Introduction
Microsurgery describes any surgery conducted under a high-powered microscope, and is used in situations where very small structures (for example nerves and blood vessels) have to be operated on. Microsurgery is also referred to as 'microsurgical resection or removal'. Indications Microsurgery in brain surgery is used in many instances, but is particularly valuable in…
- Arteriovenous malformations.
- Dural arteriovenous fistula (DAVF) – where endovascular embolisation is not possible.
In some cases, endovascular embolisation and microsurgery approaches are used as separate complementary procedures, or together in the same procedure.
Preoperative Instructions
Before all neurosurgical procedures, including microsurgery, you should…
- Not eat or drink anything after midnight the night before the procedure (medication can be taken with very small sips of water).
- Avoid taking any non-steroidal anti-inflammatory medication (NSAIDs) two weeks ahead of the procedure.
- If you take regular blood thinners (e.g. aspirin, Plavix, warfarin etc) – you may need to stop taking these medications ahead of the procedure. Please consult your surgeon about when to stop and resume them.
- Avoid undergoing dental treatment (within three weeks) or any other form of surgery (within three months) of the planned procedure.
- To minimise risks of peri-operative infection, let our office know if you develop any symptoms of infection, e.g. a cold or flu, before surgery, or if you are receiving treatment for an infection within a few days of your scheduled operation.
Procedure
Microsurgery for AVM and DAVF involves a craniotomy (where a section of the skull is removed). Image-guided navigation ensures that the craniotomy is performed appropriately and the location of the AVM or DAVF is precisely identified during the procedure. The blood vessels feeding the malformation are either cauterised or sealed with medical 'clips', such that abnormal blood flow within the malformation/fistula is completely blocked or disconnected, prior to the cluster of blood vessels being removed. Once the procedure is complete the section of bone removed from the skull is put back into place and secured plates and screws and the skin is moved back into place and the incision closed.
Postoperative Instructions
Any surgery involving a craniotomy involves a hospital stay of 3-7 days. Full recovery from the procedure can take 2-3 months. If any of the following symptoms occur after returning home, you should contact us immediately…
- Severe and worsening headaches, not improved with pain medication.
- Temperature over 38 °C.
- Any discharge from the incision site.
- Seizure.
- Stroke symptoms – Numbness / weakness / vision / speech changes.
- Confusion / memory loss.
- Breathing issues.
- Nausea / vomiting.
Risks
Risks/complications associated with the procedure are those of surgery generally (risks associated with anaesthesia, wound infection, pneumonia, DVT), and specifically…
- Bleeding in the brain.
- Stroke – causing balance / coordination problems, weakness, speech problems, visual changes.
- Brain swelling.
- Cerebrospinal fluid leakage.
- Coma.
- Memory issues.
- Seizure.
Related Information
Brain Arteriovenous Malformations Dural Arteriovenous Fistulas and Carotid Cavernous Fistulas AVM, DAVF and CCF - Embolisation