Transtubular microendoscopic approach for resection of a choroidal arteriovenous malformation

Technical note

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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 4 × 22–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.

Abbreviation used in this paper: AVM = arteriovenous malformation.

Article Information

Address correspondence to: Andrew Jea, M.D., Children's Hospital, CCC 1230.01, 12th Floor, Houston, Texas 77030. email:

© AANS, except where prohibited by US copyright law.



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    Axial CT scan of the head at presentation showing ventricular enlargement due to obstruction from intraventricular hemorrhage in the left lateral ventricle and third ventricle.

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    Preoperative left carotid artery (CA) angiogram (lateral view) demonstrating a small intraventricular choroidal AVM in the trigone of the left lateral ventricle (arrow) with feeders from both the anterior choroidal artery and the posterior lateral choroidal artery.

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    Illustration of transtubular microendoscopic approach for resection of choroidal AVM in the trigone of the left lateral ventricle.

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    Postoperative left CA angiogram (lateral view) after complete resection of the choroidal AVM (arrow); both the anterior choroidal artery and the posterior lateral choroidal artery remain intact.



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