Surgical Strategy and Techniques for treating Cerebral Arteriovenous Malformation

概要

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A well planned treatment strategy as well as a high level of surgical skill is necessary to accomplish cerebral arteriovenous malformation (AVM) surgery successfully. In this paper, we will discuss the standard strategy and surgical techniques when AVMs are treated by open surgery alone. First, careful planning based-on the preoperative 3-dimentional radiological examinations must be made. We also must prepare the operative instruments and seek the assistance of another neurosurgeon for relief support. AVM removal surgery consists of the following 4 steps : (1) make a sufficient craniotomy and separate the cortical sulci to secure the proximal feeding artery, (2) coagulate and cut the feeding arteries just before going into the nidus, (3) dissect the nidus using the gliosis area as a margin and the vessels loop as a guidepost, and coagulate the feeding arteries coming from the deep area, (4) cut the drainer after confirming its appearance has changed into the color of venous blood and then remove the nidus. The surgical skills to achieve those 4 steps are a standard technique to master as a vascular neurosurgeon.