Surgery of intracranial arteriovenous malformation; infratentorial, complex
CPT4 code
Name of the Procedure:
Surgery of Intracranial Arteriovenous Malformation; Infratentorial, Complex
(Also known as: Infratentorial AVM Surgery, Intracranial AVM Removal)
Summary
Infratentorial AVM surgery is a procedure to remove an arteriovenous malformation (AVM) located in the lower part of the brain, below the tentorium cerebelli. This area involves critical structures such as the brainstem and cerebellum. The surgery is highly intricate due to the location and complexity of the AVM.
Purpose
This surgery addresses intracranial arteriovenous malformations that can cause symptoms like headaches, seizures, and neurological deficits due to the abnormal blood vessel connections. The goals are to prevent hemorrhages, reduce seizure occurrence, and improve neurological function by removing the AVM.
Indications
- Severe, recurrent headaches
- Seizures not controllable with medication
- Neurological deficits (e.g., weakness, dizziness, vision problems)
- Evidence of previous or risk of future hemorrhage
- Significant AVM size and location posing a high risk of complications
Preparation
- Pre-procedure imaging tests (e.g., MRI, CT scan, cerebral angiography)
- Blood tests and general health assessment
- Fasting for 8-12 hours before surgery
- Adjustment or cessation of certain medications as instructed
- Informed consent discussion regarding risks and benefits
Procedure Description
- Administration of general anesthesia to ensure the patient is unconscious and pain-free.
- A craniotomy is performed, where an incision is made in the scalp and a section of the skull is removed to access the brain.
- Using microsurgical techniques and high-precision tools, the neurosurgeon carefully isolates and removes the AVM.
- The blood flow is managed to prevent bleeding during the removal.
- The skull section is reattached, and the incision is closed.
Duration
The procedure typically takes between 4 to 8 hours, depending on the complexity of the AVM and its location.
Setting
The surgery is conducted in a hospital operating room equipped with advanced neurosurgical tools and imaging technology.
Personnel
- Neurosurgeon
- Surgical nurses
- Anesthesiologist
- Radiology technician (for intraoperative imaging)
- Post-operative care team
Risks and Complications
- Bleeding (hemorrhage)
- Infection
- Neurological deficits (e.g., weakness, speech difficulties)
- Stroke
- Cerebral edema (swelling)
- Anesthesia-related complications
Benefits
- Reduction or elimination of hemorrhage risk
- Improvement in symptoms such as headaches and seizures
- Better overall neurological function
- Potentially life-saving in preventing catastrophic hemorrhage
Recovery
- Initial stay in the ICU for monitoring
- Hospital stay of 5-10 days
- Gradual return to regular activities over weeks to months
- Physical therapy may be required
- Regular follow-up appointments to monitor brain healing and neurological function
Alternatives
- Endovascular embolization (less invasive but may not be curative)
- Stereotactic radiosurgery (may take time to see results and not always complete)
- Medical management (symptomatic treatment without addressing the AVM directly)
Patient Experience
During the procedure, the patient will be under general anesthesia and will not be conscious or feeling pain. Post-surgery, the patient may experience mild to moderate pain at the incision site, which can be managed with medication. Dizziness, weakness, and fatigue are common but typically improve over time. Regular follow-up and rehabilitation are essential components of recovery.