A case of arteriovenous malformation (AVM) of the left lateral recess of the fourth ventricle is presented in this paper.
The patient, an eight-year-old girl complaining of vomiting and vertigo, was admitted to our hospital with horizontal nystagmus and ataxic gait. Computerized tomography (CT) scans and angiograms demonstrated an AVM of the lateral recess of the fourth ventricle, which was fed predominantly by the choroidal branches of the left posterior inferior cerebellar artery, and drained by the petrosal vein. At first, the patient underwent resection of the nidus through the midline approach. Postoperative CT scans, however, demonstrated a residual nidus of AVM in the area of the left cerebellar peduncle and a probable draining vein in the left cerebellopontine angle. Therefore, a second operation was designed for the lateral approach. The residual AVM was found in the middle and inferior cerebellar peduncle being supplied by the choroidal branches of the left anterior inferior cerebellar artery and small branches of the left superior cerebellar artery at the cerebellopontine angle and in the lateral recess of the fourth ventricle. Postoperative angiograms revealed complete obliteration of the AVM, although CT scans demonstrated a small hematoma in the lateral recess of the fourth ventricle. The patient was discharged with mild hearing disturbance and dysmetria on the left side, which disappeared six months later.
Operative techniques as well as the surgical indication for the posterior fossa AVM are discussed and a review of the literature is given.
