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- Department of Neurosurgery, Universidade Federal de São Paulo, Brazil
- Department of Radiology, Hospital Beneficencia Portuguesa de São Paulo, Brazil
- Department of Interventional Neuroradiology, Pontificia Universidade Católica de Campinas, Campinas, São Paulo, Brazil,
- 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 [
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.
