Gandhi Sirin, Mascitelli Justin R, Cavallo Claudio, Tayebi Meybodi Ali, Lawton Michael T
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Oper Neurosurg (Hagerstown). 2020 Sep 15;19(4):E423. doi: 10.1093/ons/opaa092.
Lateral medullary arteriovenous malformations (AVMs) are located in the pia on the lateral medullary surface.1 They are supplied by arterial feeders from the V4 segment of the vertebral artery or posterior inferior cerebellar artery. A 64-yr-old man presented with leg spasms and progressively worsening gait. Angiography demonstrated a lateral medullary AVM. Patient consent was obtained for the surgical treatment of this lesion. Owing to its eloquent location, an occlusion in situ was performed without resection.1,2 This technique relies on the interruption of the arterial blood supply and occlusion of the draining vein to occlude the AVM. Intraoperative neurophysiological monitoring of motor and somatosensory evoked potentials was used, and the elimination of arteriovenous shunt flow was confirmed using indocyanine green videoangiography. Occlusion in situ preserves the flow to the delicate brainstem perforators and is safer than resection in selected cases like this one. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
延髓外侧动静脉畸形（AVM）位于延髓外侧表面的软膜上。它们由椎动脉V4段或小脑后下动脉的动脉供血支供血。一名64岁男性出现腿部痉挛且步态逐渐恶化。血管造影显示为延髓外侧AVM。已获得患者对该病变进行手术治疗的同意。由于其位置特殊，未进行切除而是进行了原位闭塞。该技术依靠中断动脉供血和闭塞引流静脉来闭塞AVM。术中使用了运动和体感诱发电位的神经生理监测，并通过吲哚菁绿视频血管造影确认动静脉分流血流已消除。原位闭塞保留了流向脑干精细穿支的血流，在像这样的特定病例中比切除更安全。经亚利桑那州凤凰城巴罗神经学研究所许可使用。
