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Recurrent Pediatric Callosal AVM

March 02, 2015

Transcript

This video reviews techniques for resection of a Recurrent Callosal Arteriovenous Malformations, and the involved microsurgical challenges. This is a 14 year old male who underwent removal of his callosal arteriovenous malformation a decade earlier. However, presented with a small recurrent AV malformation on surveillance imaging. Especially in pediatric AVMs, it's not rare for the malformation to recur decades later. That's why surveillance imaging is quite important, specially for pediatric arteriovenous malformations. The location of the recurrent malformation in the preventricular area, along the left frontal horn of the lateral ventricle is apparent. This malformation owned a very small diffused nidus, was closer related to the hypertrophic precocial artery and owned a draining vein traveling laterally through the ventricle. Patient underwent a right-sided parasagittal craniotomy, and right side, the Corpus callosotomy was completed. The hypertrophic precocial artery was identified through this scar and follow to the level of the malformation. This important vessel preserved along its entire segment. Here's further sharp dissection of the vessel within this scar. Here's the space within the ventricle. I wanted to skeletonize this vessel, so that it's feeding vessels to the malformation can be effectively disconnected. Here you can see some of the feeding vessels to the malformation from the precocial artery. These feeding vessels were individually isolated, coagulated and transected. Here's another feeding vessel. Here's the nidus of the malformation. I continued to, disconnect the feeding vessels to the malformation one by one. Additional feeding vessels were found and controlled. And you can see the cross court approach using a right-sided inter approach, to assure an expanded trajectory and exposure and left-sided preventricular aliasing. The anterior malformation is being disconnected. Some bleeding from the white matter feeders was encountered. Here you can see the deep draining vein within the ventricle traveling laterally. The malformation is now being disconnected along this lateral border. Joining the wall of the frontal horn of the lateral ventricle, here is part of the nidus. The of the nidus is underneath the suction device. More so the malformation is disconnected at this stage. The nidus was removed after it was disconnected from the laterally traveling draining vein within the ventricle. Further inspection reveal no residual malformation along the lateral wall of the left frontal horn of the lateral ventricle. The precocial artey appears intact. A clip was placed around the precocial artery, as a marker so that intraoperative angiogram can be performed. The results of the angiogram did not reveal any evidence of residual malformation. Higher quality post-operative angiogram images confirm complete exclusion of the malformation, without any AV shunting. And the post-operative CT also demonstrated no evidence of ischemia and this patient made an excellent recovery from his operation. Thank you.

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