Interhemispheric Surgical Approaches for Ruptured Intraventricular Arteriovenous Malformation-Associated Aneurysms: Technical Report and Case Series.
Adolescent
Aged
Aneurysm, Ruptured
/ etiology
Angiography, Digital Subtraction
Child
Child, Preschool
Female
Humans
Intracranial Aneurysm
/ etiology
Intracranial Arteriovenous Malformations
/ complications
Lateral Ventricles
/ surgery
Male
Middle Aged
Neurosurgical Procedures
/ methods
Recurrence
Retrospective Studies
Third Ventricle
/ surgery
Aneurysm
Arteriovenous malformation
Brain
Microsurgical resection
Surgical technique
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
12
03
2020
revised:
07
04
2020
accepted:
09
04
2020
pubmed:
28
4
2020
medline:
27
10
2020
entrez:
28
4
2020
Statut:
ppublish
Résumé
Aneurysms associated with brain arteriovenous malformations (AVMs) represent a hemorrhage risk in addition to that of the AVM nidus. In high-risk or unresectable cases, targeted treatment of an aneurysm causing hemorrhage may effectively decrease future hemorrhage risk. The objective of this report is to describe our series of patients with intraventricular AVM-associated aneurysms treated surgically. We highlight technical nuances of the surgical approaches to aneurysms in the lateral and third ventricles. A retrospective review was performed of patients in whom an intraventricular aneurysm rupture was responsible for hemorrhage. In each patient, the aneurysm was excluded surgically via an interhemispheric approach, including transcallosal, transchoroidal, or transcingulate corridors. Aneurysm, AVM characteristics, surgical approach, and outcomes were reviewed. Six patients were included in the series. In 5 patients, the disease was located on the left and approached from the right. Aneurysms were located in, or projecting into, the lateral ventricle in 4 patients (transcingulate approach) and in the third ventricle in 2 patients (transchoroidal fissure approach). The aneurysm was clipped in 1 patient and resected in 5 patients. The associated AVM was resected in 2 patients. In all patients, the surgical approach allowed adequate treatment of the aneurysm without new neurologic morbidity. No patients experienced recurrent intraventricular hemorrhage during follow-up. Ruptured intraventricular aneurysms associated with brain AVMs can be treated surgically to reduce the risk of rebleeding in patients in whom the aneurysms are not accessible to endovascular treatment and in which the AVM nidus may not be safely resected.
Sections du résumé
BACKGROUND
Aneurysms associated with brain arteriovenous malformations (AVMs) represent a hemorrhage risk in addition to that of the AVM nidus. In high-risk or unresectable cases, targeted treatment of an aneurysm causing hemorrhage may effectively decrease future hemorrhage risk. The objective of this report is to describe our series of patients with intraventricular AVM-associated aneurysms treated surgically. We highlight technical nuances of the surgical approaches to aneurysms in the lateral and third ventricles.
METHODS
A retrospective review was performed of patients in whom an intraventricular aneurysm rupture was responsible for hemorrhage. In each patient, the aneurysm was excluded surgically via an interhemispheric approach, including transcallosal, transchoroidal, or transcingulate corridors. Aneurysm, AVM characteristics, surgical approach, and outcomes were reviewed.
RESULTS
Six patients were included in the series. In 5 patients, the disease was located on the left and approached from the right. Aneurysms were located in, or projecting into, the lateral ventricle in 4 patients (transcingulate approach) and in the third ventricle in 2 patients (transchoroidal fissure approach). The aneurysm was clipped in 1 patient and resected in 5 patients. The associated AVM was resected in 2 patients. In all patients, the surgical approach allowed adequate treatment of the aneurysm without new neurologic morbidity. No patients experienced recurrent intraventricular hemorrhage during follow-up.
CONCLUSIONS
Ruptured intraventricular aneurysms associated with brain AVMs can be treated surgically to reduce the risk of rebleeding in patients in whom the aneurysms are not accessible to endovascular treatment and in which the AVM nidus may not be safely resected.
Identifiants
pubmed: 32339737
pii: S1878-8750(20)30773-7
doi: 10.1016/j.wneu.2020.04.066
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e618-e625Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.