Microsurgical treatment for arteriovenous malformation of the corpus callosum and choroidal fissure

Abstract

<jats:p>The management of arteriovenous malformations (AVMs) of the corpus callosum and choroidal fissure is challenging because they commonly receive arterial feeders from the anterior and posterior circulation, and drain to deep veins. In this video the authors present the case of a 20-year-old man who presented with acute onset of headache, loss of consciousness, and nuchal rigidity. Computed tomography, MRI, and cerebral angiography performed in tandem revealed a ruptured, large, Grade IV AVM of the corpus callosum and choroidal fissure with two groups of arterial feeders: one from the pericallosal artery and the other from the medial and lateral posterior choroidal arteries. The treatment strategy included two stages. The first stage involved preoperative embolization of the arterial feeders from the posterior circulation, which promoted reduction of the nidus flow of the AVM. The second involved a microsurgical resection, using the interhemispheric approach, with the patient in the prone position, which allowed accessing the anterior circulation feeders and the complete resection of the AVM, without associated morbidity.</jats:p><jats:p>The video can be found here: <jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="https://youtu.be/5wcYKhcJtls">https://youtu.be/5wcYKhcJtls</jats:ext-link>.</jats:p>

Endovascular treatment of brain arteriovenous malformations involving the anterior cerebral artery

“…For example, there is a potential collateral circulation between the posterior part of the ACA and the PCA, and the anterior part of the ACA can only be compensated by the pial branches from the MCA. BAVMs occurring in the posterior part of the corpus callosum and ACA are closer to the deep venous system (15). Therefore, statistical analysis was performed for IVH presentation, deep vein involvement and PCA involvement among the different types of ACA-BAVMs to determine whether the types of ACA-BAVMs are associated with IVH presentation, deep vein involvement and PCA.…”

“…For example, there is a potential collateral circulation between the posterior part of the ACA and the PCA, and the anterior part of the ACA can only be compensated by the pial branches from the MCA. BAVMs occurring in the posterior part of the corpus callosum and ACA are closer to the deep venous system ( 15 ).…”

Choroidal fissure and choroidal fissure cysts: a comprehensive review

“…The interhemispheric approach allows access to the anterior circulation via the choroidal fissure. This is particularly helpful in some arteriovenous malformation cases, as demonstrated by da Costa et al [ 4 ], and for removal of large tumors in the third ventricle [ 5 ]. Surgery involving the choroidal fissure should be conducted at the level of the taenia fornis and taenia fimbriae.…”

The Posterior Transylvian Peri-Insular Approach to a Cavernous Malformation of the Pulvinar Thalamus: 2-Dimensional Operative Video

“…The surgical approach can affect morbidity and outcomes due to factors such as the structures at risk, working space, and distance. 4-10…”

“…The surgical approach can affect morbidity and outcomes due to factors such as the structures at risk, working space, and distance. [4][5][6][7][8][9][10] The ubiquitous availability of neuronavigation does not eliminate the need for a good understanding of the surface anatomy of the brain and its relationship to the deep structures of the central core. We discuss a step-by-step guide to using the inferior Rolandic point and Heschl and supramarginal gyri to safely navigate to the pulvinar and atrium.…”