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Vermian AVM: Resection Techniques

September 02, 2015

Transcript

Let's go ahead and review methodologist for a section of Vermian AVMs. This is a 26 year-old female presented with a spontaneous cerebellar intracranial hemorrhage, underwent evacuation in an outside hospital, and subsequently transferred to our institution. You can see the of the malformation somewhat affected by the recent history of hemorrhage. The primary feeding vessels were from the superior cerebellar artery, and the draining vein joins the midline and ultimately the vein of Galen. Here's the location of the AVM, which is primarily vermian. She subsequently went reopening of her suboccipital craniotomy. Here's another view of the angiogram including the draining vein along the midline, joining the stress sinus ultimately, linear incision was used. Here's the reopening of the midline suboccipital craniotomy, here's the tore killer transfer sinus on both sides. The dural opening, and the area of the vermis. The hematoma evacuation that was performed previously, was located around the area of the carotenoid. During the dural incision one of the lakes close to transfer sinus was unfortunately torn, you'll see in a moment. In this circumstance, it's best to primarily close the area of the terror. As you can see here, further coagulation, often these two expansion of the terror and further venous bleeding. Small pressure and tempnology using a piece of cotton can be quite effective to avoid massive bleeding. And as you can see, the sutures were able to control the bleeding effectively and timely. Here's the supracerebellar corridor, here's the midline or totalize draining vein, joining the Galen and straight sinus. After finding the totalize midline vein, I continue to dissect the natus, from the surrounding normal white matter of the cerebellum. Here, you can see the abnormal or trial structure of their malformation. I continued to work on both sides of the Varmis and now inferiorly to disconnect the natus circumferentially. Here's the inferior disconnection of the malformation. The malformation essentially only is being held by the arterialized vein. Here's the tentorium, here's disconnection of some of the superior cerebellar artery feeding vessels to the malformation. Again, the tentorium confirmation of disconnection of all the feeding vessels next day, draining vein is disconnected from underneath the tentorium and natus is delivered. Here, you can see that after the malformation is disconnected, it's quite collapsed. And the natus is very much smaller than expected. Hemostasis was performed after the natus was removed. Here's a view of the operative corridor at the end of our resection, watertight door closure is reasonable in this case. Additional sutures were placed to complete the dural closure and the postoperative angiogram confirms removal of the malformation, no evidence of early or to Venous shunting and the CT scan also excludes other complicating features, thank you.

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