Journal of Cerebrovascular and Endovascular Neurosurgery

Korean Society of Cerebravascular Surgeons (대한뇌혈관외과학회)
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Awake craniotomy removal of a corticospinal tract developmental venous anomaly hemorrhage: A case report

  • Ignacio J. Barrenechea (Department of Neurosurgery, Hospital Privado de Rosario - Grupo Gamma) ;
  • Luis M. Marquez (Department of Neurosurgery, Hospital Privado de Rosario - Grupo Gamma) ;
  • Vanina A. Cortadi (Department of Radiology, Hospital Privado de Rosario - Grupo Gamma) ;
  • Hector P. Rojas (Department of Neurosurgery, Hospital Privado de Rosario - Grupo Gamma) ;
  • Robin Ingledew (Department of Neurophysiology, Hospital Privado de Rosario - Grupo Gamma)
  • Received : 2022.03.24
  • Accepted : 2022.10.14
  • Published : 2023.09.30
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Abstract

Developmental venous anomalies (DVAs) are composed of mature venous vessels that lack malformed or neoplastic elements. Although the hemorrhage risk is considered negligible, some patients may have neurological symptoms attributable to acute infarction or intracranial hemorrhage secondary to thrombosis, in the absence of a coexisting cavernous malformation. We report the case of a 42-year-old patient who presented with acute left-hand paresis secondary to a subcortical hemorrhage. This bleeding originated from a DVA in the corticospinal tract area and was surgically drained through an awake craniotomy. To accomplish this, we used a trans-precentral sulcus approach. After the complete removal of the coagulum, small venous channels appeared, which were coagulated. No associated cavernoma was found. Although the main DVA trunk was left patent, no signs of ischemia or venous infarction were observed after coagulating the small venous channels found inside the hematoma cavity. Two weeks after the procedure, the patient's hand function improved, and he was able to resume desktop work. DVA-associated hemorrhage within the cortico-spinal tract could be safely removed with modern awake mapping techniques. This technique allowed the patient to rapidly improve his hand function.

Keywords

Acknowledgement

The authors would like to thank Maria Fernanda Ruiz for her assistance in preparing the pathology section.

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