Sylvian Arteriovenous Malformation Resection and Associated Middle Cerebral Artery Aneurysm Clipping: Technical Nuances of Concurrent Surgical Treatment

Dale Ding; Thomas J Buell; Daniel M Raper; Ching-Jen Chen; Panagiotis Mastorakos; Kenneth C Liu; Dennis G Vollmer

doi:10.7759/cureus.2166

Sylvian Arteriovenous Malformation Resection and Associated Middle Cerebral Artery Aneurysm Clipping: Technical Nuances of Concurrent Surgical Treatment

Cureus. 2018 Feb 7;10(2):e2166. doi: 10.7759/cureus.2166.

Authors

Dale Ding¹, Thomas J Buell², Daniel M Raper³, Ching-Jen Chen², Panagiotis Mastorakos², Kenneth C Liu⁴, Dennis G Vollmer²

Affiliations

¹ Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
² Department of Neurological Surgery, University of Virginia.
³ Department of Neurological Sugery, University of Virginia, Charlottesville, United States.
⁴ Department of Neurological Surgery, University of Virginia, Charlottesville, United States.

Abstract

Approximately 10-30% of brain arteriovenous malformations (AVM) have associated arterial aneurysms (AAA), and the management of these lesions can be challenging. In this video technical note, we demonstrate the microsurgical treatment of an unruptured, Spetzler-Martin grade I AVM in the distal Sylvian fissure with two AAAs arising proximally from the inferior M2 trunk immediately distal to the middle cerebral artery (MCA) bifurcation. First, we resected the superficially located AVM to normalize the blood flow through the Sylvian vein. Next, we performed a Sylvian fissure dissection to access and clip the two MCA AAAs. We also discuss the technical nuances of tandem surgical intervention for AVMs with AAAs as it pertains to this case, particularly with respect to the order of lesion treatment, Sylvian fissure dissection, nidal resection, and aneurysm clipping.

Keywords: intracranial aneurysm; intracranial arteriovenous malformation; microsurgery; middle cerebral artery; sylvian fissure; vascular malformations.