Combined Endovascular and Microsurgical Management of a Tentorial Arteriovenous Malformation in a Hybrid Neurovascular Operating Room: 2-Dimensional Operative Video. Issue 3 (6th May 2021)

• Record Type: Journal Article
• Authors: Glauser, Gregory; Detchou, Donald K E; Arena, John; Choudhri, Omar
• Is Part Of: Operative neurosurgery. Volume 21:Issue 3(2021)
• Page Start: E272
• Page End: E273
• Publication Date: 2021-05-06
• Subjects: Arteriovenous malformation -- AVM -- Onyx embolization -- Lateral supracerebellar approach -- Microsurgical resection -- Posterior fossa; Nervous system -- Surgery -- Periodicals; 617.480590
• DOI: 10.1093/ons/opab142
• Languages: English
• ISSNs: 2332-4252

Abstract

Abstract: Tentorial margin arteriovenous malformations (AVMs) at the cerebello-mesencephalic fissure are deep lesions, which can be safely resected via a lateral supracerebellar infratentorial approach. This video illustrates the case of a patient who presented with hemorrhage from a tentorial AVM. He was managed in the hybrid neurovascular operating room with Onyx (Medtronic) embolization of a superior cerebellar artery feeder followed by resection of the AVM, which included cerebellar relaxation from lumbar cerebrospinal fluid (CSF) drainage and lateral positioning. Wide cisternal arachnoid dissection at the quadrigeminal cistern allowed for a straight trajectory to the AVM without fixed retraction. Intraoperative transradial angiography confirmed complete AVM exclusion. This video was deemed Institutional Review Board (IRB) exempt by the University of Pennsylvania IRB as it is considered a case report, which does not require IRB approval or patient consent. The patient consented to the procedure.