Open Surgical Resection of Cerebral Arteriovenous Malformations

Abstract

Source: Rennert, R. C., et al. Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations. J. Vis. Exp. (2017).

This video demonstrates the open surgical resection of a cerebral arteriovenous malformation (AVM) in a human brain. The procedure involves creating a bone flap, accessing the subarachnoid space, identifying and occluding feeding arteries and draining veins, and carefully removing the AVM. Intraoperative angiography confirms complete resection, followed by closure of the surgical site and patient monitoring during recovery.

Protocol

All procedures involving human participants have been performed in compliance with the institutional, national, and international guidelines for human welfare and have been reviewed by the local institutional review board.

1. AVM resection

1. Obtain informed consent, with assistance from anesthesia, place the patient under general anesthesia, and position the patient based on the location of the AVM and the desired craniotomy. Have blood consent and products available.

2. In conjunction with a neuromonitoring team, establish baseline neuromonitoring, with continued monitoring throughout the case.

3. Sync pre-operative imaging with an intra-operativ....

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Midas Rex High Power Drill System	Medtronic, Minneapolis, MN	PM700	Used for craniotomy
Matchstick Drill Bit	Medtronic, Minneapolis, MN	10MH30-MN	Used to create burr hole for craniotomy
Tapered Drill Bit	Medtronic, Minneapolis, MN	F1/8TA15	Used to complete craniotomy
#11 and 15 Blade Surgical Scalpels	BD Bard-Parker, Franklin Lakes, NJ	372615	Used for groin incision for angiography and dural opening for external ventricular drain placement or AVM resection
Metzenbaum Dissecting Scissors	Stoelting Co, Wood Dale, IL	52134-01P	Used for dural opening
Bone Elevator	Stoelting Co, Wood Dale, IL	52169	Used for separating dura from the inner skull
Gerald Forceps	Stoelting Co, Wood Dale, IL	52106-52	Used for dural opening and manipulation
Microsurgical Instruments	Accurate Surgical & Scientific Instruments Corporation, Westbury, NY	ASSI.BML1	Used for AVM microsurgical resection
Bipolar Forceps	Accurate Surgical & Scientific Instruments Corporation, Westbury, NY	ASSI.BPNS20423FP	Used for AVM microsurgical resection
Electrosurgery Generator	Bovie Medical Products, Clearwater, FL	IDS-200	Used for electrosurgical cutting/coagulation
Small Aneurysm Clips	Codman Neuro, Raynham, MA	20-1801	Used for occlusion of arterial AVM feeders not amenable to coagulation
Brain Retractors	Medicon, Tuttlingen, Germany	22.00.06	For brain retraction for deep AVM dissection/resection
Variable Action Suction tip	Millennium Surgical, Narberth, PA	6-8607	For suction with AVM dissection/resection
Fibrillar Absorbable Hemostatic Agent	Ethicon, Somerville, NJ	63713-0019-61	For hemostatis within surgical cavity
4-0 Suture	Ethicon, Somerville, NJ	C554D	For dural closure
2-0 Absorbable Suture	Ethicon, Somerville, NJ	J286G	For deep tissue closure
3-0 Nylon Suture	Ethicon, Somerville, NJ	ET-663G	For skin closure
Surgical Staples	Medline, Mundelein, IL	STAPLER35RB	For skin closure
Bone Plating System	Biomet, Warsaw, IN	15-7378-12	For bone flap securement
Operating Microscope	Leica Microsystems, Buffalo Grove, IL	M720 OH5	Used for AVM microsurgical resection
BrainLab Neuronavigation Imaging System	Brainlab, Inc, Chicago, IL	Brainlab Curve	Used for AVM microsurgical resection