Rennert Robert C, Steinberg Jeffrey A, Cheung Vincent J, Santiago-Dieppa David R, Pannell Jeffrey Scott, Khalessi Alexander A
Department of Neurosurgery, University of California, San Diego;
Department of Neurosurgery, University of California, San Diego.
J Vis Exp. 2017 Oct 20(128):55522. doi: 10.3791/55522.
Arteriovenious malformations (AVMs) are associated with significant morbidity and mortality, and have a rupture risk of ~3% per year. Treatment of AVMs must be tailored specifically to the lesion, with surgical resection being the gold standard for small, accessible lesions. Pre-operative embolization of AVMs can reduce nidal blood flow and remove high-risk AVM features such as intranidal or venous aneurysms, thereby simplifying a challenging neurosurgical procedure. Herein, we describe our approach for the staged endovascular embolization and open resection of AVMs, and highlight the advantages of having a comprehensively trained neurovascular surgeon leading a multi-disciplinary clinical team. This includes planning the craniotomy and resection to immediately follow the final embolization stage, thereby using a single session of anesthesia for aggressive embolization, and rapid resection. Finally, we provide a representative case of a 22-year-old female with an unruptured right frontal AVM diagnosed during a seizure workup, who was successfully treated via staged embolizations followed by open surgical resection.
动静脉畸形（AVM）与显著的发病率和死亡率相关，每年有大约3%的破裂风险。AVM的治疗必须根据病变具体定制，手术切除是小的、可触及病变的金标准。AVM的术前栓塞可减少瘤巢血流并去除高风险的AVM特征，如瘤巢内或静脉动脉瘤，从而简化具有挑战性的神经外科手术。在此，我们描述了我们对AVM进行分期血管内栓塞和开放切除的方法，并强调由全面培训的神经血管外科医生领导多学科临床团队的优势。这包括规划开颅手术和切除，以便在最后栓塞阶段后立即进行，从而在一次麻醉中进行积极栓塞和快速切除。最后，我们提供了一个有代表性的病例，一名22岁女性在癫痫检查中被诊断为未破裂的右额叶AVM，通过分期栓塞随后进行开放手术切除而成功治愈。
