Giant diffuse cerebellar AVM: managing ultimate intraoperative challenges.

Benjamin K Hendricks,Aaron A Cohen-Gadol

doi:10.3171/2020.10.focvid2093

Benjamin K Hendricks, Aaron A Cohen-Gadol

Open Access

https://doi.org/10.3171/2020.10.focvid2093

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Abstract

Surgery within the posterior cranial fossa uniquely requires excellence in microsurgical technique, given the complexity of the neurovascular structures housed within this region. Arteriovenous malformations (AVMs) within this region represent the greatest surgical challenge because of the difficulty in resecting an AVM completely while preserving the highly eloquent surrounding structures. The AVM in this video exemplifies a surgeon’s “most challenging case,” a surgery that spanned two stages, including 14 hours of resection, but concluded with complete resection despite the complexity of deep arterial and dural feeders.The video can be found here: https://youtu.be/WNBuwFHSrQ0

Highlights

Angiogram again demonstrates very diffuse malformation involving the hemisphere with feeding vessels from the PICA, AICA, and superior cerebellar arteries
You can see the later phases of the angiogram as well as the deep draining veins
Is along the CP angle where the feeding vessels from AICA or PICA are further devascularized while protecting the lower cranial nerves

Summary

Introduction

Angiogram again demonstrates very diffuse malformation involving the hemisphere with feeding vessels from the PICA, AICA, and superior cerebellar arteries. Is along the CP angle where the feeding vessels from AICA or PICA are further devascularized while protecting the lower cranial nerves. Some of these feeding vessels can be quite fragile, and persistence is required to control the bleeding.

Results

Conclusion