Microsurgical treatment for cerebellomesencephalic fissure arteriovenous malformations after multiple sessions of endovascular treatment
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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.
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.
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.
This illustrative video highlights the role of microsurgery as a feasible therapeutic strategy for complete resection of cerebellar AVMs after endovascular embolization.
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
Conflicts of interest
There are no conflicts of interest.
[Video 1]-Available on:
- Journal of Neurosurgical Sciences. 1997.Endovascular treatment of pial AVMs: Technical options, indications and limits in pediatric age patients. In:
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