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Arteriovenous Malformation (AVM) Resection

Abstract

Introduction: Arteriovenous malformations (AVMs) are abnormal connections between arteries and veins that lack an intervening capillary network. The high flow of arterial blood directly into veins can lead to the weakening of venous walls, potentially resulting in life-threatening hemorrhages.The primary treatment modalities for cerebral arteriovenous malformations (AVMs) include surgical resection, endovascular embolization.

Case presentation: A 34-year-old female presented with a roughly 7×7 cm arteriovenous malformation (AVM) located in the right temporoparietal area. The AVM extended both superficially and deeply into the infratemporal fossa and laterally towards the orbit. Imaging revealed the presence of multiple large contributing vessels in the preauricular area. The patient underwent embolization with interventional radiology one day prior to the surgical procedure.

Methods: Markings were made along the right upper hairline after trimming and continued down the preauricular skin. A #15 blade was utilized to make incisions through the epidermis and dermis, reaching the subcutaneous tissues. The temporoparietal and temporal flap fascia were dissected and carefully raised. Once the AVM was detached from the surrounding temporalis muscle and the zygomatic bone, its feeder vessels were ligated near the tragal pointer using hemoclips to aid in future localization. Hemostasis was successfully achieved with bipolar cautery. The temporalis muscle and its adjacent fascia were sutured closed with vicryl suture. Closure of the deep dermal layer was accomplished with 4-0 PDS, and the skin was closed in a running subcutaneous fashion using 5-0 monocryl.

Conclusion : We present a successful surgical resection of Arteriovenous Malformation with a prior embolization by interventional radiologist

Surgeons:

Coleman, Madison, MD,

Aryan D Shay ,MD

Gresham T Richter, MD, FACS

Conflicts of Interest: None

Funding: This research received no external funding

Department of Otolaryngology – Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
Arkansas Children’s Hospital, Little Rock, AR, USA

Excision of Right Temporoparietal Arteriovenous Malformation
A 34-year-old female presented with a roughly 7x7 cm arteriovenous malformation (AVM) located in the right temporoparietal area. The AVM extended both superficially and deeply into the infratemporal fossa and laterally towards the orbit. Imaging revealed the presence of multiple large contributing vessels in the preauricular area.
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4-channel facial nerve NIM monitoring system was then hooked up to the patient electrodes at the orbicularis oris, orbicularis oculi, frontalis, and mentalis muscles
The patient underwent embolization with interventional radiology one day prior to the surgical procedure.
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Bleeding, Patient had undergone embolization with interventional radiology prior to the surgery Hemostasis was achieved with bipolar cautery throughout the surgery
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1.Ozpinar A, Mendez G, Abla AA. Epidemiology, genetics, pathophysiology, and prognostic classifications of cerebral arteriovenous malformations. Handb Clin Neurol. 2017;143:5-13. 2. Zyck S, Davidson CL, Sampath R. Arteriovenous Malformations. [Updated 2022 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK531479/

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