Abstract
This is the case of a ruptured Spetzler-Martin grade II arteriovenous malformation (AVM) located in the cerebellopontine angle and draining into the transverse sinus. The AVM was initially treated with staged embolization using Onyx (ev3 Neurovascular). However, recurrence was noted and treatment with microsurgical resection was undertaken. The authors present technical nuances of the approach and strategies for microsurgical resection of a previously embolized recurrent AVM with the aid of intraoperative indocyanine green angiography. Follow-up after endovascular treatment is critical, and curative treatment with microsurgical resection can be achieved with low morbidity in such AVMs as demonstrated by this case.The video can be found here: https://youtu.be/LMpz_YTFC0g
Highlights
This is a case of a previously ruptured recurrent cerebellopontine angle arteriovenous malformation (AVM) that was initially treated with endovascular embolization
Stage 1 of endovascular treatment occurred with embolization of two branches of the superior cerebellar artery feeding the AVM
Patient recovered from his hemorrhage and was discharged to rehab. His neurological exam was significant for dysarthria, stable right abducens palsy, right facial droop, and left hemiparesis as a complication of nontarget embolization of a lateral pontine artery
Summary
This is a case of a previously ruptured recurrent cerebellopontine angle AVM that was initially treated with endovascular embolization.0:29 Patient History and Exam. CTA head showed a suspected AVM with a draining vein toward the right transverse-sigmoid junction. It contained flow-related perinidal aneurysms, which are known to be associated more with posterior circulation AVMs.[1,2] It drained through a dilated cerebellar vein into the right transverse sinus. Stage 1 of endovascular treatment occurred with embolization of two branches of the superior cerebellar artery feeding the AVM.
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