Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, No. 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
National Center for Neurological Disorders, Shanghai, 200040, China.
Acta Neurochir (Wien). 2024 Jan 30;166(1):53. doi: 10.1007/s00701-024-05915-4.
Due to their crucial functional location, surgical treatment of brainstem arteriovenous malformations (AVMs) has always been challenging. For unruptured AVMs, we can determine whether radiological therapy, interventional treatment, or surgical resection is feasible based on the AVM structure. However, for ruptured AVMs, microsurgical resection and interventional embolization are effective methods to prevent further rupture. In the microsurgical resection of AVMs, we usually use a hybrid operation to confirm the AVM structure and determine if the AVM is completely resected during the surgery.
We report a case of juvenile ruptured brainstem AVM resection. The right lateral position and left suboccipital retrosigmoid approach were used. We established an interventional approach via left radial artery and set a microcatheter in the feeding artery. Methylene blue injection via a microcatheter showed the AVM structure, and we totally resected the brainstem AVM under electrophysiological monitoring and navigation. Intraoperative angiography was performed to ensure complete resection without residual nidus.
This case demonstrates that the trans-radial approach is convenient and safe for special positions in hybrid operations. Methylene blue injection via a microcatheter in the feeding artery provides clearer visualization of the AVM structure under the microscope.
由于其关键的功能位置，脑干动静脉畸形（AVM）的手术治疗一直具有挑战性。对于未破裂的 AVM，我们可以根据 AVM 的结构来确定是否可行放射治疗、介入治疗或手术切除。然而，对于破裂的 AVM，显微切除和介入栓塞是预防进一步破裂的有效方法。在 AVM 的显微切除中，我们通常采用杂交手术来确认 AVM 的结构，并在手术中确定 AVM 是否完全切除。
我们报告了一例青少年破裂的脑干 AVM 切除病例。采用右侧侧卧位和左侧枕下入路。我们经左侧桡动脉建立介入入路，并将微导管置于供血动脉中。通过微导管注射亚甲蓝显示 AVM 结构，我们在电生理监测和导航下完全切除了脑干 AVM。术中进行血管造影，以确保完全切除，无残留病灶。
该病例表明，经桡动脉入路在杂交手术的特殊部位是方便和安全的。微导管经供血动脉注射亚甲蓝可在显微镜下更清晰地显示 AVM 结构。
