• World Neurosurg · Dec 2023

    Case Reports

    Trans-Peduncular Approach for Resection of Ruptured 4th Ventricular Arteriovenous Malformation.

    • Lorenzo Rinaldo, Sean Wilkinson, Todd B Dubnicoff, Roberto Rodriguez Rubio, and Adib A Abla.
    • Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
    • World Neurosurg. 2023 Dec 1; 180: 6969.

    AbstractThe lateral recess of the fourth ventricle can be challenging to access surgically. We present a case of a previously ruptured arteriovenous malformation (AVM) of the fourth ventricle that was surgically resected via a retrosigmoid craniotomy and transinferior cerebellar peduncular approach. The patient is a 54-year-old female who experienced an intraventricular hemorrhage several months before presentation to our institution. Imaging studies suggested the presence of an AVM located in the right lateral recess of the fourth ventricle. After discussion of all possible treatment options, the patient elected to proceed with surgical resection. To access the lesion, we performed a retrosigmoid craniotomy and entered into the fourth ventricle via s small incision in the inferior cerebellar peduncle. Postoperative imaging demonstrated complete removal of the AVM nidus. Video 1 demonstrates this approach and discusses the anatomic landmarks used to guide resection.Copyright © 2023 Elsevier Inc. All rights reserved.

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