Thursday, March 20, 2014

Cerebral Arteriovenous Malformation

A gentleman aged 38 years presented with a 5 years history of a feeling off epigastric discomfort followed by automatic movements lasting for 10 minutes followed by complete recovery. He had no memory of the episode. He was diagnosed as a case of complex partial seizures which were poorly controlled with medication.
CT scan of the head showed a lesion in the right temporal lobe of the brain(yellow arrows).

MRI brain also revealed an Arterio-venous malformation in the right temporal lobe(yellow arrows)

Digital Subtraction Angiography showed that the malformation was fed by branches from the middle cerebral artery with veins draining towards the surface and into the depth.

The AV malformation was completely removed by microsurgical technique. During surgery multiple tortuous arterialized veins were fed by right first part of the middle cerebral artery. It was drained by two veins, one over the brain surface and the other towards its lower surface.

Post-operative CT scan of head showed surgical changes and the cavity left after removal of the AVM (yellow dots)

The patient recovered well and was discharged intact on long term anti-epileptic medication.
The patient and was advised to get a CT angiogram of the Brain after 3 months of surgery during follow up.



  1. Right Tempolar lobe AVM. Did you preoperative embolize the AVM ?
    Great work in such challenging case.
    Dr TOmasz Skaba

  2. Hello,
    I will be grateful to accept me as a member of Indian Neurosurgery Forum.
    Thank you in advance.
    Kindly regards,
    Dr Tomasz Skaba
    Specialist in Neurosurgery

  3. Categorization of temporal AVMs into subtypes can assist with surgical planning and also standardize reporting. Lateral AVMs are the easiest to expose surgically, with circumferential access to feeding arteries and draining veins at the AVM margins. Basal AVMs require a subtemporal approach, often with some transcortical dissection through the inferior temporal gyrus. Medial AVMs are exposed tangentially with an orbitozygomatic craniotomy and transsylvian dissection of anterior choroidal artery and posterior cerebral artery feeders in the medial cisterns. Medial AVMs posterior to the cerebral peduncle require transcortical approaches through the temporooccipital gyrus. Sylvian AVMs require a wide sylvian fissure split and differentiation of normal arteries, terminal feeding arteries, and transit arteries. Ventricular AVMs require a transcortical approach through the inferior temporal gyrus that avoids the Meyer loop. Surgical results with temporal lobe AVMs are generally good, and classifying them does not offer any prediction of surgical risk.