Neurosurg Focus
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Case Reports
Surgical treatment of a complex Grade III Spetzler-Martin posterior temporal arteriovenous malformation.
Grade III Spetzler-Martin arteriovenous malformations (AVMs) are a distinct subgroup of brain AVMs. Their variety in terms of location, type of venous drainage, and size makes them the most heterogenous group in the AVM classification. The surgical risk of treatment is also variable depending on the specifics of a given Grade III AVM. ⋯ The detail of the AVM resection is described in the video clip. A total resection was achieved, and the patient's neurological examination was intact after the procedure. The video can be found here: https://youtu.be/fj5Cxw3kpXQ .
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This is the case of a 14-year-old female who presented with headache and seizures. Cranial magnetic resonance imaging revealed an arteriovenous malformation (AVM) located at the posterior portion of the right-sided fusiform gyrus. Cerebral angiography showed that the AVM was fed mainly by branches from the inferior temporal trunk of the posterior cerebral artery. ⋯ Postoperative MRI and cerebral angiography confirmed the total resection. The patient was discharged on the 5th postoperative day without neurological deficit. The video can be found here: https://youtu.be/QPrUl8AP7G8 .
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Case Reports
Contralateral transcallosal resection of a ventricular body arteriovenous malformation: 3D operative video.
A 46-year-old male presented with an incidentally discovered left ventricular body arteriovenous malformation (AVM). It measured 2 cm in diameter and had drainage via an atrial vein into the internal cerebral vein (Spetzler-Martin Grade III, Supplementary Grade 4). Preoperative embolization of the posterior medial choroidal artery reduced nidus size by 50%. ⋯ This case demonstrates strategic circumferential disconnection of feeding arteries (FAs) to the nidus, the use of aneurysm clips to control large FAs, and the use of dynamic retraction and importance of a generous callosotomy. Postoperatively, he was neurologically intact, and angiogram confirmed complete resection. The video can be found here: https://youtu.be/j0778LfS3MI .
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Case Reports
Microsurgical treatment for arteriovenous malformation of the corpus callosum and choroidal fissure.
The management of arteriovenous malformations (AVMs) of the corpus callosum and choroidal fissure is challenging because they commonly receive arterial feeders from the anterior and posterior circulation, and drain to deep veins. In this video the authors present the case of a 20-year-old man who presented with acute onset of headache, loss of consciousness, and nuchal rigidity. Computed tomography, MRI, and cerebral angiography performed in tandem revealed a ruptured, large, Grade IV AVM of the corpus callosum and choroidal fissure with two groups of arterial feeders: one from the pericallosal artery and the other from the medial and lateral posterior choroidal arteries. ⋯ The first stage involved preoperative embolization of the arterial feeders from the posterior circulation, which promoted reduction of the nidus flow of the AVM. The second involved a microsurgical resection, using the interhemispheric approach, with the patient in the prone position, which allowed accessing the anterior circulation feeders and the complete resection of the AVM, without associated morbidity. The video can be found here: https://youtu.be/5wcYKhcJtls .
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Case Reports
Selective embolization of ruptured feeding artery aneurysm followed by resection of arteriovenous malformation.
This is the case of a man in his 40s who suffered sudden collapse into a deep coma as a result of a ruptured arteriovenous malformation (AVM) feeding artery aneurysm within the lateral ventricle. The ruptured aneurysm was successfully treated with Onyx embolization of the feeding pedicle. ⋯ It also reviews the anatomy of the choroidal fissure. The video can be found here: https://youtu.be/UeqFzhTRU1Q .