Microsurgical resection of unruptured cerebellar arteriovenous malformation presenting with trigeminal neuralgia.

Walter Marani,Kosumo Noda,Hiroyasu Kamiyama,Rokuya Tanikawa,Paolo Perrini,Nakao Ota,Nicola Montemurro,Yu Kinoshita,Shoichiro Tsuji

doi:10.3171/2020.10.focvid2071

Abstract

Cerebellar arteriovenous malformations (AVMs) represent 10%–15% of all intracranial AVMs and are associated with a greater risk for hemorrhagic presentation compared with supratentorial AVMs. When they reach the cerebellopontine angle cistern, neurovascular compression syndromes, including trigeminal neuralgia and hemifacial spasm, can occur. Due to the aggressive natural history of cerebellar AVM, an effective treatment strategy is required. In this video, the authors demonstrate the technical nuances of microsurgical resection of an unruptured cerebellar AVM in a 24-year-old female presenting with trigeminal neuralgia. The patient underwent right retrosigmoid craniotomy and complete resection of the AVM with resolution of trigeminal neuralgia.The video can be found here: https://youtu.be/6GmNjgFQwx8

Highlights

We will discuss the surgical treatment of posterior fossa arteriovenous malformation (AVM) in a young patient
The preoperative angiogram demonstrated the main feeders coming from the superior cerebellar artery (SCA), anterior inferior cerebellar artery (AICA), and from the posterior inferior cerebellar artery (PICA)
The subarachnoid dissection is of paramount importance for distinguishing the arterial and venous structures related with the AVM from the normal vessels, which should be preserved

Summary

Introduction

KEYWORDS posterior fossa; arteriovenous malformation; AVM; surgery; surgical treatment We will discuss the surgical treatment of posterior fossa arteriovenous malformation (AVM) in a young patient. Patient refused radiosurgery and endovascular treatment and chose for surgical removal of the AVM.[2] The preoperative angiogram demonstrated the main feeders coming from the superior cerebellar artery (SCA), anterior inferior cerebellar artery (AICA), and from the posterior inferior cerebellar artery (PICA).

Results

Conclusion