Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio.
Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio.
Oper Neurosurg (Hagerstown). 2018 Jul 1;15(1):32-38. doi: 10.1093/ons/opx186.
Although tubular retractor systems have gained popularity for other indications, there have been few reports of their use for arteriovenous malformation (AVM) surgery. A patient was diagnosed with a ruptured 1.2-cm subcortical AVM after presenting with intracerebral hemorrhage in the right frontal lobe and anterior basal ganglia. The characteristics of this AVM made it amenable to resection using a tubular retractor.
To demonstrate the feasibility and safety of AVM resection using a tubular retractor system.
Resection of the ruptured 1.2-cm subcortical AVM was performed utilizing the BrainPathTM (NICO corp, Indianapolis, Indiana) tubular retractor system.
The BrainPathTM approach provided sufficient visualization and surgical freedom to permit successful AVM resection and hematoma evacuation. Postoperative imaging demonstrated near total hematoma removal and angiographic obliteration of the AVM. There were no complications, and the patient made an excellent recovery.
Tubular retractors warrant consideration for accessing small, deep, ruptured AVMs. The nuances of such systems and their role in AVM surgery are discussed.
尽管管状牵开器系统在其他适应证中已得到广泛应用，但用于动静脉畸形（AVM）手术的报道却很少。一位患者因右额叶和前基底节区脑出血而被诊断为 1.2cm 皮质下破裂性 AVM。该 AVM 的特点使其适合使用管状牵开器进行切除。
展示使用管状牵开器系统切除 AVM 的可行性和安全性。
使用 BrainPathTM（NICO 公司，印第安纳波利斯，印第安纳州）管状牵开器系统切除破裂的 1.2cm 皮质下 AVM。
BrainPathTM 入路提供了足够的可视化和手术自由度，可成功切除 AVM 和清除血肿。术后影像学显示血肿几乎完全清除，AVM 血管造影闭塞。无并发症发生，患者恢复良好。
对于小型、深部、破裂的 AVM，管状牵开器值得考虑。本文讨论了此类系统的细微差别及其在 AVM 手术中的作用。
