scholarly journals Thoracic 11-Lumbar 1 Laminoplasty for Resection of Conus Arteriovenous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (1) ◽  
pp. E7-E7
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Arteriovenous Malformation ◽  
Video Recording ◽  
Venous Drainage ◽  
Conus Medullaris ◽  
Imaging Evaluation ◽  
Drainage Patterns ◽  
Institutional Review ◽  
Before And After ◽  
Spinal Arteriovenous Malformations ◽  
Multiple Feeding

Abstract Conus medullaris spinal arteriovenous malformations are uniquely classified by the Spetzler classification. They possess a glomus (type II) nidus in either or both the intra- and extramedullary compartments, with multiple feeding arteries and niduses resulting in complex venous drainage patterns. These characteristics make resection of these lesions challenging, and these lesions are associated with a high risk for recurrence. This patient presented with a subarachnoid hemorrhage, and thorough imaging evaluation revealed a conus arteriovenous malformation. The patient underwent thoracic 11 to lumbar 1 laminoplasty for resection of the lesion. The arteriovenous malformation was circumdissected off the conus and lumbosacral nerve roots using sharp dissection and bipolar forceps. It was visualized both before and after resection with indocyanine green fluoroscopy. The patient tolerated the procedure well, and postoperative angiography demonstrated complete resection. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Cervical 7-Thoracic 3 Laminoplasty for Resection of Arteriovenous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (1) ◽  
pp. E3-E4
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Spinal Cord ◽  
Video Recording ◽  
Mass Effect ◽  
Feeding Artery ◽  
Pia Mater ◽  
Institutional Review ◽  
Signal Change ◽  
Spinal Arteriovenous Malformations ◽  
Intradural Extramedullary ◽  
Vascular Steal

Abstract Symptomatic spinal arteriovenous malformations (AVMs) are most frequently associated with hypoperfusion of the spinal cord, either from venous congestion or vascular steal, and are less frequently associated with hemorrhage. This patient had a large cervicothoracic spinal AVM and presented with right hemibody sensory deficit with intact motor function. The AVM had significant preoperative mass effect on the dorsal spinal cord with cord signal change. Preoperative digital subtraction angiography demonstrated a left supreme intercostal feeding artery and left thyrocervical feeding artery, which was embolized preoperatively. A laminoplasty was performed from cervical 7 to thoracic 3 to allow for adequate visualization. The lesion demonstrated an intradural extramedullary presence, which made preservation of the pia mater paramount during the resection. The AVM was disconnected and removed in its entirety as determined by operative visualization and postoperative imaging. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Lumbar 4-5 Laminoplasty for Ligation of Dural Fistula: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (3) ◽  
pp. E70-E71
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Mass Effect ◽  
Imaging Evaluation ◽  
Thoracic Spinal Cord ◽  
Arteriovenous Fistulas ◽  
Institutional Review ◽  
Thoracic Spinal ◽  
Surgical Cure ◽  
Spinal Dural Arteriovenous Fistulas ◽  
Arterial Feeder

Abstract The goal of treatment for spinal dural arteriovenous fistulas is disconnection of the fistulous point to eliminate venous congestion-associated hypoperfusion and mass effect. The nidus can be surgically excised or disconnected from the arterial feeder just proximal to the dilated venous plexus. This patient had a filus terminale dural arteriovenous fistula. The patient had multiple findings of myelopathy, which prompted the imaging evaluation that revealed prominent flow voids and significant caudal thoracic spinal cord edema. Preoperative digital subtraction angiography demonstrated a fistulous point at the lumbar 4 level. A lumbar 4 and lumbar 5 laminoplasty was performed for spinal canal access. Following achievement of intradural access, exploration was performed, augmented by indocyanine green fluoroscopy. The filum terminale was then transected, and the fistula was then completely excised to achieve surgical cure. Following the procedure, the patient's myelopathy improved, and she regained ambulatory status. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Cervical 3 to Cervical 6 Laminectomy for Arteriovenous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (5) ◽  
pp. E200-E200
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Arteriovenous Malformation ◽  
Surgical Resection ◽  
Video Recording ◽  
Institutional Review Board ◽  
Digital Subtraction ◽  
Pia Mater ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Complete Obliteration ◽  
System 1

Abstract According to the Spetzler spinal cord classification system,1 this patient had an extradural-intradural arteriovenous malformation (AVM), also known as a type III or juvenile AVM. The patient underwent a surgical resection of the lesion via a cervical 3 to cervical 6 laminoplasty. Direct observation confirmed intra- and extramedullary components. During the surgical resection, an attempt was made to avoid transgressing the pia mater. Therefore, the traversing vessels were interrupted during the circumdissection. The nidus was removed, and postprocedural digital subtraction angiography confirmed complete obliteration. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Ruptured Conus Medullaris Arteriovenous Malformation

