Sitting supracerebellar infratentorial approach for resection of posterior fossa arteriovenous malformation

Evan Joyce,Ramesh Grandhi,William T Couldwell

doi:10.3171/2020.10.focvid2091

Abstract

Arteriovenous malformations (AVMs) of the posterior fossa represent just 5%–15% of all intracranial AVMs. Rupture often leads to devastating brainstem compression, with mortality reported as high as 67%. A life-saving decompressive craniectomy with or without hematoma evacuation may be necessary in the acute setting to alleviate mass effect before proceeding with definitive treatment of the vascular pathology. Here, the authors demonstrate the utility of using a generously sized temporizing decompressive suboccipital craniectomy to subsequently allow for a more judicious resection of a Spetzler-Martin grade III AVM fed by the right superior cerebellar artery using a sitting supracerebellar infratentorial approach.The video can be found here: https://youtu.be/L195wmw3p_4

Highlights

Arteriovenous malformations (AVMs) of the posterior fossa represent just 5%–15% of all intracranial AVMs
0:28 This is a case of a 63-year-old woman who had a devastating intraparenchymal hemorrhage within the cerebellum from a Spetzler-Martin grade III arteriovenous malformation
She was taken emergently for a life-saving decompression, but the CTA had demonstrated a known AVM, just behind the brainstem at the mesencephalic-pontine junction. It was fed predominantly from the superior cerebellar artery on the right side, with the draining vein on the dorsum of the cerebellum going to the region of the torcula

Summary

Introduction

Arteriovenous malformations (AVMs) of the posterior fossa represent just 5%–15% of all intracranial AVMs. She was taken emergently for a life-saving decompression, but the CTA had demonstrated a known AVM, just behind the brainstem at the mesencephalic-pontine junction. It was fed predominantly from the superior cerebellar artery on the right side, with the draining vein on the dorsum of the cerebellum going to the region of the torcula. 1:07 We took her to the operating room, and 2.5 weeks later, do a sitting position, and use the previous decompression incision to open up and expose the region of the posterior fossa.

Results

Conclusion