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Present State of Microneurosurgery of Cerebral Arteriovenous Malformations

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Book cover Surgical Management of Cerebrovascular Disease

Part of the book series: Acta Neurochirurgica Supplementum ((NEUROCHIRURGICA,volume 107))

Abstract

Microneurosurgical excision is known to be the definitive treatment for brain arteriovenous malformation (AVMs). The most important factors governing the operability of an AVM are location, size, age of the patient, and the neurosurgeon’s and team’s experience. We present in this review the surgical experience of the senior author (JH) in microneurosurgical treatment of brain AVMs. This consists of the following steps: (1) accurate preoperative embolization; (2) optimal selection of the surgical approach; (3) accurate definition and preservation of the normal arterial vessels of passage; (4) temporary clipping of the feeding arteries; (5) a special method of coagulation called “dirty coagulation” of the deep small difficult vessels inside apparently normal brain around the AVM; (6) removal of all AVM; (7) meticulous hemostasis; (8) intra- and postoperative digital subtraction angiography (DSA); (9) clinical and radiological follow-up. These steps are not possible in AVMs lying entirely within central eloquent areas. Nine out of ten small- and medium-sized arteriovenous malformations (AVMs) are suitable for direct surgery, but surgical complications increase drastically with the size of the AVM. Nevertheless, the actual results of combined treatment with preoperative Onyx embolization followed by microsurgery have decreased these risks.

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Authors and Affiliations

  1. Department of Neurosurgery, Helsinki University Central Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland

    Juha Hernesniemi, Rossana Romani, Martin Lehecka, Puchong Isarakul, Reza Dashti, Özgür Celik, Ondrej Navratil, Mika Niemelä & Aki Laakso

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  1. Juha Hernesniemi
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  2. Rossana Romani
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  3. Martin Lehecka
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  4. Puchong Isarakul
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  5. Reza Dashti
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  6. Özgür Celik
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  7. Ondrej Navratil
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  8. Mika Niemelä
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  9. Aki Laakso
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Correspondence to Juha Hernesniemi .

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Hernesniemi, J. et al. (2010). Present State of Microneurosurgery of Cerebral Arteriovenous Malformations. In: Surgical Management of Cerebrovascular Disease. Acta Neurochirurgica Supplementum, vol 107. Springer, Vienna. https://doi.org/10.1007/978-3-211-99373-6_11

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  • DOI: https://doi.org/10.1007/978-3-211-99373-6_11

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  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-211-99372-9

  • Online ISBN: 978-3-211-99373-6

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