Surgery of intracranial arteriovenous malformation; dural, simple
CPT4 code
Name of the Procedure:
Surgery of Intracranial Arteriovenous Malformation (AVM); Dural, Simple Common names: Dural AVM Surgery, Brain AVM Surgery
Summary
This surgical procedure is performed to remove or correct an arteriovenous malformation (AVM) located in the dural, which is the outer membrane covering the brain. An AVM is an abnormal tangle of blood vessels connecting arteries and veins in the brain, which can disrupt normal blood flow and lead to serious complications.
Purpose
- Medical condition addressed: Intracranial arteriovenous malformation
- Goals: The primary goal is to remove or rectify the AVM to prevent or treat bleeding, reduce seizures, and alleviate associated neurological symptoms. Successful surgery can prevent future hemorrhages and reduce the risk of stroke.
Indications
- Symptoms like headaches, seizures, or neurological deficits.
- Presence of an AVM detected through imaging studies.
- Previous bleeding due to AVM.
- Risk of rupture leading to potential brain damage.
Preparation
- Pre-procedure instructions: Fasting for 8-12 hours before surgery. Adjustments to medications as directed by your doctor.
- Diagnostic tests: MRI or CT scan, cerebral angiography, blood tests, and physical examination.
Procedure Description
- Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
- Incision: A surgical incision is made in the scalp, and a craniotomy (temporary removal of a bone flap) is performed to access the brain.
- Locating AVM: With the help of microsurgical techniques and imaging guidance, the dural AVM is located.
- Removal/Correction: The abnormal blood vessels are meticulously separated and removed or corrected using specialized surgical tools.
- Closure: The bone flap is replaced, and the incision is closed with sutures or staples.
Duration
The procedure typically takes 3 to 6 hours, depending on the complexity of the AVM.
Setting
The surgery is performed in a hospital operating room equipped with advanced neurosurgical technology.
Personnel
- Neurosurgeon
- Anesthesiologist
- Surgical nurses
- Surgical technician
Risks and Complications
- Common risks: Infection, bleeding, adverse reactions to anesthesia.
- Rare risks: Stroke, brain swelling, neurological deficits, seizures, or recurrence of AVM.
- Management: Immediate medical intervention for complications. Close post-operative monitoring.
Benefits
- Reduces the risk of hemorrhage from the AVM.
- Potential reduction or elimination of seizures.
- Improvement in neurological function and quality of life.
Recovery
- Post-procedure care: Hospital stay for several days, followed by home care.
- Instructions: Wound care, activity restrictions, medication regimen, and follow-up appointments.
- Recovery time: Several weeks to months. Full recovery may involve physical therapy and gradual return to normal activities.
Alternatives
- Endovascular embolization: Less invasive, where glue-like material or coils are used to block the AVM.
- Stereotactic radiosurgery: Focused radiation to shrink the AVM over time.
- Observation: Monitoring the AVM if it's small and asymptomatic.
- Pros and cons: Alternatives may have lower immediate risks but may not be as definitive as surgery. Suitable for different clinical scenarios.
Patient Experience
- During the procedure: The patient will be under general anesthesia and thus unconscious.
- After the procedure: Potential for headaches, fatigue, mild pain at the incision site. Pain management with prescribed medications.
- Comfort measures: Adequate pain control, emotional support, and gradual resumption of normal activities as advised.
Overall, the surgery aims to mitigate the risks associated with an intracranial dural AVM and improve the patient's long-term health outcomes.