Operative Neurosurgery 24:499–506, 2023
Arteriovenous malformations (AVMs) in the subcortical and/or periventricular regions can cause signiﬁcant intraventricular and intracranial hemorrhage. These AVMs can pose a unique surgical challenge because traditional, open approaches to the periventricular region require signiﬁcant cortical/white matter retraction to establish sufﬁcient operative corridors, which may result in risk of neurological injury. Minimally invasive tubular retractor systems represent a novel, feasible surgical option for treating deep-seated AVMs.
OBJECTIVE: To explore 5 cases of NICO BrainPath-assisted resection of subcortical/ periventricular AVMs.
METHODS: Five patients from a single institution were operated on for deep-seated AVMs using tubular retractor systems. Collected data included demographics, AVM speciﬁcations, preoperative neurological status, postoperative neurological status, and postoperative/intraoperative angiogram results.
RESULTS: Five patients, ranging from age 10 to 45 years, underwent mini-craniotomy for stereotactically guided tubular retractor-assisted AVM resection using neuronavigation for selecting a safe operative corridor. No preoperative embolization was necessary. Mean maximum AVM nidal diameter was 8.2 mm. All deep-seated AVMs were completely resected without complications. All AVMs demonstrated complete obliteration on intraoperative angiogram and on 6-month follow-up angiogram.
CONCLUSION: Minimally invasive tubular retractors are safe and present a promising surgical option for well-selected deep-seated AVMs. Furthermore, study may elucidate whether tubular retractors improve outcomes after microsurgical AVM resection secondary to mitigation of iatrogenic retraction injury risk.