Hepzibha Alexander, BSN – Children’s National Medical Center, Division of Neurosurgery and Georgetown University School of Medicine
Ehsan Dowlati, MD – Children’s National Medical Center, Division of Neurosurgery and Medstar Georgetown University Hospital
Deki Tsering, MS – Children’s National Medical Center, Division of Neurosurgery
Robert Keating, MD – Children’s National Medical Center, Division of Neurosurgery and George Washington University School of Medicine (corresponding author)
Surgical Theater is an emerging 3D virtual reality platform that has an inherent value in assisting the surgeon during any operative procedure with complex three dimensional anatomy. The 360-degree reconstruction of the patient’s unique anatomy aids surgical planning as well as intraoperative visualization and navigation. This technical advantage is invaluable when resecting any intricate three-dimensional object such as tumors or an involved arteriovenous malformation (AVM), whereby accurate localization of feeding arteries and draining veins is crucial to ensure complete resection. Our patient presented with a right parietooccipital AVM that was primarily supplied by the right posterior cerebral artery and a smaller contribution from the inferior division of the right middle cerebral artery. Embolization could not be performed due to the small caliber of the blood vessels and a surgical route utilizing frameless navigation was chosen. Due to the technical difficulties in performing an intraoperative angiogram in the prone position, a new surgical tool, Surgical Theater, was employed to help confirm not only localization of the many feeding and draining vessels, but also to help ensure a complete resection at the conclusion. The Surgical Theater was utilized multiple times during the surgery in conjunction with frameless navigation to determine the boundaries of the AVM and at the end, the Surgical Theater was able to clearly demonstrate prior surgical localization points providing visual confirmation that all areas of interest were adequately seen and that no residual AVM was present. This educational video demonstrates the value of Surgical Theater as an adjunct in AVM resection, particularly when intraoperative confirmation using angiogram is not feasible.