with Dr. Kunal Vakharia
This case study presents the surgical management of a 40-year-old male who developed malignant edema following radiosurgery for a left frontal arteriovenous malformation (AVM). The patient initially presented with headaches and seizures, leading to the diagnosis of an AVM. Radiosurgery was performed, but the patient subsequently developed significant malignant edema and midline shift, presenting with a blown pupil. Emergent decompressive craniectomy was performed to manage the life-threatening edema. Over time, radiation necrosis developed at the AVM site, requiring further surgical intervention. Intraoperative neuro-navigation and ultrasound were used to guide the meticulous dissection of the gliotic and necrotic tissues along with the AVM. Using microsurgical techniques and electrocautery, the AVM was successfully resected, achieving complete decompression and hemostasis. The patient experienced a gradual recovery, with improvement in hemiparesis and resolution of edema. Postoperative imaging confirmed the successful removal of the AVM and necrotic tissues, with no residual mass. A year later, the patient's bone flap was replaced, and his neurological condition remained stable.
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