"Transinsular approach" for the treatment of a medial temporal arteriovenous malformation.

A new approach for the treatment of arteriovenous malformations in the medial temporal lobe is proposed. This approach, referred to as the "transinsular approach," comprises incising the superior part of the anterior insula and exploring the plexal point of the anterior choroidal artery through the space between the dissected insula and the frontal lobe. A representative case of a patient with a large medial temporal arteriovenous malformation that was successfully extirpated by this approach is reported. The advantages of this approach and the functional results of partial incision of the insula are discussed.