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Video Abstract
2021
:12;
214
doi:
10.25259/SNI_187_2021

Microsurgical treatment for cerebellomesencephalic fissure arteriovenous malformations after multiple sessions of endovascular treatment

Department of Neurosurgery, Universidade Federal de São Paulo, Brazil
Department of Radiology, Hospital Beneficencia Portuguesa de São Paulo, Brazil
Department of Interventional Neuroradiology, Pontificia Universidade Católica de Campinas, Campinas, São Paulo, Brazil,
Department of Neurosurgery, Bolivian Neurosurgery Institute, Cochabamba, Bolivia.
Corresponding author: Marcos Devanir Silva da Costa, Department of Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil. marcoscostaneuro@gmail.com
Licence

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Lessa SS, Paz-Archilla JA, Amorim BL, Filho JM, de Siqueira Campos CM, de Deus Silva L, et al. Microsurgical treatment for cerebellomesencephalic fissure arteriovenous malformations after multiple sessions of endovascular treatment. Surg Neurol Int 2021;12:214.

Abstract

Background:

Arteriovenous malformations (AVMs) are relatively uncommon congenital vascular anomalies, and only 7–15% of AVMs occur in the posterior fossa. Most posterior fossa AVMs clinically present with hemorrhage and are associated with a high risk of neurological deficits and mortality. These malformations are associated with a high incidence of flow-related aneurysms. Endovascular treatment of infratentorial AVMs is challenging in pediatric patients.

Case Description:

We describe an 11-year-old female adolescent with cerebellar syndrome [Video 1], who was diagnosed with a cerebellomesencephalic fissure AVM. We observed a sequential increase in the size of the AVM after multiple sessions of endovascular treatment and performed successful microsurgical resection of the lesion.

Conclusion:

This illustrative video highlights the role of microsurgery as a feasible therapeutic strategy for complete resection of cerebellar AVMs after endovascular embolization.

Keywords

Arteriovenous malformation
Cerebrovascular
Microsurgery

Annotation[1-7]

  • 1) 0:00 – Title

  • 2) 0:10 – Clinical Presentation

  • 3) 0:33 – Neurological Examination

  • 4) 0:42 – Neuroimage Findings/First Episode de Hemorrhage, CT Scan

  • 5) 0:47 – Neuroimage Findings/First Episode de Hemorrhage

  • 6) 0:55 – Neuroimage Findings/First Angiography

  • 7) 1:19 – Neuroimage Findings/First Embolization

  • 8) 1:28 – Neuroimage Findings/Second Hemorrhage

  • 9) 1:49 – Neuroimage Findings/Second Angiography

  • 10) 2:00 – Neuroimage Findings/Pre and Post Second Embolization

  • 11) 2:09 – Neuroimage Findings/Third Embolization

  • 12) 2:17 – Neuroimage Findings/Final Control of Third Embolization

  • 13) 2:38 – Neuroimage Findings/Preoperative MRI

  • 14) 2:50 – Neuroimage Findings/Preoperative Embolization

  • 15) 2:56 – Neuroimage Findings/Post Embolization

  • 16) 3:05 – Rationale for Procedure

  • 17) 3:10 – Risks of the Procedure and Its Potentials Benefits

  • 18) 3:37 – Alternatives and Why They Were Not Chosen

  • 19) 3:48 – Positioning and Craniotomy

  • 20) 3:57 – Key Surgical Steps

  • 21) 4:12 – Subarachnoid Dissection and Feeding Coagulation, left side

  • 22) 4:39 – Subarachnoid Dissection and Feeding Coagulation, right side

  • 23) 4:54 – Clipping the Vermian Vein

  • 24) 4:57 – Dissecting and Coagulating Tentorial Veins

  • 25) 5:02 – Decompressing the Fourth Ventricle

  • 26) 5:09 – Removal of Nidus and Onyx

  • 27) 5:27 – Final Aspect

  • 28) 5:43 – Disease Background

  • 29) 6:20 – A Brief Review of Clinical and Image Outcome

  • 30) 6:34 – Postoperative MRI

  • 31) 6:42 – Postoperative Angiography

  • 32) 6:51 – References

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

[Video 1]-Available on:

www.surgicalneurologyint.com

REFERENCES

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