Surgical approaches to trigonal arteriovenous malformations

Area of Science:

• Neurosurgery
• Vascular Neurology
• Neuroradiology

Background:

• Intracranial arteriovenous malformations (AVMs) are rare, with only 5% predominantly located in the ventricular system.
• This study focuses on AVMs within the ventricular trigone, a challenging neurosurgical location.

Observation:

• Fifteen patients with ventricular trigone AVMs were treated between 1981 and 1986.
• The average patient age was 24, with a 2:1 female predominance.
• Intracranial hemorrhage, particularly intraventricular hemorrhage, was the most common presenting symptom.

Findings:

• Arterial supply typically originated from the posterior cerebral artery (PCA) branches.
• Venous drainage predominantly flowed into the galenic system.
• Surgical approaches included interhemispheric, middle/inferior temporal gyrus, and subtemporal routes, with generally safe outcomes.

Implications:

• Specific surgical strategies are recommended based on AVM angioarchitecture and location relative to the PCA.
• An interhemispheric approach is advised for medially projecting trigone AVMs.
• Middle temporal gyrus or subtemporal approaches are suggested for laterally projecting or inferiorly projecting AVMs, respectively.