• José Ernesto Chang Mulato, Willian Pegoraro Kus, Luís Gustavo Biondi Soares, Felipe Salvagni Pereira, AlejandroSebastián AníbalSADepartment of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Sao Paulo, Brazil., Hugo Leonardo Dória-Netto, Jose Maria Campos Filho, and Feres Chaddad-Neto.
• Department of Neurology and Neurosurgery, Universidade Federal de São Paulo, São Paulo, Sao Paulo, Brazil.
• World Neurosurg. 2022 May 1; 161: 4.

AbstractCerebral arteriovenous malformations (AVMs) are dynamic neurovascular disorders that occur mainly in young adults, presenting an annual risk of rupture of 2% - 4% per year.1 They can be asymptomatic, representing an incidental radiologic finding, or present with neurologic deficits according to their brain location, size, and presence or absence of bleeding.2,3 AVMs located in eloquent areas4 represent a great challenge for neurosurgeons, sometimes directed to alternatives therapies (e.g., embolization, radiotherapy) due to the difficulty in planning and surgical technique. Despite the complexity, we consider that there is benefit to removing these lesions; this can be done safely, as with the adequate microsurgical strategy and neuroanatomic knowledge. In Video 1, we show the case of a 55-year-old male patient with an AVM positioned over the right central sulcus. He presented with intermittent left-hand paresthesia followed by an episode of involuntary movements in the left arm without loss of consciousness and with spontaneous resolution. Angiography showed an AVM feed by branches of the middle cerebral artery and multiple venous drainage for the Trolard complex and superficial middle cerebral vein, with a 4-cm nidus, making it grade III in the Spetzler-Martin classification.4 The patient underwent surgery with total resection of the lesion without any complication or new neurologic deficits.Copyright © 2022 Elsevier Inc. All rights reserved.

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