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How we do it? The surgical resection of a medial parietal arteriovenous malformation under multimodal imaging technology-guided hybrid operation

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Abstract

Background

This report described the surgical resection of a challenging medial parietal lobe arteriovenous malformation (AVM) using the hybrid operation theater with a multimodal imaging-guided technology.

Method

A 29-year-old male was admitted to treat a ruptured medial parietal AVM. The deep and diffusive compartment of the nidus was embolized before resection. Preoperatively and intraoperatively, mixed reality technology with multimodality imaging was utilized for surgical planning and navigation. The nidus was totally resected and confirmed by intraoperative angiography. The patient recovered without sequella.

Conclusion

We hope this report provides new insights into applying multimodal imaging technology-guided hybrid operation for brain AVM.

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Acknowledgements

This study was sponsored by the Shanghai Municipal Alliance for Clinical Competence Improvement and Advancement in Neurosurgery (SHDC22021303), the Fujian Province Science and Technology Innovation Joint Fund (No. 2021Y9135), and Pudong New Area Science and Technology Development Fund (No. PKX2020-R03). The mixed reality planning is courtesy of Shanghai Licyo Medical Technology Co., LTD. The DTI images in this manuscript were reconstructed using an automatic algorithm software “DiffusionGo.”

Author information

Author notes

  1. Kai Quan and Xuanfeng Qin contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, National Center for Neurological Disorders, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Kai Quan, Xuanfeng Qin, Jianping Song & Wei Zhu

  2. Neurosurgical Institute of Fudan University, Shanghai, 200040, China

    Kai Quan, Xuanfeng Qin, Jianping Song & Wei Zhu

  3. Shanghai Clinical Medical Center of Neurosurgery, Shanghai, 200040, China

    Kai Quan, Xuanfeng Qin, Jianping Song & Wei Zhu

  4. Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, 200040, China

    Kai Quan, Xuanfeng Qin, Jianping Song & Wei Zhu

  5. Research Unit of New Technologies of Micro-Endoscopy Combination in Skull Base Surgery (2018RU008), Chinese Academy of Medical Sciences (CAMS), Shanghai, 200040, China

    Kai Quan, Xuanfeng Qin, Jianping Song & Wei Zhu

  6. Department of Neurosurgery, National Regional Medical Center, Huashan Hospital Fujian Campus, Fudan University, Fuzhou, 350209, Fujian, China

    Jianping Song

Authors
  1. Kai Quan
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  2. Xuanfeng Qin
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  3. Jianping Song
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  4. Wei Zhu
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Corresponding author

Correspondence to Jianping Song.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by Huashan Hospital Institutional Review Board (HIRB), Fudan University, Shanghai, China.

Informed consent

It represents a video of a surgical case. The patient gave approval for this publication.

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Key points

1. Surgical resection of medial parietal AVMs can be challenging due to their location and proximity to eloquent structures.

2. The distal cortical branches of the ACA and PCA are the main suppliers of medial parietal AVMs.

3. The drainage route for medial parietal AVMs can be either superficial or deep, ascending towards the SSS and/or descending towards the VoG.

4. Medial parietal AVMs invading the paracentral lobule are considered eloquent, as they are associated with the somatosensory cortex responsible for leg sensation.

5. The hybrid operation theater can ensure safe, comprehensive multimodality evaluation and treatment of brain AVM, offering the opportunity for favorable curative treatment.

6. The mixed reality technology can be utilized to understand surgical anatomy and plan thoroughly.

7. Embolization through the PCA can be used to occlude the most diffusive and deepest compartment of the medial parietal AVM.

8. Temporary clipping of the primary suppliers to the nidus is the key for early proximal control during surgery.

9. Careful dissection and inspection are crucial to prevent contralateral ACA and PCA injury.

10. The drainage veins should only be transected after most of the nidus was circumstantially devascularized.

Supplementary information

This video illustrates the set-up of the position under the guidance of Hololens 2 and the surgical procedure of a right medial parietal AVM resection. (MP4 117101 kb)

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Quan, K., Qin, X., Song, J. et al. How we do it? The surgical resection of a medial parietal arteriovenous malformation under multimodal imaging technology-guided hybrid operation. Acta Neurochir 165, 3787–3791 (2023). https://doi.org/10.1007/s00701-023-05836-8

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  • DOI: https://doi.org/10.1007/s00701-023-05836-8

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