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Updated: Jan 14, 2026
Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Breaking paradigms in choroidal fissure arteriovenous malformations: Anatomical aspects, surgical subtypes, and
Mariano Teyssandier1, Erica Antunes Effgen1, Luis Ángel Canache Jiménez1
1Department of Neurology and Neurosurgery, Federal University of São Paulo, São Paulo - SP, Brazil.
Insights
Microsurgical resection of choroidal fissure arteriovenous malformations (AVMs) is challenging but achievable. Applying detailed anatomical knowledge and understanding AVM angioarchitecture ensures safe and effective treatment for these complex vascular lesions.
Area of Science:
- Neurosurgery
- Vascular Neurology
- Anatomical Studies
Background:
- Choroidal fissure (CF) arteriovenous malformations (AVMs) are rare but dangerous, often causing intraventricular hemorrhage.
- Their deep location and involvement of eloquent structures like the thalamus pose significant microsurgical challenges.
- Deep venous drainage is a characteristic feature of these lesions.
Purpose of the Study:
- To demonstrate the application of anatomical knowledge to the microsurgical treatment of CF AVMs.
- To describe anatomical aspects, surgical subtypes, and approaches for CF AVM resection.
- To present a case series illustrating the microsurgical resection of CF AVMs.
Main Methods:
- Cadaveric dissection was performed to detail the microsurgical anatomy of the CF, lateral ventricles, and periventricular regions.
- Three surgical cases, each representing a distinct AVM subtype, were used to illustrate the application of anatomical principles.
- Surgical approaches were tailored based on AVM angioarchitecture and topography.
Main Results:
- CF AVMs were classified into three subtypes based on angioarchitecture and location.
- All patients who underwent microsurgical resection experienced positive outcomes.
- No visual field impairments, memory deficits, or permanent neurological complications were observed post-surgery.
Conclusions:
- A thorough understanding of microsurgical anatomy and AVM angioarchitecture is crucial for safe and definitive resection.
- Microsurgical resection is an adequate and effective therapeutic option for deep and complex CF AVMs.
- Anatomical application provides a safe pathway for treating these challenging neurovascular lesions.
Background:
Despite being a rare location, choroidal fissure (CF) arteriovenous malformations (AVMs) are associated with considerable morbidity and mortality, due in part to the fact that their bleeding usually occurs intraventricularly. In addition, they present deep venous drainage and, depending on their size, may involve eloquent structures such as the thalamus. They represent a challenge for microsurgical treatment, due to its deep location and to the presence of important neurovascular structures closely related. In this article, our objective is to present the application of the anatomy to the microsurgical treatment of this type of AVM, making it a suitable choice, by describing the anatomical aspects to be considered, the surgical subtypes with their respective surgical approaches and to demonstrate what has been stated with a series of cases of microsurgical resection of this type of AVM.
Methods:
Cadaver dissection was performed to describe the microsurgical anatomy of the CF, lateral ventricles, and periventricular structures. Application of this anatomy is illustrated through description of three surgical cases, each one related to one of the described subtypes of AVMs of the CF.
Results:
The division into three subtypes according to the AVM's angioarchitecture and to their topography in this region was carried out. After microsurgical resection, the patients evolved without visual field impairments, memory complaints, or permanent neurological complications.
Conclusion:
Application of anatomy to microsurgery and knowledge of AVM's angioarchitecture constitutes a definitive and safe way to achieve the resection of these deep and complex AVMs, making it an adequate therapeutic option.
