• Samantha Lorena Paganelli, AlejandroSebastián AníbalSADepartment of Neurosurgery, Universidade Federal de Sao Paulo, São Paulo, São Paulo, Brazil., José Ernesto Chang Mulato, Evelyn Judith Vela Rojas, Daniela de Souza Coelho, Hugo Leonardo Dória-Netto, Campos FilhoJosé MariaJMDepartment of Neurosurgery, Universidade Federal de Sao Paulo, São Paulo, São Paulo, Brazil; Hospital Beneficência Portuguesa de São Paulo, São Paulo, São Paulo, Brazil., and Feres Chaddad-Neto.
• Department of Neurosurgery, Universidade Federal de Sao Paulo, São Paulo, São Paulo, Brazil.
• World Neurosurg. 2022 Jul 1; 163: 37.

AbstractArteriovenous malformations (AVMs) are complex, heterogeneous, and uncommon neurovascular disorders that frequently manifest in young adults. Parenchymal AVMs are thought to be congenital, but this has been recently questioned in the literature.1,2 AVMs can change over time and cause focal neurological signs or neurocognitive deficits.3 The clinical presentation of an AVM is variable and depends mainly on the occurrence of bleeding as well as its location, size, and ability to take flow from adjacent areas.4 AVMs can be treated by a single modality or a combination of different modalities. According to the Expert Consensus on the Management of Brain Arteriovenous Malformations, neurosurgery may be the best option for Spetzler-Martin grade 2 AVMs.5 However, the treatment of these lesions when located in eloquent areas, especially in the central lobe, is controversial. Awake craniotomy allows identification of eloquent gyrus and can potentially facilitate resection with functional preservation. An alternative is stereotactic radiosurgery, but a qualitative comparative analysis revealed higher obliteration rate with awake AVM excision compared with stereotactic radiosurgery.6 Awake craniotomy was the earliest surgical procedure known, and it has become fashionable again. It was used in the past for surgical management of intractable epilepsy, but its indications are increasing, and it is a widely recognized technique for resection of mass lesions involving the eloquent cortex and for deep brain stimulation.7 Its application for resection of vascular lesions, including AVMs, is still limited. In the Video, we present a case of a cerebral AVM of the precentral gyrus in which we achieved complete resection with awake microsurgical treatment without any neurological sequelae for the patient.Copyright © 2022 Elsevier Inc. All rights reserved.

16 keywords...

hide…