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Silvio Sarmento Lessa1, Juan Alberto Paz-Archilla1, Bruno Loof Amorim1, Jose Maria Campos Filho1, Christiane Monteiro de Siqueira Campos2, Leonardo de Deus Silva3, Richard Gonzalo Parraga Choque4, Marcos Devanir Silva da Costa1, Feres Chaddad-Neto1
  1. Department of Neurosurgery, Universidade Federal de São Paulo, Brazil
  2. Department of Radiology, Hospital Beneficencia Portuguesa de São Paulo, Brazil
  3. Department of Interventional Neuroradiology, Pontificia Universidade Católica de Campinas, Campinas, São Paulo, Brazil,
  4. Department of Neurosurgery, Bolivian Neurosurgery Institute, Cochabamba, Bolivia.

Correspondence Address:
Marcos Devanir Silva da Costa
Department of Neurosurgery, Universidade Federal de São Paulo, Brazil

DOI:10.25259/SNI_187_2021

Copyright: © 2021 Surgical Neurology International 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, tweak, 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: Silvio Sarmento Lessa1, Juan Alberto Paz-Archilla1, Bruno Loof Amorim1, Jose Maria Campos Filho1, Christiane Monteiro de Siqueira Campos2, Leonardo de Deus Silva3, Richard Gonzalo Parraga Choque4, Marcos Devanir Silva da Costa1, Feres Chaddad-Neto1. Microsurgical treatment for cerebellomesencephalic fissure arteriovenous malformations after multiple sessions of endovascular treatment. 10-May-2021;12:214

How to cite this URL: Silvio Sarmento Lessa1, Juan Alberto Paz-Archilla1, Bruno Loof Amorim1, Jose Maria Campos Filho1, Christiane Monteiro de Siqueira Campos2, Leonardo de Deus Silva3, Richard Gonzalo Parraga Choque4, Marcos Devanir Silva da Costa1, Feres Chaddad-Neto1. Microsurgical treatment for cerebellomesencephalic fissure arteriovenous malformations after multiple sessions of endovascular treatment. 10-May-2021;12:214. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=10800

Date of Submission
22-Feb-2021

Date of Acceptance
02-Apr-2021

Date of Web Publication
10-May-2021

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.

Keywords: Arteriovenous malformation, Cerebrovascular, Microsurgery

Video 1

Annotation[1-7]

1) 0:00 – Title

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

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.

[Video 1]-Available on:

www.surgicalneurologyint.com

References

1. Batjer H, Samson D. Arteriovenous malformations of the posterior fossa: Clinical presentation, diagnostic evaluation and surgical treatment. Neurosurg Rev. p.

2. Kouznetsov E, Weill A, Ghostine JS, Gentric JC, Raymond J, Roy D. Association between posterior fossa arteriovenous malformations and prenidal aneurysm rupture: Potential impact on management. Neurosurg Focus. p.

3. Lai LF, Chen JX, Zheng K. Posterior fossa brain arteriovenous malformations: Clinical features and outcomes of endovascular embolization, adjuvant microsurgery and radiosurgery. Clin Neuroradiol. p.

4. Mpotsaris A, Loehr C, Harati A, Lohmann F, Puchner M, Weber W. Interdisciplinary clinical management of high grade arteriovenous malformations and ruptured flow-related aneurysms in the posterior fossa. Interv Neuroradiol. p.

5. Perini S.editors. Endovascular treatment of pial AVMs: Technical options, indications and limits in pediatric age patients. Journal of Neurosurgical Sciences. 1997. p.

6. Robert T, Blanc R, Ciccio G. Endovascular treatment of posterior fossa arteriovenous malformations. J Clin Neurosci. p.

7. Stein KP, Wanke I, Schlamann M. Posterior fossa arterio-venous malformations: Current multimodal treatment strategies and results. Neurosurg Rev. p.

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