2019 ◽  
pp. 297-306
Author(s):  
Michaela H. Lee ◽  
Brandon D. Liebelt ◽  
Peter Nakaji ◽  
Robert F. Spetzler
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformation ◽  
Sexual Function ◽  
Neurological Deficit ◽  
Arteriovenous Malformations ◽  
Vascular Supply ◽  
Conus Medullaris ◽  
Proper Diagnosis ◽  
Spinal Arteriovenous Malformations ◽  
Posterior Spinal Arteries

Abstract: Conus medullaris arteriovenous malformations are an exceedingly rare cause of neurological deficit. They occupy the tip of the spinal cord and can generate motor, sensorty, bowel, bladder, or sexual function deficits. Because of the complex vascular supply of the caudal aspect of the spinal cord, which usually includes multiple feeders from both the anterior and posterior spinal arteries, management may be endovascular, microsurgical, or both. Making the proper diagnosis and distinguishing it from other similar pathologies such as arteriovenous fistula is critical. As with other spinal arteriovenous malformations, it is usually not necessary to pursue the nidus into the spinal cord parenchyma at the time of surgery. This chapter discusses the diagnosis and management of this rare disorder.

scholarly journals Grade 4 Temporal Arteriovenous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (2) ◽  
pp. E36-E37
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Informed Consent ◽  
Arteriovenous Malformations ◽  
Video Recording ◽  
Venous Drainage ◽  
Complete Resection ◽  
Elevated Risk ◽  
Institutional Review Board ◽  
Institutional Review Board Approval ◽  
Institutional Review ◽  
Martin Grade

Abstract The 2% to 4% annual rupture rate for arteriovenous malformations (AVMs) must be weighed against the risk of intervention during surgery within an eloquent brain region. Following a hemorrhage event, AVMs that were initially considered to be nonoperative or unfavorable for surgical resection can be intervened on to avoid the significantly elevated risk of rehemorrhage. This patient had a dominant temporal lobe Spetzler–Martin grade 4 AVM with deep venous drainage, representing a significant surgical challenge. The arachnoid plane microdissection was performed using microscissors but was tenuous, and it was necessary to define the draining vein and adjacent feeding arteries. This video demonstrates the major principles of AVM resection during the circumdissection and disconnection of the nidus. The postoperative angiography demonstrated complete resection. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Intradural lumbar radicular arteriovenous malformation mimicking perimedullary arteriovenous malformation of the conus medullaris: illustrative case

2021 ◽  
Vol 2 (21) ◽  
Author(s):  
Izumi Koyanagi ◽  
Yasuhiro Chiba ◽  
Hiroyuki Imamura ◽  
Toshiya Osanai
Keyword(s):  
Arteriovenous Malformation ◽  
Cauda Equina ◽  
Venous Drainage ◽  
Conus Medullaris ◽  
Arteriovenous Shunt ◽  
Anterior Spinal Artery ◽  
Illustrative Case ◽  
Posterior Root ◽  
Appropriate Treatment ◽  
Flow Void

BACKGROUND Intradural radicular arteriovenous malformation (AVM) of the cauda equina is a rare entity of spinal AVMs. Because of the specific arterial supply of the conus medullaris and cauda equina, AVMs in this area sometimes present with confusing radiological features. OBSERVATIONS The authors reported a rare case of intradural radicular AVM arising from the lumbar posterior root. The patient presented with urinary symptoms with multiple flow void around the conus medullaris, as shown on magnetic resonance imaging. Digital subtraction angiography demonstrated arteriovenous shunt at the left side of the conus medullaris fed by the anterior spinal artery via anastomotic channel to the posterior spinal artery and rich perimedullary drainers. There was another arteriovenous shunt at the L3 level from the left L4 radicular artery. Preoperative diagnosis was perimedullary AVM with radicular arteriovenous fistula. Direct surgery with indocyanine green angiography revealed that the actual arteriovenous shunt was located at the left L4 posterior root. The AVM was successfully treated by coagulation of feeding branches. LESSONS Unilateral arteriovenous shunt fed by either posterior or anterior spinal artery at the conus medullaris may include AVM of the cauda equina despite abundant perimedullary venous drainage. Careful pre- and intraoperative diagnostic imaging is necessary for appropriate treatment.

scholarly journals Microsurgical Resection of Brainstem Arteriovenous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (2) ◽  
pp. E38-E38
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Radiation Treatment ◽  
Video Recording ◽  
Cranial Nerves ◽  
Venous Drainage ◽  
Mass Effect ◽  
Fiber Tracts ◽  
Institutional Review ◽  
Ventriculoperitoneal Shunting ◽  
Microsurgical Resection ◽  
Martin Grade

