Multidisciplinary Approach to an Arteriovenous Malformation

Abstract

Objective: Arteriovenous malformations (AVMs) are composed of abnormally connecting feeding arteries and draining veins and lack a regulatory system. Frequent recurrences and unpredictable behavior are their main problems. This study introduces a complicated case of AVM with massive bleeding through the external auditory canal that was treated with a multidisciplinary approach. Method: We report a complicated case of a huge AVM with a fistula and massive bleeding in the head and neck region to share our treatment experience, together with a literature review. Results: The patient underwent wide excision with free flap reconstruction after embolization of the bilateral ECA the day before surgery. We used a subtemporal-infratemporal fossa approach. The dura was exposed after the middle fossa approach and the masticator space before removing the mass. The mass measured 15x15 cm, and the external jugular vein was dilated. The defect was reconstructed using a latissimus dorsi musculocutaneous free flap, measuring 25x15cm in size and 15 mm thick. No flap or wound complication was observed on CT. Conclusion: The treatment of complicated AVMs in the head and neck region is challenging and a multidisciplinary approach is needed to eradicate the AVM completely without recurrence or complications. This consists of preoperative embolization of vessels, meticulous resection without injuring the feeding vessels, and a reconstruction with well-vascularized free flap.