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| Name | Contralateral Transcallosal Transchoroidal Fissure Clipping-Excision |
| Video Uploader | Video From NEUROSURGERY Journal |
| Upload Date | This Video Uploaded At 09-10-2015 14:37:55 |
| Video Discription | Intraventricular aneurysms of the third ventricle are extremely rare. A case of a ruptured third ventricle aneurysm clip-excision and thalamic arteriovenous malformation (AVM) resection via a contralateral interhemispheric transcallosal trans-choroidal fissure approach is demonstrated. A previously healthy 51-year-old female presented with sudden headache and loss of consciousness. On examination, she was lethargic but arousable and oriented to self, with hemiparesis on the right side. A computed tomography (CT) scan revealed diffuse intraventricular hemorrhage. Cerebral angiogram demonstrated a 5 mm aneurysm adherent to the left inferior thalamus beneath the massa intermedia and a small AVM with a prominent vein draining into the left internal cerebral vein. Hemosiderin was demonstrated, indicative of prior hemorrhage. A transcallosal trans-choroidal fissure approach was performed from the right side, and both the aneurysm and AVM were treated simultaneously. Adenosine was available in surgery, given the limitations in proximal control, but not administered. Her postoperative angiogram demonstrated no residual aneurysm or AVM. Following surgery, the patient demonstrated profound recovery and was discharged on the 7th day following surgery. At six weeks follow-up, she is neurologically intact with the exception of episodic mild confusion. The unique pathology in this case allowed for concurrent resection of a thalamic AVM and third-ventricle aneurysm. The high-risk features of ruptured pre-nidal aneurysm, deep AVM location, deep venous drainage, and evidence of prior hemorrhages made observation unfavorable for either lesion. To the author’s knowledge, this case represents the first report of a transcallosal trans-choroidal fissure approach for treatment of an intra-third-ventricular aneurysm. |
| Category | Science & Technology |
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