Abstract Brainstem arteriovenous malformations (AVMs) are rare lesions (2%-6% of all intracranial AVMs) that are surgically challenging because of the high eloquence of the brainstem, including dense fiber tracts, cranial nerves, and multiple vital cerebrovascular structures. All these lesions possess eloquence and deep venous drainage, making them innately Spetlzer–Martin grade III or above. This patient had a large midbrain AVM with a complex clinical course beginning with ventriculoperitoneal shunting due to mass effect; the patient experienced 4 hemorrhages, underwent radiation treatment, and finally underwent surgical resection. The surgical approach involved a large torcular craniotomy exposing all posterior sinuses at the confluence. The vein of Galen was exposed and carried deeply to permit ambient cistern opening and relaxation of the cerebellum. Because of earlier radiation therapy, the vessels had undergone hyalinosis, which resulted in difficult manipulation of the nidus but did permit excellent coagulation of the vessels. The complete nidus was removed, as confirmed on postoperative angiography. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

Resection of Right Frontal Arteriovenous Malformation: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (1) ◽  
pp. 111-111
Author(s):  
William T Couldwell
Keyword(s):  
Arteriovenous Malformation ◽  
Venous Drainage ◽  
Complete Resection ◽  
Institutional Review Board ◽  
3 Dimensional ◽  
Bone Removal ◽  
Institutional Review ◽  
Brain Interface ◽  
Grade Ii ◽  
The Right

Abstract The video demonstrates resection of a Grade II Spetzler-Martin unruptured, medium-sized arteriovenous malformation (AVM). A young woman presented with headaches and seizures. The right frontal lesion measured 4.5 cm in largest dimension and had superficial venous drainage. Partial Onyx embolization, primarily of the anterior cerebral feeding arteries, was performed. Bone removal for exposure allowed identification of indentation from the large superficial draining vein. The video demonstrates careful microsurgical dissection on the AVM/brain interface, with selective interruption of feeding arteries circumferentially. The lesion was removed after ligation of the large superficial draining vein. Postoperative day 1 and 1-yr angiography demonstrated complete resection. The patient's symptoms abated after resection. This case is presented with a waiver of informed consent as per the Institutional Review Board.

Interhemispheric Transfalcine Approach for Resection of Contralateral Arteriovenous Malformation: 2-Dimensional Operative Video

2020 ◽  
Vol 18 (5) ◽  
pp. E155-E156 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Informed Consent ◽  
Arteriovenous Malformation ◽  
Frontal Lobe ◽  
Video Recording ◽  
Complete Removal ◽  
Institutional Review Board ◽  
Ipsilateral Hemisphere ◽  
Institutional Review Board Approval ◽  
Interhemispheric Approach ◽  
Institutional Review

Abstract The high versatility and efficacy of the contralateral interhemispheric approach is demonstrated in this resection of an arteriovenous malformation (AVM). This patient had a large AVM along the medial frontal lobe amenable to approach via the contralateral interhemispheric approach. The head was rotated to permit gravity retraction of the ipsilateral hemisphere to the AVM, avoiding the use of rigid retractors. Under the guidance of neuronavigation, the falx was opened to permit visualization of the AVM. Circumdissection with a disconnection of the nidus was performed in a standard fashion. Postoperative angiography confirmed complete removal of the AVM. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

scholarly journals Posterior C2-6 Laminoplasty for Resection of Arteriovenous Malformation: 2-Dimensional Operative Video

2019 ◽  
Vol 18 (3) ◽  
pp. E72-E73 ◽  
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Vertebral Artery ◽  
Video Recording ◽  
Preoperative Embolization ◽  
Surgical Morbidity ◽  
Imaging Evaluation ◽  
Institutional Review ◽  
Long Term Follow Up ◽  
History Of ◽  
Surgical Cure ◽  
The Right

Abstract Large extramedullary-intramedullary arteriovenous malformations (AVMs) within the spinal cord provide a unique management opportunity, compared with the cranial counterpart, in that the surgical morbidity can be minimized and surgical cure can still be achieved by resecting the extramedullary segment and leaving the intramedullary segment without invading the parenchyma. This management strategy minimizes morbidity and provides an excellent chance of surgical cure. This patient had a history of longstanding left hemiparesis since birth that progressed, prompting imaging evaluation that demonstrated a large cervical AVM with bilateral vertebral artery, anterior spinal artery, and left thyrocervical trunk feeding vessels. The AVM had both extramedullary and intramedullary components, making this a challenging lesion for microsurgical obliteration and preservation of neurological function. Preoperative embolization was utilized through the right vertebral artery pedicle. Microdissection was performed to isolate the extramedullary from the intramedullary component. Surgical cure was attempted for this patient by removing the extramedullary component and leaving the intramedullary segment. Indocyanine green fluoroscopy was used to isolate the feeding pedicle and guide surgical resection. Postoperative imaging demonstrated a small residual from the thyrocervical injection, which was obliterated with embolization. The patient improved neurologically within the postoperative period and regained ambulatory status during long-term follow-up. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.

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