Transtubular microendoscopic approach for resection of a choroidal arteriovenous malformation

The authors describe the novel use of a table-mounted tubular retractor system (MetRx) originally designed for minimally invasive spine surgery, in the resection of an intraventricular arteriovenous malformation (AVM) in a 12-year-old child. The tubular retractor system may have several advantages over traditional Greenberg or Leyla retractors in selected intracranial procedures. In our case, the low-profile 4x22-mm tube and fixed table attachment offered excellent exposure of the trigone of the lateral ventricle where the choroidal AVM was located and from which it was completely resected. Immediate postoperative cerebral angiography confirmed that the entire AVM had been resected. The patient suffered no new neurological deficits as a result of the retractor system or the exposure that it afforded. Although the good clinical results of a single case cannot be directly compared with those obtained using other open techniques of intracranial surgery in larger series, microendoscopic surgery of the brain is an alternative to the other techniques and may be recommended as a time-saving, trauma-reducing procedure with the potential to improve postoperative outcomes.