Abstract
Subcentimeter arteriovenous malformations (AVMs) located in deep or eloquent cortex
can be difficult to localize intraoperatively and safely remove with surgery. Nevertheless,
surgical resection may be the optimal definitive treatment option available for select
patients. In this communication, we describe our experience using a framed-based stereotactic
approach for resecting these AVMs. The operative records of all AVMs treated at our
institution over an 8-year period (1996-2004) were reviewed. 180 surgically treated
AVMs were identified. From this group of patients, frame-based stereotaxy was used
for 8 AVMs (4.4%) in 7 patients. The angiograms, operative reports, and medical records
for these 7 patients were retrospectively reviewed with attention to neurological
outcome, extent of AVM obliteration, and anatomic factors that impacted the decision
to employ a frame-based stereotactic approach. All AVMs removed with this technique
were less than 1 cm in diameter. Angiography confirmed complete resection in all cases.
No new neurological deficits occurred in any patient. By providing highly accurate
three-dimensional nidus localization and minimizing approach-related brain manipulation,
frame-based stereotaxy reduces the morbidity associated with resection of subcentimeter
AVMs located in deep or eloquent regions of the brain. This technique makes a definitive
surgical cure available to patients who otherwise would only be considered for radiosurgery.
Key words
arteriovenous malformation - eloquent cortex - stereotaxy - surgery
References
Correspondence
russes01@yahoo.com
