{"id":"f4cf7ebf-92e4-494c-b6cb-8be5768d1a9e","slug":"microsurgical-treatment-for-cerebellomesencephalic-fissure-arteriovenous-malformations-after-multiple-sessions-of-endovascular-treatment","title":"Microsurgical treatment for cerebellomesencephalic fissure arteriovenous malformations after multiple sessions of endovascular treatment","authors":["Silvio Sarmento Lessa","Juan Alberto Paz-Archilla","Bruno Loof Amorim","Jose Maria Campos Filho","Christiane Monteiro de Siqueira Campos","Leonardo de Deus Silva","Richard Gonzalo Parraga Choque","Marcos Devanir Silva da Costa","Feres Chaddad-Neto"],"abstract":"Background: 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. Case Description: 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. Conclusion: This illustrative video highlights the role of microsurgery as a feasible therapeutic strategy for complete resection of cerebellar AVMs after endovascular embolization. 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 The authors certify that they have obtained all appropriate patient consent. There are no conflicts of interest. www.surgicalneurologyint.com","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/placeholders/specialty/pediatric-neurosurgery.png","publishDate":"2021-05-10T00:00:00.000Z","doi":"10.25259/SNI_187_2021","categories":["Pediatric Neurosurgery","Video Abstract"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2021/05/10800/SNI-12-214.pdf"}