Introduction: Unlike other cortically-based AVMs, ventricular and periventricular AVMs are based on ependymal surfaces and are surrounded by CSF spaces rather than brain parenchyma. Although these features may simplify their resection, their deep location makes them challenging to expose. We reviewed our surgical experience with these rare lesions.
Methods: The prospective registry of the UCSF Brain AVM Study Project was searched to identify 25 patients with ventricular/periventricular AVMs managed surgically over a 16-year period. These AVMs were located in the corpus callosum, ventricular body, atrium, or temporal horn. Medical records, radiographic studies, and clinical evaluations were reviewed retrospectively.
Results: 20 patients (80%) presented with intraventricular hemorrhage. There were 7 callosal, 4 ventricular body, 11 atrial, and 3 temporal horn AVMs. The majority of AVMs were small in size and all drained deep (most common Spetzler-Martin grade was III, 16 patients, 64%). The most common supplementary grade was also III (10 patients, 40%). Most patients (80%) did not undergo embolization preoperatively. Callosal and body AVMs were approached through an anterior interhemispheric-transcallosal approach (ipsi- or contralateral), while atrial and temporal horn AVMs were approached transcortically through a superior parietal lobule or transtemporal approach, respectively. Overall, 20 patients (83%) had good outcomes (modified Rankin Scale scores = 2). 22 patients were improved/unchanged (92%) and 2 patients were worse (8%; 1 patient was lost). Best outcomes were observed with callosal, ventricular body, and temporal horn AVMs.
Conclusions: Although ventricular/periventricular AVMs reside in ventricular chambers floating in CSF, they are adjacent to critical anatomy and require deep and narrow surgical exposures. Thalamus and fornix must be handled gently, and transcortical routes must be chosen to protect eloquent fiber tracts. Excellent patient outcomes justify surgical management, particularly with AVMs that have ruptured.
Patient Care: By discussing the features, surgical approaches and outcomes after microsurgery of periventricular AVMs,doctors would better understand and treat these lesions thus advancing patient care
Learning Objectives: By the conclusion of this session, participants should be able to: (1) Understand the peculiar anatomy of periventricualr AVMs; (2) Cite the most common clinical presentation forms; (3) Describe surgical approaches to periventricular AVMs (4) Discuss outcomes of microsurgical resection