Endoscopic hematoma removal and third ventriculostomy for the management of acute hydrocephalus due to the rupture of a deep-seated arteriovenous malformation: Report of two cases

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  • Sakuma Jun
    Department of Neurosurgery, Faculty of Medicine, Fukushima Medical University
  • Sato Yusuke
    Department of Neurosurgery, Faculty of Medicine, Fukushima Medical University
  • Kojima Takao
    Department of Neurosurgery, Faculty of Medicine, Fukushima Medical University
  • Iijima Ayako
    Department of Neurosurgery, Faculty of Medicine, Fukushima Medical University
  • S. Bakhit Mudathir
    Department of Neurosurgery, Faculty of Medicine, Fukushima Medical University
  • Ito Yuhei
    Department of Neurosurgery, Faculty of Medicine, Fukushima Medical University
  • Hiruta Ryo
    Department of Neurosurgery, Faculty of Medicine, Fukushima Medical University
  • Naruse Yu
    Department of Neurosurgery, Faculty of Medicine, Fukushima Medical University
  • Saito Kiyoshi
    Department of Neurosurgery, Faculty of Medicine, Fukushima Medical University

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Other Title
  • 脳動静脈奇形破裂による脳室内出血に対する内視鏡下血腫除去と第３脳室底開窓術
  • 症例 脳動静脈奇形破裂による脳室内出血に対する内視鏡下血腫除去と第3脳室底開窓術
  • ショウレイ ノウドウ ジョウミャク キケイ ハレツ ニ ヨル ノウ シツナイ シュッケツ ニ タイスル ナイシキョウ カケッシュ ジョキョ ト ダイ3 ノウシツテイ カイソウジュツ

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<p>  We report two cases of an intraventricular hemorrhage due to the rupture of an arteriovenous malformation (AVM). An endoscopic hematoma removal and/or a third ventricular ventriculostomy (ETV) were performed in the acute and subacute stages, and through the combination of these therapies good clinical outcomes were obtained. Case 1: A 15‒year‒old Japanese male was referred to our hospital, unconsciousness and with right hemiparesis. Computed tomography (CT) and magnetic resonance imaging revealed a left thalamic hemorrhage extending to the left lateral ventricle, with acute hydrocephalus. A Spetzler‒Martin grade IV AVM was identified at the left basal ganglia with a nidus measuring 5 cm with multiple feeders from the basilar artery, left posterior cerebral artery, and left middle cerebral artery. An urgent endoscopic hematoma removal and endoscopic ventricular drainage (EVD) insertion were conducted to manage the already increased intracranial pressure, followed by an ETV on the 17th postoperative day and intravascular embolization to the feeders on three different occasions in the chronic stage of the illness. Case 2: A‒25‒year‒old Japanese woman became comatose and was transferred to our hospital. CT showed a bilateral ventricular hemorrhage and acute hydrocephalus with a ruptured AVM of the lateral ventricular trigone. Endoscopic hematoma removal, ETV, and EVD insertion were performed in the same setting. On the 3rd postoperative day, three feeders originating from the left posterior cerebral arteries were embolized, and a reduction of the flow of the arterio‒venous shunt was achieved. The EVD was removed after embolization. One month later, stereotactic radiotherapy was performed. There are few published reports regarding endoscopic removal with ETV for an intraventricular hemorrhage due to a ruptured AVM. Although our sample is just two patients, their outcomes indicate that in addition to acute intracranial pressure control, ETV has the advantage of shortening the EVD insertion procedure and the elimination of the necessity of shunting, which may improve patient outcomes.</p>

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