Parikh Kara A, Motiwala Mustafa, Lesha Emal, Dugan John E, Yagmurlu Kaan, Arthur Adam S, Khan Nickalus R
Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, Tennessee, United States.
Surg Neurol Int. 2025 Apr 4;16:120. doi: 10.25259/SNI_1102_2024. eCollection 2025.
Arteriovenous malformations (AVMs) carry an estimated 2-4% annual risk of rupture, with an estimated 70-75% lifetime risk. They are typically discovered during young adulthood, occurring in approximately 5/10,000 individuals. Modalities of treatment involve endovascular treatment, Gamma Knife, microsurgical resection under general anesthesia, awake craniotomy, or a combination of these modalities.
We present the case of a 33-year-old male presenting with headaches who was found to have an incidental left inferior frontal Spetzler-Martin Grade 3 AVM adjacent to Broca's area. Given the large size of the AVM, the patient's young age, and the lifetime risk of rupture, the patient underwent a planned 2-stage preoperative embolization and microsurgical resection under general anesthesia with intraoperative monitoring. Complete resection of the AVM was observed on postoperative digital subtraction angiography. The patient was discharged home on postoperative day 4. The patient's transient postoperative mixed aphasia had fully resolved by the time of discharge. A review of the benefits of preoperative embolization and the technical considerations of resection of a large AVM in eloquent regions of the brain are included. The patient consented to the procedure and the publication of his images. The Institutional Review Board approval was deemed unnecessary due to the retrospective, case-report nature of this work.
Large AVMs in the eloquent brain can present a challenge to the surgeon. Staged, multi-modality intervention involving staged preoperative embolization and functional MRI preoperative planning can be an effective treatment strategy for strategic, safe microsurgical resection under general anesthesia for AVMs in the eloquent brain.
动静脉畸形（AVM）每年破裂风险估计为2%-4%，终生破裂风险估计为70%-75%。它们通常在青年期被发现，约每10000人中就有5人发病。治疗方式包括血管内治疗、伽玛刀治疗、全身麻醉下的显微手术切除、清醒开颅手术或这些方式的联合应用。
我们报告一例33岁男性，因头痛就诊，偶然发现左额下叶Spetzler-Martin 3级AVM，毗邻布洛卡区。鉴于AVM体积较大、患者年轻且有终生破裂风险，患者接受了计划中的两阶段术前栓塞及全身麻醉下术中监测的显微手术切除。术后数字减影血管造影显示AVM完全切除。患者术后第4天出院。出院时患者短暂的术后混合性失语已完全恢复。本文还讨论了术前栓塞的益处以及在脑功能区切除大型AVM的技术要点。患者同意进行该手术及公布其影像资料。由于本研究为回顾性病例报告性质，故认为无需获得机构审查委员会批准。
脑功能区的大型AVM对外科医生来说是一项挑战。分阶段、多模式干预，包括分阶段术前栓塞及功能磁共振成像术前规划，对于在全身麻醉下对脑功能区AVM进行策略性、安全的显微手术切除可能是一种有效的治疗策略。
