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Multimodal treatment of a pediatric posterior fossa arteriovenous malformation employing endovascular and microsurgical techniques

Zeferino Demartini Jr., Guilherme H. W. Ceccato, Érico S. G. G. da Trindade, and Luis A. B. Borba

Intracranial hemorrhage is the most common presentation of posterior fossa arteriovenous malformations (AVMs) and may have serious consequences. The authors present a case of a 7-year-old girl with headache, vomiting, dysmetria, and ataxia due to a ruptured cerebellar grade III AVM. After two sessions of embolization, the patient underwent total microsurgical resection through a suboccipital craniotomy. There were no additional postoperative deficits, and the patient improved progressively during 6 months of rehabilitation. These challenging lesions should be removed after rupture, especially in children with long-term cumulative risk of rebleeding. Multimodal treatment reduces the perioperative bleeding, allowing better outcomes for pediatric AVM.

The video can be found here: https://youtu.be/HQWnjD8ENZQ

In Neurosurgical Focus: Video Volume 4: Issue 1 (Jan 2021): Posterior Fossa Arteriovenous Malformations

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Matas test revisited: carotid compression for embolization of high-flow pediatric pial arteriovenous fistulas

Zeferino Demartini Jr., Gelson Luis Koppe, Bernardo Corrêa de Almeida Teixeira, Adriano Keijiro, Alexandre Novicki Francisco, and Luana Antunes Maranha Gatto

OBJECTIVE

Cerebral pial arteriovenous fistula (AVF) is a rare vascular malformation and may cause hemorrhage and neurological deficit. The presence of high-flow shunts constitutes a challenge when performing the endovascular technique, due to risk of distal embolization. The authors report a simple maneuver, adapted from the Matas test, that was successfully applied to treat a child with two pial AVFs.

METHODS

An 8-year-old boy presented with headache and vomiting due to two single-channel high-flow intracerebral pial AVFs. He was treated with an endovascular approach using brief, gentle compression of the ipsilateral cervical carotid artery. The temporary flow arrest ensured proper placement of the first coil, allowing definitive obliteration of the shunt.

RESULTS

There were no complications with the procedure, and the patient recovered uneventfully. Throughout the 9-month follow-up, the patient experienced a stable neurological condition, with both fistulas occluded and improvement of local circulation.

CONCLUSIONS

This easy-to-perform maneuver allows precise positioning of embolic material into high-flow shunts to facilitate treatment of pial AVF.

In Journal of Neurosurgery: Pediatrics Publish Before Print