{"id":"d38f6ba3-213e-43de-a47c-4945bc23cc4a","slug":"microsurgical-resection-and-endovascular-embolization-of-a-left-inferior-frontal-and-sylvian-spetzler-martin-grade-3-arteriovenous-malformation","title":"Microsurgical resection and endovascular embolization of a left inferior frontal and Sylvian Spetzler-Martin grade 3 arteriovenous malformation","authors":["Kara A. Parikh","Mustafa Motiwala","Emal Lesha","John E. Dugan","Kaan Yagmurlu","Adam S. Arthur","Nickalus R. Khan"],"abstract":"Background: Arteriovenous malformations (AVMs) carry an estimated 2–4% annual risk of rupture, with an estimated 70–75% lifetime risk. They are typically discovered during young adulthood, occurring in approximately 5/10,000 individuals. Modalities of treatment involve endovascular treatment, Gamma Knife, microsurgical resection under general anesthesia, awake craniotomy, or a combination of these modalities. Case Description: We present the case of a 33-year-old male presenting with headaches who was found to have an incidental left inferior frontal Spetzler-Martin Grade 3 AVM adjacent to Broca’s area. Given the large size of the AVM, the patient’s young age, and the lifetime risk of rupture, the patient underwent a planned 2-stage preoperative embolization and microsurgical resection under general anesthesia with intraoperative monitoring. Complete resection of the AVM was observed on postoperative digital subtraction angiography. The patient was discharged home on postoperative day 4. The patient’s transient postoperative mixed aphasia had fully resolved by the time of discharge. A review of the benefits of preoperative embolization and the technical considerations of resection of a large AVM in eloquent regions of the brain are included. The patient consented to the procedure and the publication of his images. The Institutional Review Board approval was deemed unnecessary due to the retrospective, case-report nature of this work. Conclusion: Large AVMs in the eloquent brain can present a challenge to the surgeon. Staged, multi-modality intervention involving staged preoperative embolization and functional MRI preoperative planning can be an effective treatment strategy for strategic, safe microsurgical resection under general anesthesia for AVMs in the eloquent brain. 0:12 Clinical Presentation 0:28 Preoperative Imaging 1:50 Rationale for the Procedure 2:06 Risks of Procedure and Potential Benefit 2:16 Alternatives for Treatment 2:53 Description of Setup 3:50 Post-embolization Angiography 4:06 Splitting Sylvian Fissure 4:56 Indocyanine Green Angiography 5:05 Resection of AVM Nidus 6:00 Anatomical Schematic of Surgical Site 6:54 Disease Background 7:25 Technical Considerations 7:50 Literature Review 8:20 Clinical and Imaging Outcome 8:36 Postoperative Angiography Benefit of preoperative embolization of eloquent AVMs. Intraoperative adjuncts for eloquent SM3 AVMs. The Institutional Review Board has waived the ethical approval for this study. The authors certify that they have obtained all appropriate patient consent. There are no conflicts of interest. The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript, and no images were manipulated using AI. The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/d38f6ba3-213e-43de-a47c-4945bc23cc4a/featured/hero-1781558747367.png","publishDate":"2025-04-04T00:00:00.000Z","doi":"10.25259/SNI_1102_2024","categories":["Skull Base","Video Abstract"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/d38f6ba3-213e-43de-a47c-4945bc23cc4a/pdf"}