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Choroidal fissure arteriovenous malformations (ChFis-AVMs) are uncommon and challenging to treat due to their deep location and pattern of supply.1 The choroidal fissure lies between the thalamus and fornix, from the foramen of Monroe to the inferior choroidal point.2 AVMs in this location receive their supply from the anterior, lateral posterior choroidal artery and medial posterior choroidal arteries and drain to the deep venous system.3 The anterior-transcallosal corridor to the ChFis is favored due to the ease in opening the taenia fornicis from the foramen Monroe, and it increases in length for lesions located more posteriorly.4-7 We present a case of a posterior ChFis-AVM. The patient, a previously healthy woman in her 20s, presented with a sudden severe headache. She was diagnosed with intraventricular hemorrhage. This was managed conservatively with subsequent magnetic resonance imaging and digital subtraction angiography revealing a ChFis-AVM at the body of the left lateral ventricle, between the fornix and superior layer of the tela choroidae. It received its supply from the left lateral posterior choroidal artery and medial posterior choroidal artery and drained directly into the internal cerebral vein, classified as Spetzler-Martin grade II.8 A posterior-transcallosal approach to the ChFis was chosen to reduce the working distance and afford a wider corridor by avoiding cortical bridging veins (Video 1). Complete resection of the AVM was achieved with no additional morbidity. Microsurgery in experienced hands offers the best chance of cure for AVMs.9 In this case we demonstrate how to adapt the transcallosal corridor to the choroidal fissures for safe AVM surgery in this complex location.

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INTRODUCTION: Choroidal fissure cysts (CFC) are usually an incidental finding on imaging and lead to morbidity only in rare cases. The aim of this study was to present the case of a patient with a giant CFC and its treatment. CASE REPORT: The patient was a male infant of 9 days of life that presented with symptoms of intracranial hypertension. A CFC measuring 56 × 70 × 86 mm was diagnosed. Endoscopic fenestration of the cyst was performed; however, the communication closed thereafter. A reservoir catheter was inserted, which subsequently became infected and was then replaced by a ventriculoperitoneal shunt. DISCUSSION: The choroidal fissure is a C-shaped cleft located between the fornix and the thalamus separated from the temporal horn by the layer of tela choroidea. The pathophysiology of CFC is still unclear. In our case, initial endoscopic treatment was decided on to avoid shunt-related complications. Currently, there are no guidelines for the best surgical treatment for CFC. CONCLUSION: We describe an atypical case of CFC and analyze the surgical treatment performed. Although endoscopic treatment is recommended for CFC, currently no guidelines exist regarding the best management of the entity.

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In this paper, the authors discuss the embryology and anatomy of the choroidal fissure, as well as the pathophysiology and treatment of cerebrospinal fluid cysts of this structure. Understanding its anatomical relations to nearby structures plays an essential role during brain surgeries. With the advancement and availability of imaging techniques, lesions of the choroidal fissure are often found incidentally. Patients are usually asymptomatic or exhibit symptoms that do not correlate with anatomical location or do not require surgical treatment. The choroidal fissure is a key landmark used during brain surgery. Therefore, a comprehensive understanding of it and nearby anatomical structures is essential. Choroidal fissure cysts can be found incidentally, and well-known key features will allow one to differentiate them from other lesions. Surgical treatment should be reserved for symptomatic patients while asymptomatic patients should be monitored.

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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 treatment strategy included two stages. 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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Introduction: Our aim was to evaluate the correlation between choroid plexus mass (g) in the choroidalfissure and the ipsilateral interventricular foramen area, bilaterally. Material and methods: We analyzed sevencadaveric specimens with exposed brain, reaching the transcallosum access in all specimens, dissecting thecorpus callosum to reach the left and right choroidal fissure. After identifying the thalamostriate and septalveins, we localized the interventricular foramen scrapping all the choroid plexus in that region as well asits posterior extension allowing us to completely visualize the III ventricle. The area of the interventricularforamen was calculated with a pachimeter using the formula ðR2. The choroid plexus mass was measured withan appropriate scale. The choroid plexus mass and ipsilateral interventricular foramen correlation was evaluatedby the Pearson correlation. Results and conclusion: Neither difference between right and left choroid plexusmass was observed (Student t test – p = 0.374) nor with interventricular foramen area (p = 0.345) andwe decided to evaluate the 14 results together. There was correlation between choroid plexus mass and itsrespective IF (r = 0.6863; p < 0.01). A better knowledge of the choroidal fissure is very important to a moreprecise approach to the pathologic processes that affect the III ventricle. Different from the transforaminal,interforniceal, subchoroidal, and subforniceal, the choroidal fissure access is a natural approach. We speculatethat undetermined etiology hydrocephaly may have its origins in a deficit of ventricular drainage or in thechoroid plexus excess.

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STUDY DESIGN: Two case reports of a choroidal fissure cyst in the temporal horn associated with complex partial seizure. OBJECTIVES: To describe the clinical course, image findings and literature review of choroidal fissure cysts. SUMMARY AND BACKGROUND DATA: there are few reported cases of choroidal fissure cysts. RESULTS: We report two patients with complex partial seizures and temporal choroidal fissure cysts. The seizures were controlled in both patients. CONCLUSION: The choroidal fissure cyst diagnosis must highlight the importance of considering this lesion in the differential diagnosis of temporal lobe cyst and temporal lobe seizure.

DESENHO DO ESTUDO: Dois relatos de caso de cisto de fissura coroidal no corno temporal associado com crise parcial complexa. OBJETIVOS: Descrever o curso clínico, achados radiológicos e fazer uma revisão da literatura a respeito de cistos da fissura coroidal. RESUMO DOS DADOS DA LITERATURA: existem poucos casos descritos de cistos da fissura coroidal. RESULTADOS: Nós descrevemos dois pacientes com crises parciais complexas e cistos de fissura coroidal. As crises foram controladas em ambos os pacientes. CONCLUSÃO: O diagnóstico de cisto da fissura coroidal deve ser levado em conta no diagnóstico diferencial de cistos do lobo temporal e em crises de lobo temporal.

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