Download PDF
Minim Invasive Neurosurg 2008; 51(2): 114-118
DOI: 10.1055/s-2007-1022532
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Frame-Based Stereotactic Resection of Subcentimeter Arteriovenous Malformations in Deep or Eloquent Regions of the Brain: Indications and Technique with Eight Consecutive Operations

N. Post 1 , S. M. Russell 1 , P. Huang 1 , J. Jafar 1
  • 1Department of Neurosurgery, New York University School of Medicine, New York, USA
Further Information

Publication History

Publication Date:
09 April 2008 (online)

    Permissions and Reprints

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

  • 1 Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations.  J Neurosurg. 1986;  65 476-483
    Search in Google Scholar
  • 2 Graham GD. Arteriovenous malformations in the brain.  Curr Treat Options Neurol. 2002;  4 435-444
    CrossrefPubMedSearch in Google Scholar
  • 3 Guo WY, Karlsson B, K, Lindqvist M. Even the smallest remnant of an AVM constitutes a risk of further bleeding. Case report.  Acta Neurochir (Wien). 1993;  121 212-215
    CrossrefPubMedSearch in Google Scholar
  • 4 Hadjipanayis CG, Levy EI, Niranjan A, Firlik AD, Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic radiosurgery for motor cortex region arteriovenous malformations.  Neurosurgery. 2001;  48 70-76 , ; discussion 76-77
    CrossrefPubMedSearch in Google Scholar
  • 5 Sorimachi T, Koike T, Takeuchi S, Minakawa T, Abe H, Nishimaki K, Ito Y, Tanaka R. Embolization of cerebral arteriovenous malformations achieved with polyvinyl alcohol particles: angiographic reappearance and complications.  AJNR Am J Neuroradiol. 1999;  20 1323-1328
    PubMedSearch in Google Scholar
  • 6 Alterman RL, Kall B, Beric A, Sterio D, Kelly PJ. Pallidal targeting with the COMPASS system.  Stereotact Funct Neurosurg. 1997;  69 69-72
    PubMedSearch in Google Scholar
  • 7 Stiver SI. Microarteriovenous malformations.  Neurosurg Clin N Am. 1999;  10 485-501
    PubMedSearch in Google Scholar
  • 8 Russell SM, Woo HH, Joseffer SS, Jafar JJ. Role of frameless stereotaxy in the surgical treatment of cerebral arteriovenous malformations: technique and outcomes in a controlled study of 44 consecutive patients.  Neurosurgery. 2002;  51 1108-1116 , ; 1116-1118
    Search in Google Scholar
  • 9 Kelly PJ, Alker  Jr  GJ, Zoll JG. A microstereotactic approach to deep-seated arteriovenous malformations.  Surg Neurol. 1982;  17 260-262
    PubMedSearch in Google Scholar
  • 10 Sisti MB, Solomon RA, Stein BM. Stereotactic craniotomy in the resection of small arteriovenous malformations.  J Neurosurg. 1991;  75 40-44
    Search in Google Scholar
  • 11 Raabe A, Krishnan R, Zimmermann M, Seifert V. Frame-less and frame-based stereotaxy? How to choose the appropriate procedure.  Zentralbl Neurochir. 2003;  64 1-5
    Thieme ConnectPubMedSearch in Google Scholar
  • 12 Steinmeier R, Rachinger JM, Ganslandt O, Huk W, Fahlbusch R. Factors influencing the application accuracy of neuronavigation systems.  Stereotact Funct Neurosurg. 2000;  75 188-202
    CrossrefPubMedSearch in Google Scholar
  • 13 Benardete EA, Leonard MA, Weiner HL. Comparison of frameless stereotactic systems: accuracy, precision, and applications.  Neurosurgery. 2001;  49 1409-1415
    CrossrefPubMedSearch in Google Scholar
  • 14 Grunert P, Charalampaki K, Kassem M, Boecher-Schwarz H, Filippi R, Grunert  Jr  P. Frame-based and frameless stereotaxy in the localization of cavernous angiomas.  Neurosurg Rev. 2003;  26 53-61
    PubMedSearch in Google Scholar
  • 15 Maciunas RJ, Galloway  Jr  RL, J Latimer J, Cobb C, Zaccharias E, Moore A, Mandava VR. An independent application accuracy evaluation of stereotactic frame systems.  Stereotact Funct Neurosurg. 1992;  58 103-107
    PubMedSearch in Google Scholar

Correspondence

S.M. RussellMD 

530 First Avenue

Suite 8R

10016 New York

USA

Phone: +1/212/263 80 02

Fax: +1/212/263 80 42

Email: russes01@yahoo.com