Microsurgical treatment for cerebellomesencephalic fissure arteriovenous malformations after multiple sessions of endovascular treatment.

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. Copyright:

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