61682 Surgery of intracranial arteriovenous malformation; supratentorial, complex

Name of the Procedure:

Surgery of Intracranial Arteriovenous Malformation; Supratentorial, Complex.

Summary

This surgery is performed to remove or reduce an arteriovenous malformation (AVM) located in the supratentorial region of the brain. An AVM is an abnormal tangle of blood vessels connecting arteries and veins, which can disrupt normal blood flow and oxygen delivery.

Purpose

The procedure addresses AVMs to prevent or treat symptoms related to them, such as headaches, seizures, or bleeding (hemorrhage). The goals are to reduce the risk of hemorrhage, alleviate symptoms, and improve overall neurological function.

Indications

• Recurrent headaches or migraines.
• Seizures not controlled by medication.
• Evidence or history of brain hemorrhage.
• Focal neurological deficits (e.g., weakness, numbness).
• Risk of rupture due to AVM size or location.
• Imaging findings indicating increased AVM complexity or risk.

Preparation

• Fasting for at least 8 hours before surgery.
• Discontinuation of certain medications (e.g., blood thinners) as instructed by the healthcare provider.
• Pre-operative imaging studies like MRI, CT scans, or angiography to map the AVM.
• Comprehensive blood tests and physical examination.
• Meeting with the anesthesiologist for assessment and risk evaluation.

Procedure Description

1. The patient is placed under general anesthesia.
2. A craniotomy is performed (removing a portion of the skull) to access the brain.
3. Image-guided neurosurgical tools are used to precisely locate the AVM.
4. The AVM is carefully isolated and resected using microsurgical techniques to minimize damage to surrounding brain tissue.
5. The blood flow is redirected away from the AVM.
6. The bone flap is replaced and secured, and the incision is closed with sutures or staples.
7. The patient is taken to the recovery room for observation.

Duration

The procedure typically takes between 4 to 6 hours, depending on the complexity of the AVM.

Setting

This surgery is performed in a hospital operating room equipped for complex neurosurgical procedures.

Personnel

• Neurosurgeon
• Surgical nurses
• Anesthesiologist
• Neurointerventional radiologist (if intraoperative imaging is needed)
• Operating room technicians

Risks and Complications

• Infection
• Bleeding
• Stroke or transient ischemic attacks (TIAs)
• Swelling or edema in the brain
• Seizures
• Neurological deficits (e.g., speech problems, motor function impairment)
• Adverse reactions to anesthesia
• Cerebral vasospasm

Benefits

• Reduced risk of hemorrhage due to AVM rupture.
• Alleviation of symptoms such as headaches and seizures.
• Improved neurological function and quality of life.
• Stabilization or improvement of the patient’s condition.

Recovery

• Initial post-operative care in the Intensive Care Unit (ICU) for close monitoring.
• Medications for pain management, anti-seizure, and to reduce swelling.
• Gradual return to regular activities as supervised by the healthcare provider.
• Follow-up appointments for imaging studies to ensure the AVM has been completely removed.
• Physical therapy may be recommended based on individual patient needs.
• Total recovery time can range from several weeks to a few months.

Alternatives

• Stereotactic radiosurgery (Gamma Knife or CyberKnife) for smaller AVMs.
• Endovascular embolization, where the blood vessels to the AVM are blocked using a catheter.
• Conservative management with medication for symptom control (often for less complex or asymptomatic AVMs).
• Each alternative has its own risks and benefits and is chosen based on AVM size, location, and patient health.

Patient Experience

• During the procedure, the patient is under general anesthesia and does not feel pain.
• Post-operatively, some discomfort and swelling around the surgical site are normal.
• Pain and anti-seizure medications will help manage post-surgical pain and prevent seizures.
• The patient will experience fatigue and may need support with daily activities initially.
• Gradual improvement with steady recovery of strength and neurological functions as healing progresses.

This concise overview prepares patients and their families for what to expect before, during, and after the surgery of intracranial arteriovenous malformation; supratentorial, complex.