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One of the pressing constraints in the treatment for arteriovenous malformations (AVM) is the potential development of new neurological deficits, mainly when the AVM is in an eloquent area. The risk of ischemia when an “en passage” arterial supply is present is not negligible. In this regard, awake surgery holds promise in increasing the safety of low-grade AVMs resection.

We conducted a pilot trial on 3 patients with low-grade AVMs affecting speech areas to evaluate the safety of awake craniotomy. Each feeder was temporarily clipped before the section. Also, we performed a systematic review to analyze the existing data about the impact of awake surgery in eloquent AVM resection.

None of the 3 patients presented with neurological deficits after the procedure. Awake craniotomy was useful in one case, as it allowed the detection of speech arrest during the temporal clipping of one of the …