Multimodal treatment of a pediatric posterior fossa arteriovenous malformation employing endovascular and microsurgical techniques

Zeferino Demartini,Guilherme H W Ceccato,Luis A B Borba,Érico S G G Da Trindade

doi:10.3171/2020.10.focvid2064

Abstract

Intracranial hemorrhage is the most common presentation of posterior fossa arteriovenous malformations (AVMs) and may have serious consequences. The authors present a case of a 7-year-old girl with headache, vomiting, dysmetria, and ataxia due to a ruptured cerebellar grade III AVM. After two sessions of embolization, the patient underwent total microsurgical resection through a suboccipital craniotomy. There were no additional postoperative deficits, and the patient improved progressively during 6 months of rehabilitation. These challenging lesions should be removed after rupture, especially in children with long-term cumulative risk of rebleeding. Multimodal treatment reduces the perioperative bleeding, allowing better outcomes for pediatric AVM.The video can be found here: https://youtu.be/HQWnjD8ENZQ

Highlights

This video demonstrates the multimodal treatment of a pediatric posterior fossa arteriovenous malformation employing both endovascular and microsurgical techniques.0:30 Case Presentation and Exams.The patient was a 7-year-old female presenting with a history of sudden onset of headache, nausea, and vomiting, associated with dysmetria and gait ataxia
Magnetic resonance angiography (MRA) depicts a lesion highly suggestive of an arteriovenous malformation (AVM) in the left cerebellar hemisphere, presenting arterial supply suggestive coming from SCA, AICA, and PICA, as well demonstrates big arterialized venous channels arising from the nidus of the arteriovenous malformations (AVMs), and we can better see these features in these coronal cuts
We have a lateral view demonstrating the left cerebellar arteries arising from the basilar and going around brainstem to reach the cerebellum and feed the AVM. In this 3D model, we can better observe the configuration of the AVM, presenting feeders coming from all the left cerebellar arteries (SCA, AICA, and PICA), but mainly from a dilated SCA

Summary

Introduction

This video demonstrates the multimodal treatment of a pediatric posterior fossa arteriovenous malformation employing both endovascular and microsurgical techniques.0:30 Case Presentation and Exams.The patient was a 7-year-old female presenting with a history of sudden onset of headache, nausea, and vomiting, associated with dysmetria and gait ataxia. The patient underwent a CT scan that demonstrates two sites of acute bleeding, one inside the upper part of the fourth ventricle and the other at the left petrosal surface of cerebellum.

Results

Conclusion