Combined Pterional Transsylvian and Bifrontal Interhemispheric Approach to Ruptured Subcallosal and Pericallosal Brain Arteriovenous Malformation with Skeletonization of the Entire A2 ACA Segment.
World Neurosurg
; 134: 427, 2020 Feb.
Article
en En
| MEDLINE
| ID: mdl-31756504
ABSTRACT
A 39-year-old man presented with a large left paramedian frontal lobe intracerebral hemorrhage. Computed tomography angiography and magnetic resonance imaging revealed a tangle of vessels arising from the anterior cerebral arteries (ACAs) and dilated draining veins entering the superior sagittal sinus. Angiography confirmed a Spetzler-Martin grade 3, supplemented 2 arteriovenous malformation (AVM) with predominant supply from branches of the left ACA with superficial and deep drainage (Video 1). The case illustrates an unusual cerebrovascular pathology involving the entire A2 ACA segment. The AVM extended from the A1/2 junction along the entire A2 segment past the genu of the corpus callosum (A3 segment). A combined pterional transsylvian and bifrontal interhemispheric approach was performed. The proximal sylvian fissure and opticocarotid cistern were opened to expose the A1/2 junction. Once proximal control was obtained, the hematoma was evacuated to define the lateral border of the AVM. The interhemispheric fissure was then opened to identify the draining vein and the distal pericallosal arteries. The interhemispheric approach also defined the medial border of the AVM. The A2 ACAs were then skeletonized from the AVM from the A1/2 junction to the pericallosal arteries. Aneurysm clips were used to interrupt large AVM feeders from the A2 arteries, which avoids cautery and heat transmission to the parent vessel. Once the AVM was disconnected and skeletonized from the A2s, the draining vein was clipped and the nidus was removed. Indocyanine green angiography confirmed patency of the A2s and pericallosal arteries. Postoperative angiography demonstrated no residual shunting, and the patient was discharged in good condition.
Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Malformaciones Arteriovenosas Intracraneales
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Fístula Arteriovenosa
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Procedimientos Neuroquirúrgicos
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Arteria Cerebral Anterior
Tipo de estudio:
Etiology_studies
/
Prognostic_studies
Límite:
Adult
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Humans
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Male
Idioma:
En
Año:
2020
Tipo del documento:
Article