Gross Total Resection of a Ruptured Micro-arteriovenous Malformation within the Cerebellar Peduncle: A Case Report and Qualitative Review of the Literature

M. Omar Iqbal; Nicholas Lariccia; Christopher Markosian; Catherine Christie; Luke D. Tomycz

doi:10.1055/s-0042-1744299

Journal of Neurological Surgery Part A: Central European Neurosurgery, Table of Contents

J Neurol Surg A Cent Eur Neurosurg 2023; 84(06): 600-605
DOI: 10.1055/s-0042-1744299

Case Report

Gross Total Resection of a Ruptured Micro-arteriovenous Malformation within the Cerebellar Peduncle: A Case Report and Qualitative Review of the Literature

Authors

M. Omar Iqbal

¹Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States
Nicholas Lariccia

²Department of Radiology, Newark Beth Israel Medical Center, Newark, New Jersey, United States
Christopher Markosian

¹Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, United States
Catherine Christie

³Department of Neurosurgery, New Jersey Pediatric Neuroscience Institute, Morristown, United States
Luke D. Tomycz

⁴Department of Neurosurgery, New Jersey Brain and Spine, Montclair, New Jersey, United States

Abstract

Deep-seated micro-arteriovenous malformations (micro-AVMs) may pose a challenge for complete yet safe resection. We propose the strategic placement of two to three microaneurysm clips throughout the hemorrhage cavity to successfully localize the micro-AVM nidus via digital subtraction angiography (DSA). We successfully demonstrate this novel method in a 15-year-old adolescent boy with cerebellar intraparenchymal hemorrhage who underwent hematoma evacuation and expansile duraplasty. He was found to have a 1-cm nidus of a micro-AVM with early venous drainage located in the right middle cerebellar peduncle. Five days later, we proceeded to resect the micro-AVM; however, a clear nidus or bleeding source was unable to be localized intraoperatively despite the use of stereotactic neuronavigation. In turn, we placed two mini-aneurysm clips superiorly and inferiorly within the hematoma cavity, which led to successful localization via DSA and complete resection. No surgical complications occurred. The patient completely recovered from right-sided weakness and dysarthria 6 to 12 months postoperatively. Our technique allows for the rapid localization and complete resection of micro-AVM nidi when stereotactic neuronavigation is inadequate.

Keywords

aneurysm clip - digital subtraction angiography - hemorrhage - micro-AVM - pediatric

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References

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