• Marco Cenzato, Flavia Dones, Eleonora Marcati, Alberto Debernardi, Alba Scerrati, and Maurizio Piparo.
• Department of Neurosurgery, Metropolitan Hospital Niguarda, Milano, Italy.
• World Neurosurg. 2017 Oct 1; 106: 746-749.

BackgroundArteriovenous malformation surgery is particularly demanding owing to the need to control bleeding of small, deep white matter vessels during and after removal of the nidus; this is probably one of the most critical moments of arteriovenous malformation surgery. The aim of this article is to describe a useful technique based on the use of tweezers to temporarily stop the blood flow followed by coagulation with the thulium laser.MethodsSurgery was performed in 20 patients with unruptured cerebral arteriovenous malformations. In each case, the superficial feeder vessels were easily coagulated with nonstick bipolar tips. The finer and deeper feeder vessels were coagulated with use of tweezers and thulium laser.ResultsAll patients were treated successfully. Optimal intraoperative hemostasis was achieved.ConclusionsResults were good with no postoperative complications. Our results could encourage a more standardized use of the described technique.Copyright © 2017 Elsevier Inc. All rights reserved.

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