View/Download PDF

Translate this page into:
Notice: Please configure GTranslate from WP-Admin -> Settings -> GTranslate to see it in action.

Video Abstract
2022
:13;
163
doi:
10.25259/SNI_217_2022

Multimodality resection of Oliveira Type IIIC* cerebellar AVM: A distinct entity

Department of Neurosurgery, Lewis Katz School of Medicine, Temple University, Philadelphia, United States,
Department of Neurosurgery, Harvard Medical School, Brigham and Women’s Hospital, Boston, United States.
Corresponding author: Ossama Al-Mefty, MD, Director of Skull Base Surgery, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, United States. oalmefty@partners.org
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, 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:

www.surgicalneurologyint.com

Annotations[1-5]

  1. 00:14 – Preamble

  2. 01:03 – Clinical presentation

  3. 01:09 – Neuroimaging

  4. 01:40 – Embolization

  5. 02:38 – Surgical setup

  6. 02:57 – Key surgical steps

  7. 03:46 – PICA

  8. 03:58 – Superficial draining veins

  9. 06:20 – Draining vein clipping

  10. 07:51 – SCA

  11. 09:23 – Outcomes.

Video 1: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:

https://doi.org/10.25259/SNI_217_2022

REFERENCES

  1. , , , , , . Surgical treatment of cerebellar arteriovenous malformations. In: , , , eds. Brain Arteriovenous Malformations and Arteriovenous Fistulas. New York: Thieme; .
    [Google Scholar]
  2. , , , , , . Posterior fossa arteriovenous malformations. Neurosurg Focus. 2009;26:E12.
    [Google Scholar]
  3. , . Arteriovenous malformations of the posterior fossa. Clinical presentation, diagnostic evaluation, and surgical treatment. J Neurosurg. 1986;64:849-56.
    [Google Scholar]
  4. , , . Multidisciplinary approach to arteriovenous malformations. Neurol Med Chir (Tokyo). 1998;38:177-85.
    [Google Scholar]
  5. , , , . AVM of the Brain. Stuttgart, New York: Thieme; .
    [Google Scholar]
Show Sections