Pearls Callosal and periventricular AVMs are quite rare. Their deep location and association with critical neurovascular structures indicate patients should seek help from experienced centers. Indications for treatment are similar to those for all other iAVM locations. Radiosurgery, although less…
Epidemiology and Natural History Posterior fossa AVMs are rare lesions. Previous series have estimated that they make up approximately 15%–18% of all intracranial AVMs. This group can be further divided into brainstem and cerebellar AVMs. Cerebellar AVMs ( Fig. 32.1…
Pearls Eloquent (functional) cortex includes motor, sensory, visual, and speech areas as well as the thalamus, brainstem, and cerebellar peduncles. Awake craniotomy to map functional cortex is rarely used in AVM surgery. Noninvasive or minimally invasive methods to define functional…
Pearls Giant iAVMs are a rare entity. They can be symptomatic due to bleeding as well as through steal phenomena. Treatment is almost always multimodality, with an emphasis on mitigating bleeding risk and palliation of symptoms. Cure is rare. Giant…
Pearls Wada testing was originally developed to anticipate postoperative surgical deficit. Test characteristics vary based on agent used, anatomic location of the AVM, and clinical situation. The advent of microcatheter techniques has encouraged the use of superselective Wada testing. It…
Pearls Epidemiological data regarding iAVM rupture risk in pregnancy is equivocal and underpowered in the literature, and reports of peripartum iAVM rupture are rare. Physiological considerations in iAVM management include cardiac output, blood coagulability, systemic vascular resistance, and fetal gestational…
Acknowledgment The authors would like to thank Ms. Kelsey Lansdale for her assistance with the illustrations. Pearls Intracranial hemorrhage and subsequent seizures, headaches, and focal neurological deficits are common presentations in patients with symptomatic iAVMs. Multidisciplinary care of patients with…
Pearls Sudden and sustained blood loss remains an important perioperative concern in iAVM procedures and requires anticipatory management. Malignant cerebral edema and intracranial hypertension may be refractory to medical management following iAVM treatment. Clinical and subclinical seizures require vigilance in…
Pearls Hemodynamic stability is paramount during iAVM intervention and predicated upon euvolemia and adequate anesthesia depth. Brain relaxation and surgical field optimization facilitates resection (see Table 25.1 ). No anesthetic agent or hypothermia has been shown to be superior in…
Pearls Comorbidities have not been found to be predictive in iAVM treatment outcomes. Any patient with a medical comorbidity should be evaluated by the appropriate specialist. Patients who have seizures related to their iAVM benefit from resection. Liver disease is…