Removal of superior vermian arteriovenous malformation through the occipital transtentorial approach

Abstract

Background: Arteriovenous malformations (AVMs) of the superior vermis are extremely rare. Although they have a higher rate of hemorrhagic presentations than supratentorial AVMs, the surgical approaches for AVMs at this location remain controversial. Case description: We report the case of a 73-year-old man with a hemorrhagic superior vermian AVM that was treated with surgical resection through the occipital transtentorial approach (OTA). This approach, with a direct perpendicular view of the whole lesion, enabled us to control the feeding arteries safely and to finally accomplish a total resection. Conclusions: The OTA is an elegant approach for the resection of superior vermian AVMs. Detailed assessment of angiographic features is mandatory in selecting an effective and safe surgical approach for posterior fossa AVMs depending on their location. Keywords: Arteriovenous malformation, Occipital transtentorial, Posterior fossa, Superior vermian, Surgical approach