2022 AMI Online Salon

Resection Strategy for AVMs in the Optic Apparatus

Project Details

  • Entrant Name:  Kristen Keil
  • Client: Barrow Neurological Institute
  • Copyright: Barrow Neurological Institute (inset, parts A and B), Journal of Neurosurgery (part C), 2021
  • Medium/software used: Adobe Photoshop
  • Final presentation format: journal article (print and online)
  • Primary Audience: Resident and attending neurosurgeons

Project Description

The management of arteriovenous malformations (AVMs) in the optic apparatus (optic nerve, chiasm, and tract) is challenging due to the eloquence of surrounding structures. Hemorrhage from these lesions can result in significant morbidity including vision loss. Treatment is challenging for the same reason. Microsurgical management is the only treatment modality available to many of these patients. The purpose of this illustration is to depict the elements that are considered when planning the resection strategy for optic apparatus AVMs. Considerations include the craniotomy and exposure, the location of the lesion and involvement of surrounding eloquent structures, and the configuration of the associated feeding arteries and draining veins. Although AVMs are never cube shaped, it is useful to conceptualize them as a box with six sides, applying structure to an otherwise amorphous tangle. The illustration appeared in a neurosurgical journal article, so common neurosurgical abbreviations were used in labeling to provide more visual real estate for the exposure and complex anatomy of the AVM.  (A) Operative view of an arteriovenous malformation of the optic nerve via a left orbitozygomatic craniotomy (inset). (B) Orientation of the AVM box relative to the optic apparatus and surrounding vasculature. (C) AVM box with diagrammatic representation of the arterial supply (inbound arrows) and venous drainage (outbound arrows).