Interhemispheric Transcallosal Approach for Resection of Choroidal Arteriovenous Malformation: Operative Video

Choroidal arteriovenous malformations (AVMs) are rare vascular entities located deep within the brain and in close relationship with vital paraventricular structures.^1,2 Recruitment of feeders from the anterior and posterior choroidal arteries is typical in these lesions.³ We present the case of a 38-year-old woman who presented initially to an outside hospital with an intracranial hemorrhage 17 months prior. Initial computed tomography scan showed a large intraventricular hemorrhage and a right thalamic hemorrhage. She was diagnosed with a cerebral AVM and underwent treatment with placement of an external ventricular drain followed by partial embolization of a feeder with Onyx liquid embolic system (ev3, Irvine, California, USA). The patient had good functional recovery and was referred to our center for management of the residual lesion. Neurologic examination revealed no focal neurologic deficit. Diagnostic cerebral angiogram (DSA) showed persistent filling of the AVM with feeders from anterior and posterior choroidal arteries. Drainage was noted into an arterialized vein that coursed anteriorly and inferiorly prior to joining the internal cerebral vein and ultimately draining into the vein of Galen. After reviewing the management options, decision was made to proceed with microsurgical resection via an interhemispheric transcallosal approach (Video 1). The patient tolerated the procedure well and was discharged home on postoperative day 4 with no evidence of residual AVM on DSA and no neurologic deficit noted at last follow-up.