Interhemispheric transfalcine approach to a medial frontal arteriovenous malformation: operative video with positioning illustrations

Abstract

Brain arteriovenous malformations (AVM) are a complex and challenging subset of neurosurgical disease, the optimal treatment of which is nuanced and dependent on numerous patient- and disease-specific factors. Clinical features that may predispose toward resection as front-line treatment include lower grade lesions, particularly those in non-eloquent locations, as well as active pregnancy. In all AVM resections, minimization of risk to exposed healthy brain adjacent to the lesion is a key surgical principle. In this illustrative case report, we discuss the management of a young woman who presented with a new diagnosis of AVM following an intracranial hemorrhage, at which time she was also identified as newly pregnant. Resection via the contralateral transfalcine approach with preoperative embolization was recommended, the intraoperative and postoperative courses proceeded uneventfully, and the patient was cured of her AVM and went on to successfully deliver twins. Recording and description of procedure are shown in Video Case Report.

Keywords: Arteriovenous malformation; Intracranial hemorrhage; Neurology; Positioning; Pregnancy; Surgery; Transfalcine.