How I do it? A multimodality-guided awake hybrid operation for a language-area brain arteriovenous malformation and multiple intracranial aneurysms

BACKGROUND: The cure of an eloquent brain arteriovenous malformation (BAVM) and multiple intracranial aneurysms with preservation of neurological function and the minimal procedures is challenging. METHOD: A 53-year-old male was admitted to treat a left frontal language-area BAVM and concomitant five bilateral intracranial aneurysms. After repairing the ruptured right middle cerebral artery (MCA) bifurcation aneurysms and the other two unruptured ones, at the second-stage multimodality-guided awake hybrid operation, we successfully obliterated the left frontal BAVM and two other left MCA aneurysms. CONCLUSION: The multimodality-guided awake hybrid operation may be a promising technique to treat complicated cerebrovascular disease. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00701-021-05093-7.