Multimodal Approach for Treatment of Hemorrhaged Mesencephalic Arteriovenous Malformation

Carlo Bortolotti, Giacomo Bertolini, Thomas J. Sorenson, Luigi Cirillo, Giuseppe Lanzino, Carmelo Sturiale

Research output: Contribution to journalArticle

Abstract

Brainstem arteriovenous malformations (AVMs) are complex and life-threatening lesions. In our video (Video 1), we illustrate resection of a posterior midbrain hemorrhaged AVM (Spetzler-Martin grade III, Lawton-Young grade III, Supplementary Spetzler-Martin grade 6) in a 55-year-old woman presenting with ventricular hemorrhage and coma. Multimodal therapy with endovascular embolization of an associated prenidal aneurysm of the right posteromedial choroidal artery, followed by microsurgical resection via supracerebellar-infratentorial approach, is demonstrated. A total resection of the AVM was achieved. At the 4-year follow-up, the patient had a modified Rankin Scale score of 3. AVMs in eloquent brain regions require a carefully tailored, multimodal diagnostic and therapeutic approach to limit procedure-related complications and obtain acceptable outcomes. Herein, we illustrate such a situation and discuss some key points for success.

Original languageEnglish
Number of pages1
JournalWorld Neurosurgery
Volume134
DOIs
Publication statusPublished - Feb 2020

Keywords

  • Aneurysm
  • Arteriovenous malformation
  • Brainstem
  • Endovascular
  • Hemorrhage
  • Microsurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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