Without exception, each nidus was accompanied by a PDCN, which connected not only to the nidus, feeding arteries, and draining veins, via arterioles and venules, but also to normal capillaries, arterioles, and venules. The PDCN should be considered in studies aimed at gaining an understanding of the mechanisms underlying the intraoperative and postoperative bleeding, growth, and recurrence of surgically treated cerebral arteriovenous malformations.

In 1996 the authors performed the first fronto-orbital advancement by distraction osteogenesis in a patient with coronal synostosis, and they have refined the surgical technique since then. Their latest technique has the following features: 1) the osteotomy lines are almost identical to those of conventional fronto-orbital advancement except for the lack of supraorbital osteotomy and tongue-in-groove osteotomy; 2) burr holes are placed at the pterion just behind the sphenoid wing and at the bregma lateral to the anterior fontanel bilaterally, and another burr hole is placed on the glabella 1 cm above the nasion; 3) to gain access to the lateral portion of the anterior cranial base, a 7- to 10-mm-wide segment of bone is removed at the pterion using rongeurs; 4) the sphenoid ridge is widely removed; and 5) osteotomy is performed using a Gigli saw and rongeurs. They report their latest technique.

A 52-year-old man suddenly experienced headache and vomiting. Computed tomography demonstrated a small area of hemorrhage in the right cerebellar hemisphere. Angiography revealed a thalamic arteriovenous malformation (AVM) fed by the bilateral medial posterior choroidal arteries and left marginal tentorial artery, and drained into the confluence via the cerebellar veins without flow into the supratentorial venous system. The draining veins included two varices, one of which, in the right cerebellar hemisphere, was thought to be the source of bleeding. The AVM nidus was removed via the right occipital transtentorial approach. A portion of a drainer adhered to the surface of the great vein of Galen but without opening into the galenic system and all drainers from this thalamic AVM flowed into the infratentorial cerebellar venous system.

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