title: "Dirty coagulation" technique as an alternative to microclips for control of bleeding from deep feeders during brain arteriovenous malformation surgery.
abstract: Meticulous haemostasis is one of the most important factors during microneurosurgical resection of brain arteriovenous malformation (AVM). Controlling major arterial feeders and draining veins with clips and bipolar coagulation are well-established techniques, while managing with bleeding from deep tiny vessels still proves to be challenging. This technical note describes a technique used by the senior author in AVM surgery for last 20 years in dealing with the issue highlighted.
  
  
  
  "Dirty coagulation" is a technique of bipolar coagulation of small feeders carried out together with a thin layer of brain tissue that surrounds these fragile vessels. The senior author uses this technique for achieving permanent haemostasis predominantly in large and/or deep-seated AVMs. To illustrate the efficacy of this technique, we retrospectively reviewed the outcome of Spetzler-Martin (SM) grade III-V AVMs resected by the senior author over the last 5 years (2010-2015).
  
  
  
  Thirty-five cases of AVM surgeries (14 SM grade III, 15 SM grade IV and 6 SM grade V) in this 5-year period were analysed. No postoperative intracranial haemorrhage was encountered as a result of bleeding from the deep feeders. Postoperative angiograms showed complete resection of all AVMs, except in two cases (SM grade V and grade III).
  
  
  
  "Dirty coagulation" provides an effective way to secure haemostasis from deep tiny feeders. This cost-effective method could be successfully used for achieving permanent haemostasis and thereby decreasing postoperative haemorrhage in AVM surgery.
authors.affiliation: Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland. danilkozyrev@gmail.com.|Department of Paediatric Neurology and Neurosurgery, North-Western State Medical University, St. Petersburg, Russia. danilkozyrev@gmail.com.
authors.forename: Danil A
authors.initials: DA
authors.lastname: Kozyrev
authors.affiliation: Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland.
authors.forename: Peeraphong
authors.initials: P
authors.lastname: Thiarawat
authors.affiliation: Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland.
authors.forename: Behnam Rezai
authors.initials: BR
authors.lastname: Jahromi
authors.affiliation: Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland.
authors.forename: Patcharin
authors.initials: P
authors.lastname: Intarakhao
authors.affiliation: Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland.
authors.forename: Joham
authors.initials: J
authors.lastname: Choque-Velasquez
authors.affiliation: Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland.
authors.forename: Ferzat
authors.initials: F
authors.lastname: Hijazy
authors.affiliation: Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland.|Department of Neurosurgery, Bristol Institute of Clinical Neuroscience, North Bristol University Hospital, Bristol, UK.
authors.forename: Mario K
authors.initials: MK
authors.lastname: Teo
authors.affiliation: Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Hernesniemi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001777:Blood Coagulation; D002648:Child; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000601:surgery*; D020300:Intracranial Hemorrhages / Q000517:prevention & control*; D008297:Male; D008866:Microsurgery / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000517:prevention & control*; D013525:Surgical Instruments / Q000009:adverse effects
keywords: Arteriovenous malformation; Bipolar coagulation; Microneurosurgery; Neurosurgical trick