Application of Advanced Technology During Resection of Posterior Fossa Arteriovenous Malformations: 2 Sister Cases

Various advanced imaging and intraoperative technologies can be used during resection of posterior fossa arteriovenous malformations (AVMs) in a hybrid neurovascular operating room. These technologies include transradial intraoperative angiography with post-processing of angiographic data for navigation (in combination with stereotactic magnetic resonance imaging) (Figure 1). Advanced semiautomated processing allows magnetic resonance imaging, computed tomography angiography, and angiography fusion for enhanced localization of the AVM. Additional useful technologies include processing of angiographic transit time to provide valuable flow data, indocyanine green angiography, fluorescein angiography, and use of a high-definition endoscope. While these technologies are potentially useful in certain circumstances, they may not be necessary in the case of relatively straightforward vascular lesions. Keeping this in mind is of particular importance, as the use of these technologies may require extended time with the patient under anesthesia. These sister cases of cerebellar AVMs illustrate the spectrum of the advanced technologies that are potentially available to surgeons during posterior fossa AVM resection (Video 1).