• Dario Marotta, Benjamin K Hendricks, Rouzbeh Shams-Amiri, Gina Watanabe, and Aaron Cohen-Gadol.
• Alabama College of Osteopathic Medicine, Dothan, Alabama, USA; Department of Neurology, Division of Neuropsychology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
• World Neurosurg. 2022 Mar 1; 159: 348-361.

BackgroundThe decision-making process surrounding resection of arteriovenous malformations (AVMs) in proximity to vital brainstem structures is a complex topic. Intricate vasculature in the setting of exquisite brainstem eloquence creates a high-risk operative landscape with the potential for devastating complications. Effective resections are driven by mastery of the relevant operative anatomy, preservation of pertinent vasculature, and technical experience and acumen.MethodsThis article provides a narrative literature review on the resection of brainstem AVMs.ResultsOperative anatomy and approaches to AVMs of the midbrain (anterior/posterior), pons (anterior/lateral), and medulla (anterior/lateral) are discussed herein, with a focus on pearls and pitfalls for minimizing complications during resection.ConclusionsCareful consideration of the patient's clinical background, the natural history of the lesion, and expertise of the treating surgeon are paramount for improving the natural course of brainstem AVMs.Copyright © 2021 Elsevier Inc. All rights reserved.

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