Name of the Procedure:

Surgery of intracranial arteriovenous malformation; supratentorial, simple

Common names:

• AVM surgery
• Brain AVM removal
• Supratentorial AVM surgery

Summary

Supratentorial AVM surgery is a procedure to remove an abnormal tangle of blood vessels in the brain, known as an arteriovenous malformation (AVM), located above the tentorium cerebelli (an area in the brain). The goal is to prevent bleeding and other complications by surgically excising the AVM.

Purpose

Medical Condition:

• Intracranial arteriovenous malformation (AVM) ##### Goals:
• Prevent hemorrhagic stroke
• Reduce the risk of seizures
• Improve neurological function or prevent deterioration

Indications

Symptoms/Conditions:

• Recurrent headaches
• Seizures
• Unexplained neurological deficits
• Hemorrhage or recent bleeding from an AVM ##### Patient Criteria:
• Confirmed diagnosis of supratentorial AVM through imaging studies (e.g., MRI, CT scan, angiography)
• AVM causing significant symptoms or risks

Preparation

• Consultation with a neurosurgeon and anesthesiologist
• Preoperative imaging studies (MRI, angiogram)
• Blood tests and baseline health assessments
• Fasting for 8 hours before surgery
• Medication adjustments, especially if on anticoagulants
• Informing the surgical team of any allergies or existing medical conditions

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is asleep and pain-free.
2. Positioning: The patient is positioned on the surgical table with their head secured.
3. Craniotomy: A portion of the skull is removed to access the brain.
4. Exposing the AVM: The neurosurgeon carefully navigates through the brain to locate and expose the AVM.
5. Resection of AVM: Using microsurgical techniques, the AVM is meticulously separated and removed from surrounding tissues, ensuring minimal disruption to healthy brain tissue.
6. Hemostasis: Any active bleeding is controlled, and the surgical site is evaluated for residual AVM.
7. Closure: The skull bone is replaced and secured, followed by the closure of the skin incision.

Tools/Equipment:

• Microsurgical instruments
• Operating microscope
• Intraoperative navigation systems

Anesthesia/Sedation:

• General anesthesia

Duration

Typically, the procedure takes 4 to 8 hours, depending on the complexity and size of the AVM.

Setting

The procedure is performed in a hospital operating room equipped for neurosurgery.

Personnel

• Neurosurgeon
• Anesthesiologist
• Surgical nurses
• Surgical technologists
• Neurophysiologist (potentially to monitor brain function)

Risks and Complications

Common Risks:

• Infection
• Bleeding
• Swelling of the brain ##### Rare Risks:
• Stroke
• Neurological deficits
• Seizures
• Reaction to anesthesia ##### Management of Complications:
• Intensive monitoring and management in a neuro-intensive care unit (NICU)

Benefits

• Reduced risk of future brain hemorrhages
• Improvement or stabilization of neurological functions
• Potential reduction in seizure frequency or severity ##### Realization of Benefits:
• Some benefits can be seen immediately, while others may manifest over weeks to months as the brain recovers.

Recovery

Post-procedure Care:

• Hospital stay in a neuro-intensive care unit (NICU) for several days
• Pain management with prescribed medications
• Gradual resumption of normal activities ##### Recovery Time:
• Full recovery may take several weeks to months
• Regular follow-up appointments to monitor progress and healing

Alternatives

Other Treatments:

• Stereotactic radiosurgery (non-invasive)
• Endovascular embolization
• Observation with regular monitoring (in select cases) ##### Pros and Cons:
• Stereotactic radiosurgery: Less invasive but may take months to years to be effective, suitable for smaller AVMs.
• Endovascular embolization: Minimally invasive, often used as a pre-surgical adjunct but not always curative alone.
• Observation: Suitable for patients with low-risk AVMs or high surgical risks but carries the risk of future hemorrhage.

Patient Experience

During the Procedure:

• Under general anesthesia, the patient will be unconscious and pain-free. ##### After the Procedure:
• Initial discomfort from the surgical site, managed with pain relief medications
• Sensations such as headaches, fatigue, and mild cognitive changes, which typically improve over time
• Rehabilitation as needed to regain full neurological function
• Close medical supervision and support during the recovery period