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Intraoperative Rupture and Complication Management

Last Updated: September 28, 2018

Management of Intraoperative Rupture during Resection of a Lateral Temporal AVM: The “Commando” Operation

Intraoperative rupture (IOR) of an arteriovenous malformation (AVM) presents unique challenges to the surgeon unlike any others. In contrast to aneurysm surgery, there is no proximal control that can save the surgeon and bring the situation under control quickly. The AVM’s IOR tests the surgeon’s highest level of temperament and maturity, as well as his or her technical fluency and efficiency.

The best strategy for managing an IOR is to avoid it. Therefore, we must analyze the most common underlying causes for IOR during AVM surgery. I have been involved with numerous IORs because of an inadvertent injury to the primary draining vein during management of bleeding from a feeding vessel underneath this major draining vein. I have also accidentally injured primary veins during the dural opening. Aggressive coagulation of the nidus or the primary vein wrapped on the deep walls of the nidus leads to acute changes in the AVM’s drainage systems and is a guaranteed recipe for disaster.

During dural opening, the surgeon should...