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Microsurgical Resection of Tonsillar Arteriovenous Malformation: Operative Video.
Hernández, Manuel Moreno; Dória-Neto, Hugo Leonardo; Maria de Campos Filho, José; Romo, Nicolás González; Chaddad-Neto, Feres.
Afiliação
  • Hernández MM; Department of Neurology and Neurosurgery, Federal University of SãoPaulo, São Paulo, Brazil; Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
  • Dória-Neto HL; Department of Neurology and Neurosurgery, Federal University of SãoPaulo, São Paulo, Brazil; Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
  • Maria de Campos Filho J; Department of Neurology and Neurosurgery, Federal University of SãoPaulo, São Paulo, Brazil; Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil.
  • Romo NG; Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
  • Chaddad-Neto F; Department of Neurology and Neurosurgery, Federal University of SãoPaulo, São Paulo, Brazil; Department of Neurosurgery, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil. Electronic address: fereschaddad@hotmail.com.
World Neurosurg ; 174: 139, 2023 Jun.
Article em En | MEDLINE | ID: mdl-37004884
Cerebellar arteriovenous malformation (AVM) comprises 10%-15% of intracranial AVMs.1 Rupture often leads to devastating brainstem compression, with mortality reported as high as 67%.2 AVM can be a challenging disease, especially when large in size.3 AVMs can be treated by 1 or a combination of treatment modalities, namely embolization, radiosurgery, or microsurgical resection.4,5 Arterial adhesions to tonsilobulbar and telovelonsilar segments of posterior inferior cerebellar artery (PICA) can be a challenge, increasing bleeding and ischemic risk.6 We present a 2-dimensional video case of a tonsillar AVM. The patient, a previously healthy female in her 20s, presented with a chronic headache. She had no medical history. Initial magnetic resonance imaging revealed a tonsillar AVM classified as Spetzler-Martin grade II. It received its supply from the tonsilobulbar and telovelotonsilar segments of the PICA and drained directly into the precentral vein, transverse sinus, and sigmoid sinus. An angiogram revealed severe venous engorgement-the source of the patient's headache. The AVM was partially embolized 1 month preoperatively. A medial suboccipital telovelar approach was chosen to reduce the working distance and afford a wider corridor to expose the suboccipital surface of the cerebellum.7,8 Complete resection of the AVM was achieved with no additional morbidity. Microsurgery in experienced hands offers the best chance of cure for AVMs. In Video 1, we demonstrate the relationships among the tonsila, biventral lobule, vallecula cerebelli, PICA, and cerebellomedullary fissure as an important anatomic landmark in a safe total resection of a tonsillar AVM.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doenças Cerebelares / Malformações Arteriovenosas Intracranianas / Embolização Terapêutica Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Female / Humans Idioma: En Revista: World Neurosurg Assunto da revista: NEUROCIRURGIA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos
Texto completo
Adicionar na Minha BVS
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doenças Cerebelares / Malformações Arteriovenosas Intracranianas / Embolização Terapêutica Tipo de estudo: Observational_studies / Risk_factors_studies Limite: Female / Humans Idioma: En Revista: World Neurosurg Assunto da revista: NEUROCIRURGIA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: Brasil País de publicação: Estados Unidos