2332-4252
eISSN
2332-4260
D.O.I.
10.1093/ons/opy090
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Abstract

SURGICAL VIDEO Resection of Right Frontal Arteriovenous Malformation: 3-Dimensional Operative Video William T. Couldwell, MD, PhD Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opy090 Correspondence: William T. Couldwell, MD, PhD, Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N Medical Dr, Salt Lake City, UT 84132. E-mail: neuropub@hsc.utah.edu The video demonstrates resection of a Grade II demonstrates careful microsurgical dissection on the Spetzler-Martin unruptured, medium-sized arteriovenous AVM/brain interface, with selective interruption of feeding malformation (AVM). A young woman presented with arteries circumferentially. The lesion was removed after headaches and seizures. The right frontal lesion measured ligation of the large superficial draining vein. Postoper- 4.5 cm in largest dimension and had superficial venous ative day 1 and 1-yr angiography demonstrated complete drainage. Partial Onyx embolization, primarily of the resection. The patient’s symptoms abated after resection. anterior cerebral feeding arteries, was performed. Bone This case is presented with a waiver of informed consent removal for exposure allowed identification of inden- as per the Institutional Review Board. tation from the large superficial draining vein. The video KEY WORDS: Arteriovenous malformation, Feeding arteries, Microsurgical dissection Operative Neurosurgery 0:1, 2018 DOI:10.1093/ons/opy090 Received, December 7, 2017. Accepted, March 26, 2018. Disclosure he authors have presented an operative video showing the surgical treatment of a young woman with a Spetzler-Martin grade II AVM, The author has no personal, financial, or institutional interest in any of the in particular the key principles and steps of AVM surgery. This is a classic drugs, materials, or devices described in this article. case of a supratentorial, wedge-shaped lesion. As it presented unruptured, the lesion may have been considered for observation in this era; however, COMMENTS her young age tilts the decision toward resection. The operative video, which is quite bloodless, shows the benefit of preoperative embolization. he authors present a video illustrating the management of a Spetzler- However, the benefit of embolization should always be weighed against Martin grade 2 AVM of the right frontal lobe. The details and steps its non-trivial risks. of resection are well presented. I raise the question, however, of the need for preoperative embolization for this straightforward AVM. Visish M. Srinivasan Akash J. Patel Carlos A. David Burlington, Massachusetts Houston, Texas OPERATIVE NEUROSURGERY VOLUME 0 | NUMBER 0 | 2018 | 1 Downloaded from https://academic.oup.com/ons/advance-article-abstract/doi/10.1093/ons/opy090/4967787 by Ed 'DeepDyve' Gillespie user on 12 July 2018

Journal

Operative NeurosurgeryOxford University Press

Published: Apr 11, 2018

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