Surgical management

Michael K. Morgan*

*Corresponding author for this work

Research output: Chapter in Book/Report/Conference proceedingChapter

2 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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  • Cite this

    Morgan, M. K. (2017). Surgical management. In R. Spetzler, K. Moon, & R. O. Almefty (Eds.), Handbook of clinical neurology (Vol. 143, pp. 41-57). (Handbook of Clinical Neurology; Vol. 143). Oxford: Elsevier. https://doi.org/10.1016/B978-0-444-63640-9.00005-9