CPT® Code 61682

An arteriovenous malformation (AVM) is a pathological condition characterized by an abnormal connection between the arterial and venous systems, where one or more arteries and veins connect directly without the intermediary of capillaries. This congenital malformation can lead to significant complications due to the high-pressure blood flow directly from arteries into veins, bypassing the normal capillary network. Intracranial AVMs, specifically, are located within the skull and can be classified based on their anatomical location. A supratentorial AVM is situated above the tentorium cerebelli, which is a membrane that separates the cerebrum from the cerebellum and houses critical structures such as the cerebral hemispheres, lateral and third ventricles, choroid plexus, hypothalamus, and the pituitary and pineal glands. In contrast, an infratentorial AVM is found below the tentorium cerebelli, encompassing the cerebellum, brain stem, and fourth ventricle. The surgical procedure for addressing a complex supratentorial AVM involves a craniotomy, which entails creating scalp flaps and burr holes, followed by the removal of a bone flap to access the dura mater and expose the AVM. The procedure requires meticulous microsurgical techniques to identify and ligate the arterial feeders and draining veins, ultimately excising the AVM completely. This complex surgical intervention is critical to prevent potential life-threatening complications such as hemorrhage, which can arise from the high-pressure shunting of blood through the abnormal vessels.