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A Journal on Neurosurgery

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Journal of Neurosurgical Sciences 2018 Mar 26

DOI: 10.23736/S0390-5616.18.04398-9


language: English

Contemporary tools in AVM surgery

Marco CENZATO , Flavia DONES, Davide BOERIS, Eleonora MARCATI, Alessia FRATIANNI, Francesco M. CRISÀ, Alberto DEBERNARDI

Department of Neurosurgery, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy


Arteriovenous malformations (AVMs) are rare entities and therefore considered the main challenge for a neurosurgeon. Since the publication of the ARUBA study, one of the most popular debate regards the actual surgical indication for unruptured AVMs. Our group recently published a multicenter review of more than 500 cases underlying the important role of surgery. In the last decades, the expanding technologies used in the treatment of AVMs have shown an ongoing improvement overcoming some of the existing difficulties and shortcomings. In this paper, we reviewed the present literature to illustrate the main contemporary tools that, in our opinion, are crucial to obtain the best surgical and clinical outcome. Indocyanin green (ICG) is nowadays considered quite a gold standard to identify arterial feeders, draining veins, and to detect any eventual residual. The use of non-stick bipolar, 2-mm blade microclips, and thulium laser allows to obtain a better bleeding control and nidus removal. The development of the intraoperative ultrasound with neuronavigation, angiosonography, and color-Doppler improves the accuracy of AVM resection. Moreover, improvements have been developed with the use of intraoperative microdopplers combined with flow measurements, which consent to verify the gradual reduction of flow through draining veins. The possibility to perform functional pre-operative studies and intraoperative monitoring can be considered as an essential point in the decision making in eloquent or near-eloquent AVMs. Furthermore, the hybrid operating room represents the best expression of an excellent neurovascular team where the use of the intraoperative angiography allows neurosurgeons and neurointerventional radiologists to work at the same time in a combined approach to achieve the best surgical removal.

KEY WORDS: Arteriovenous malformation - Surgery - Brain AVM - Laser

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Publication History

Article first published online: March 26, 2018
Manuscript accepted: March 5, 2018
Manuscript received: February 16, 2018

Cite this article as

Cenzato M, Dones F, Boeris D, Marcati E, Fratianni A, et al. Contemporary tools in AVM surgery. J Neurosurg Sci 2018 Mar 26. DOI: 10.23736/S0390-5616.18.04398-9

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