Microsurgical resection of a ruptured right peri-ventricular brain arteriovenous malformation with preoperative embolization.
Nicolas K KhattarKimberly S MeyerDale DingIsaac Josh AbecassisPublished in: Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences (2023)
A 41-year-old female presented with a headache and left inferior quadrantanopia. Imaging demonstrated a clot spanning the atrium of the ventricle to the superior parietal lobule (SPL), with a small arteriovenous malformation (AVM) nidus outside the atrium of the ventricle. The nidus was supplied by parieto-occipital arterial (P4) feeders with a single atrial draining vein. Pre-operative embolization of a pedicle with Onyx provided a surgical marker. A parietal craniotomy was performed with a trans-cortical SPL approach. During AVM resection, the draining vein was injured, which was stabilized using a temporary clip to "spot weld" the defect and continue nidus dissection with patent venous outflow. After careful dissection, coagulation, and division of all the arterial feeders, the AVM was mobilized and the draining vein was clipped, coagulated, and divided. Follow-up indocyanine green angiography and cerebral angiography both confirmed complete resection of the AVM. The patient consented to the procedure and to publication.
Keyphrases
- pulmonary artery
- optical coherence tomography
- catheter ablation
- pulmonary hypertension
- computed tomography
- working memory
- subarachnoid hemorrhage
- minimally invasive
- mitral valve
- heart failure
- vena cava
- inferior vena cava
- atrial fibrillation
- coronary artery
- high resolution
- left ventricular
- left atrial appendage
- pulmonary arterial hypertension
- left atrial
- cerebral ischemia
- peripheral blood
- robot assisted
- resting state
- pulmonary embolism
- multiple sclerosis
- congenital heart disease
- internal carotid artery
- abdominal aortic aneurysm