July 29, 2016
Here is another example of a lateral, frontal arteriovenous malformation. This is a 27 year old female who presented with spontaneous ICH-IVH as well as subarachnoid hemorrhage. Unfortunately, she presented in a poor neurological status. CT scan demonstrates that distribution of the blood. She was also diagnosed with a large feeding pedical- Pericallosal aneurysm. related to this lateral funnel arteriovenous malformation. Due to her poor neurological status, she underwent coiling of this aneurysm uneventfully. Fortunately, she made an excellent recovery, and subsequently underwent a resection of the malformation a month later. Angiogram images, more specifically the AP carotid, as well as lateral carotid angiograms, demonstrate that most of the feeding vessels originate from the MCA branches, as well as some coming from the AC via pericallosal arteries. In addition, the malformation appears to be multilobulated or bilobed. In a more magnified view of the lateral carotid angiogram, again demonstrates the bilobed nature of this malformation with multiple draining veins, leaving the malformation more superficially. She underwent a left frontal craniotomy. Here's the malformation. Multiple draining veins were noted superficially as expected. I circumstantially disconnected the nitis, while preserving the draining veins, during the early steps of the operation. Here are those draining veins. A number of them that were preserved in the dissection continued around them. Next, white matter dissection further disconnected the depth of the nitus. Here's the entry into the frontal horn of the lateral ventricle. Here's the dissection at the apex of the malformation. After the malformation was circumstantially disconnected from the arterial feeders, the veins were also sacrificed, and the nitus was removed. Here's the final result. And again, entry into the frontal horn of the lateral ventricle. Intraoperative angiogram demonstrated complete removal of the malformation without any evidence of AV shunting. Three months MRI revealed no complicating feature, and this patient made an overall excellent recovery. Thank you.
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