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Multimodality resection of Oliveira Type IIIC* cerebellar AVM: A distinct entity
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Received: ,
Accepted: ,
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, transform, 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: Almefty R, Essayed WI, Al-Mefty O. Multimodality resection of Oliveira Type IIIC* cerebellar AVM: A distinct entity. Surg Neurol Int 2022;13:163.
Abstract
Background:
Posterior fossa AVMs constitute about 10% of AVMs and are associated with a higher rate of hemorrhage and increased morbidity and mortality rates necessitating treatment with rare exception. Cerebellar AVMs differ markedly from their supratentorial counterparts in that there are no perforating vessels involvement, drainage into the deep cerebral venous system, or presence of eloquent functional area except for the dentate nucleus. While Yaşargil has classified cerebellar AVMs into seven subtypes according to their location, de Oliveira et al. have classified them using a more impactful grading system based on the size, location, and involvement of the dentate nucleus with the highest risk being III (size over 4 cm) C (mixed superficial and deep location) * (dentate involvement). In this extensive AVM with multiple arterial feeders from the SCA, AICA, and PICAs, preoperative embolization facilitates the safe surgical removal.
Case Description:
We present the case of resection of de Oliveira et al. IIIC* cerebellar AVM highlighting the tenets of preoperative embolization, wide surgical exposure with an extended retrosigmoid approach, arachnoidal dissection of the SAC, AICA, and PICA feeders, parenchymal dissection with preservation of the dentate nucleus, and preservation of venous drainage until complete disconnection. The patient consented to surgery after presenting with hemorrhage and developed hydrocephalus and CSF leak, managed successfully.
Conclusion:
de Oliveira et al. classification is highly impactful in grading posterior fossa AVMs.
Keywords
Arteriovenous malformation
AVM embolization
Cerebellum
Microsurgery
Retrosigmoid craniotomy
[Video 1]-Available on:
Annotations[1-5]
00:14 – Preamble
01:03 – Clinical presentation
01:09 – Neuroimaging
01:40 – Embolization
02:38 – Surgical setup
02:57 – Key surgical steps
03:46 – PICA
03:58 – Superficial draining veins
06:20 – Draining vein clipping
07:51 – SCA
09:23 – Outcomes.
Video 1:
Video 1:Resection of an Oliveira type IIIC* cerebellar AVM..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.
Videos available on:
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