Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Case Western Reserve School of Medicine, Cleveland, Ohio, USA.
Oper Neurosurg (Hagerstown). 2023 May 1;24(5):499-506. doi: 10.1227/ons.0000000000000599. Epub 2023 Jan 23.
Arteriovenous malformations (AVMs) in the subcortical and/or periventricular regions can cause significant intraventricular and intracranial hemorrhage. These AVMs can pose a unique surgical challenge because traditional, open approaches to the periventricular region require significant cortical/white matter retraction to establish sufficient operative corridors, which may result in risk of neurological injury. Minimally invasive tubular retractor systems represent a novel, feasible surgical option for treating deep-seated AVMs.
To explore 5 cases of NICO BrainPath-assisted resection of subcortical/periventricular AVMs.
Five patients from a single institution were operated on for deep-seated AVMs using tubular retractor systems. Collected data included demographics, AVM specifications, preoperative neurological status, postoperative neurological status, and postoperative/intraoperative angiogram results.
Five patients, ranging from age 10 to 45 years, underwent mini-craniotomy for stereotactically guided tubular retractor-assisted AVM resection using neuronavigation for selecting a safe operative corridor. No preoperative embolization was necessary. Mean maximum AVM nidal diameter was 8.2 mm. All deep-seated AVMs were completely resected without complications. All AVMs demonstrated complete obliteration on intraoperative angiogram and on 6-month follow-up angiogram.
Minimally invasive tubular retractors are safe and present a promising surgical option for well-selected deep-seated AVMs. Furthermore, study may elucidate whether tubular retractors improve outcomes after microsurgical AVM resection secondary to mitigation of iatrogenic retraction injury risk.
位于皮质下和/或脑室周围区域的动静脉畸形（AVM）可导致显著的脑室和颅内出血。这些 AVM 可能带来独特的手术挑战，因为传统的脑室周围开放方法需要显著的皮质/白质牵拉以建立足够的手术通道，这可能导致神经损伤的风险。微创管状牵开器系统代表了一种新颖的、可行的治疗深部 AVM 的手术选择。
探讨 NICO BrainPath 辅助切除皮质下/脑室周围 AVM 的 5 例病例。
一家单中心的 5 名患者因深部 AVM 接受了管状牵开器系统的手术。收集的数据包括人口统计学、AVM 特征、术前神经状态、术后神经状态和术后/术中血管造影结果。
5 名年龄在 10 岁至 45 岁之间的患者接受了微型开颅术，使用立体定向引导的管状牵开器辅助 AVM 切除术，神经导航用于选择安全的手术通道。不需要术前栓塞。平均最大 AVM 中心直径为 8.2 毫米。所有深部 AVM 均在无并发症的情况下完全切除。所有 AVM 在术中血管造影和 6 个月随访血管造影上均显示完全闭塞。
微创管状牵开器是安全的，为精心选择的深部 AVM 提供了一种有前途的手术选择。此外，研究可能阐明管状牵开器是否通过减轻医源性牵拉损伤风险来改善显微手术 AVM 切除后的结果。
