Surgical management

Michael K. Morgan*

*Corresponding author for this work

    Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review

    3 Citations (Scopus)

    Abstract

    Surgical management includes selection of patients for surgery, performing the technical procedure of brain arteriovenous malformation (bAVM) resection and perioperative management that maximize the chance for the best outcome. In general the Spetzler–Ponce class (SPC) can divide patients into those with good evidence that surgery is appropriate in most cases (SPC A), those in whom surgery should only be considered occasionally with highly nuanced indications (SPC C), and surgery may be appropriate having made a detailed analysis of patient (including age), clinical (including mode of presentation), and AVM characteristics (including diffuseness), and a comparative analysis of outcomes with alternate management pathways for SPC B cases. The underlying competent performance of surgery must successfully achieve: consideration of the physiology; correct identification of vessel; protection of the arterial supply to normal brain; understanding of the expected anatomic relationship between feeding arteries and draining veins; and recognition and management of complex arterial feeding patterns from transdural and transosseous sources. Aggressive blood pressure management is required for bAVM with significant changes to brain vascular physiology as a consequence of surgery. For such cases, brain vascular remodeling will take approximately 1 week after surgery. During this period, protection against elevation of blood pressure must be strictly achieved.

    Original languageEnglish
    Title of host publicationHandbook of clinical neurology
    EditorsRobert Spetzler, Karam Moon, Rami O. Almefty
    Place of PublicationOxford
    PublisherElsevier
    Pages41-57
    Number of pages17
    Volume143
    ISBN (Electronic)9780444636430
    ISBN (Print)9780444636409
    DOIs
    Publication statusPublished - 2017

    Publication series

    NameHandbook of Clinical Neurology
    Volume143
    ISSN (Print)0072-9752
    ISSN (Electronic)2212-4152

    Keywords

    • arteriovenous malformation
    • AVM
    • brain
    • complications
    • management
    • risks
    • surgery
    • technique

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