Downloaded from https://academic.oup.com/ons/article-abstract/16/1/111/4967787 by Ed 'DeepDyve' Gillespie user on 16 January 2019 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: firstname.lastname@example.org 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 16:111, 2019 DOI:10.1093/ons/opy090 Received, December 7, 2017. Accepted, March 26, 2018. Published Online, April 11, 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 16 | NUMBER 1 | JANUARY 2019 | 111
Operative Neurosurgery – Oxford University Press
Published: Apr 11, 2018
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