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May 11, 1984

Laser Surgery-Reply

Author Affiliations

Universita di Torino Istituto di Neurochirurgia Turin, Italy

JAMA. 1984;251(18):2349. doi:10.1001/jama.1984.03340420021017

In Reply.—  The surgical treatment of AVMs with the traditional technique consists in the identification, isolation, and coagulation of the feeding arteries to interrupt the flow to the malformation; the nidus is then removed with reduced blood loss. The feeding arteries are located subcortically and usually in depth, requiring for this reason a deeper dissection in the healthy tissue. Since they always supply blood circulation to normal tissue, only the shunting arterioles arising from the feeding channels should be interrupted.1The main difference between traditional technique and laser technique consists essentially in the possibility to act directly on the pathological vessels of the nidus, inducing an immediate constriction by shrinkage or progressive thrombosis by endothelial damage2,3 with reduced hemorrhages. Even if not directly irradiated, because of the small size of the vessels, thrombosis propagates from the coagulated nidus into the shunting arterioles, which can be obliterated without any