Abstract
It is very difficult to totally resect a large arteriovenous malformation in the posterior fossa. We have experienced a patient who was treated successfully utilizing a balloon catheter for temporary occlusion of the basilar artery under the administration of “Sendai cocktail” (20% mannitol, vitamin E, dexamethazone) and perfluorochemicals.
The patient was a 14-year-old female who developed sudden onset of SAH with ventricular rupture and left cerebellar hemorrhage. Angiography disclosed a large left cerebellopontine angle arteriovenous malformation fed by two superior cerebellar arteries and the anterior inferior cerebellar artery and drained by the superior petrosal vein. We thought it very hazardous and difficult to undertake total resection by the conventional approach, so we considered utilizing the balloon catheter technique to occlude the feeding arteries for the adjunctive intraoperative procedure. Superselective angiography and a tolerance test were performed under the administration of “Sendai cocktail” and monitoring of auditory brain stem response (ABR) was undertaken. Total resection of the malformation was successfully performed by the unilateral suboccipital approach. Balloon catheters were introduced to the main feeding arteries (one into the anterior inferior cerebellar artery and the other into the basilar artery where the superior cerebellar artery originated)through introducing an indwelling catheter by the transfemoral route. Under the administration of “Sendai cocktail” and perfluorochemicals, catheters were inflated for temporary occlusion and the malformation was resected uneventfully. Temporary occlusion was performed under ABR monitoring for as long as 46 minutes.
The postoperative course was uneventful.
This is thought to be the first case applying a balloon catheter for intraoperative temporary occlusion of the basilar artery. If this technique is utilized with “Sendai cocktail” and perfluorochemicals, it is very safe to perform temporary occlusion of any intracranial arteries that are accessible for the intravascular approach and indications of surgical treatment of arteriovenous malformation will be extended to those thought to be inoperable by the conventional approach.
