Microsurgical Treatment for a Cerebral Arteriovenous Malformation of the Central Sulcus.

Abstract

Arteriovenous malformations (AVMs) are congenital neurovascular disorders frequently manifested in young adults. The clinical presentation is variable and depends on its location, size, and ability to steal flow from adjacent areas, but it depends mainly on the occurrence of bleeding.¹ The treatment of these lesions when located in eloquent areas, especially around the central sulcus, is controversial. Surgical resection of an AVM in the central lobe may cause postoperative sensorimotor deficits because this anatomic region includes the precentral and postcentral gyri on the lateral surface and paracentral lobule on the medial surface.² AVMs can be successfully treated by surgery, but this treatment may pose unacceptable risks to the patient if the AVM involves an eloquent cortex. We consider that surgical removal of many of these lesions is feasible when preoperative planning is performed,³ when it is based on deep anatomic knowledge, and particularly when using a refined microsurgical technique.¹ In this 3-dimensional Video 1, we present a case of a cerebral AVM of the central sulcus in which we achieved complete resection with microsurgical treatment without any neurologic sequelae for the patient. The patient consented to publication of images.