LAUSR

Cerebral Arteriovenous Malformations (AVM) are dynamic neurovascular disorders that occur mainly in young adults, presenting an annual risk of rupture of 2-4% per year. 1 They can be asymptomatic, representing incidental radiological finding, or present with neurological deficits according to their brain location, size and presence or absence of bleeding.2,3 AVMs located in eloquent areas4 represents a great challenge for neurosurgeons, sometimes directed to alternatives therapies (embolization, radiotherapy) due to the difficulty in planning and surgical technique. Despite the complexity, we consider that there is benefit in accomplish the removal of these lesions; this can be done safely as with the adequate microsurgical strategy and neuroanatomical knowledge. In this surgical video, we show a case of a 55-year-old male patient with an AVM positioned over the right central sulcus. He presented history of intermittent left-hand paresthesia followed by an episode of involuntary movements in the left arm without loss of consciousness with spontaneous resolution. Angiography showed an AVM feed by branches of the ACM and multiple venous drainage for Trolard's complex and superficial middle cerebral vein, with a 4 cm nidus, making it a Grade III of the Spetzler-Martin classification4. The patient underwent to surgery with total resection of the lesion without any complication or new neurological deficits. The patient signed the Institutional Consent Form, which allows the use of his/her images and videos for any type of medical publications in conferences and/or scientific articles.