Microsurgical Resection of a T12 Intramedullary Spinal Arteriovenous Malformation: 2-Dimensional Operative Video

Spinal arteriovenous malformations (AVMs) are rare vascular conditions that represent 2%to 4% of all intradural spinal lesions.(1)Patients typically present with back pain, bowel and bladder dysfunction, and neurological deficits.(2)Treatment options are endovascular embolization, radiosurgery, microsurgical resection, or a combination approach.(1,3-5)Wepresent the case of a woman in her early 30s with a history of lower back pain whose magnetic resonance imaging findings revealed an intradural, intramedullary spinal AVM. Patient consent was obtained for the procedure. The patient received preoperative embolization 1 day before surgery. The patient was placed in a prone position, and amid line incision was made. Laminectomies were performed from T10 to T12. The the calsac was exposed, and a midline dural opening was made. The feeding arteries to the AVM were exposed, cauterized, and divided using microsurgical techniques. The pia was dissected circumferentially from the borders of the AVM. The AVM nidus was directly entered with hemostatic control and mobilized away from adjacent spinal cord parenchyma. The final feeders from the anterior spinal artery were identified and cauterized,allowing for resection of the AVM. The draining vein was cauterized, andflow was in-spected with indocyanine green angiography. The patient tolerated the procedure well.She experienced a transient proprioceptive deficit and weakness, which resolved. She wasdischarged home on postoperative day 5 and returned to normal functioning within 6weeks. Although reports vary on the optimal treatment for spinal AVMs, microsurgicalresection should be considered a safe and effective option.