Occipital Microarteriovenous Malformation Resection, Strategy, and Nuances.

We describe a patient who presented with superior quadrianopsia due to an occipital micro AVM that bled into the optic radiation. Onyx embolization was attempted. However, early follow-up angiogram revealed recanalization and recurrence of the AVM. He was then taken to the hybrid operative room, where a complete resection was achieved confirmed by intraoperative angiogram. He made a complete recovery with no new neurologic deficit and stable visual field deficit. This case demonstrates treatment strategy, surgical planning, and technical nuances in microsurgical resection of micro AVMs located in an eloquent area. Management of a ruptured microarteriovenous malformation (microAVM) localized in an eloquent brain region is challenging. The major difficulties are those related to localizing and defining the micronidus in order to achieve complete resection and definitive cure while preserving function. The best and definitive treatment for AVMs is either surgical resection or radiosurgery. However, in our institute a small subset of microAVMs might be cured by endovascular embolization in a single session. In the case presented here, a single feeder was demonstrated and microcatheter navigation toward a good working position seemed feasible; thus we decided to try first an endovascular approach.