ABSTRACT
The surgical treatment of intracranial arteriovenous malformations (AVMs) has advanced tremendously since Cushing and Bailey wrote in 1928, to ‘‘extirpate one of these aneurysmal angiomas in its active state would be unthinkable’’ (1). As recently as the late 1970s, the senior author had the opportunity to watch Dr. Duke Samson resect a large and complex AVM. It appeared at that time that we simply did not have the appropriate technologies to deal with the fragility of the vasculature surrounding these lesions. Only high levels of surgical skill and extensive experience enhanced the patient’s chance for a good outcome by overcoming technological limitations. Progress in surgical management has been driven by two broad trends: technological development and interdisciplinary coordination. Endovascular and radiosurgical therapies have expanded the therapeutic arsenal, while the operating microscope has refined the surgical option. Advances in our understanding of the pathobiology and natural history of the disease have reshaped anesthetic and postoperative care of patients with AVMs. Neuroradiologists now provide surgeons with exceptional imaging capabilities. In the near future, we may see even tighter collaboration between disciplines. AVM surgery will likely be conducted in a modified operating room that permits simultaneous endovascular and microsurgical intervention. The increased interdisciplinary cohesion in combating AVMs has had a significant impact on surgical outcomes. These collaborative strategies are examined in more detail in other chapters.
