Arteriovenous Malformation (AVM) Surgery
Arteriovenous malformation (AVM) surgery is the microsurgical resection of the abnormal tangle of vessels (nidus) in the brain or spinal cord, where arteries connect directly to veins bypassing the capillary bed. It is often performed as part of a multimodal treatment plan together with methods such as embolization and/or stereotactic radiosurgery.
最后更新: 2026-06-09
Definition
AVM surgery is the procedure (microsurgical resection) in which the tangle of vessels (nidus) forming the abnormal direct connection between artery and vein is dissected free from the surrounding tissue and removed under the operating microscope. The aim is to controlled-occlude the feeding arteries (feeders) and draining veins and remove the malformation completely, thereby eliminating the risk of bleeding. Treatment is often not performed alone but as part of a multimodal approach combined with preoperative embolization (endovascular occlusion) and, in selected cases, stereotactic radiosurgery.
Indications
AVM surgery may be considered for malformations with a history of bleeding (hemorrhage), those causing seizures or progressive neurological symptoms, or those judged to carry a high risk of bleeding. The surgical accessibility and risk of the lesion are assessed using systems such as the Spetzler-Martin grading (nidus size, functional importance/eloquence of the surrounding brain, and whether venous drainage is superficial or deep). Low-grade, superficial AVMs in non-eloquent areas are considered more amenable to surgery, whereas observation or other methods may be preferred for high-grade lesions. The indication is determined individually for each patient.
Procedure
The procedure is performed under general anesthesia; vascular anatomy is often mapped in detail with preoperative angiography, and embolization of feeding vessels may be applied when needed. In surgery, an appropriate craniotomy (skull window) is opened and the nidus is reached under the microscope. Feeding arteries are identified and occluded in turn (coagulation/clips), the nidus is carefully separated from the surrounding brain, and finally the main draining vein is occluded to remove the malformation completely. Throughout the procedure, neuromonitoring and, when needed, intraoperative imaging/angiography are used to try to confirm completeness of the resection.
Advantages and Limitations
The main advantage of microsurgical resection is that, in suitable cases, the malformation is eliminated immediately and completely, and this can be confirmed by angiography. Unlike radiosurgery, the effect of reducing bleeding risk can be obtained immediately after treatment. As a limitation, surgical risk increases for deep-seated or eloquent lesions and for those with a high Spetzler-Martin grade. In such cases, a staged approach combined with embolization and radiosurgery, or observation alone, may be more appropriate. The treatment method is planned separately for each patient.
Recovery and Risks
Recovery time varies with the location and size of the lesion and the patient's condition. Possible risks include intraoperative or postoperative bleeding, neurological deficit (weakness, speech, vision, or sensory disturbances), seizures, infection, brain edema, and rarely a residual malformation due to incomplete resection. Additional treatment may be required in some situations. No outcome is guaranteed; the decision is individualized by considering the lesion characteristics (for example, the Spetzler-Martin grade), imaging findings, the patient's overall condition, and expectations together.
参考文献
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1504-1522.
- Spetzler RF, Kalani MYS, Nakaji P, eds. Neurovascular Surgery. 2nd ed. Thieme; 2015.
- Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg. 1986.
- Mohr JP, et al. Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet. 2014.
本文仅供一般参考，不能替代医疗检查。诊断与治疗决策因人而异。