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cerebellar_arteriovenous_malformation

Cerebellar Arteriovenous Malformation

In 1932 the first successful resection of a cerebellar Arteriovenous Malformation was performed by Axel Herbert Olivecrona and Riives 1).

Epidemiology

They comprise less than 15% of all Intracranial Arteriovenous Malformations 2). and this relatively low incidence has led authors to combine them with brainstem arteriovenous malformation in reports on infratentorial or posterior fossa AVMs 3) 4) 5) 6) 7) 8) 9) 10) 11) 12)

Rare Etiologies

Thrombosis of the ipsilateral transverse sinus 13)

Classification

Clinical Features

Arteriovenous malformation of the cerebellum are a unique subset of intracranial arteriovenous malformation AVMs that present with hemorrhage more frequently than supratentorial AVMs.

Treatment

Surgery

Emergency microsurgery is effective in the treatment of ruptured cerebellar AVM 14).

Approaches

Occipital transtentorial approach is a valuable approach for specific superior vermian, superomedian cerebellar, and tectal AVMs. Detailed assessment of angiographic features may however preclude its safety as a unique treatment plan, and complementary or alternative therapeutic options should be considered 15) 16).

Gamma knife surgery for arteriovenous malformation

Radiosurgery is an effective treatment modality for Cerebellar Arteriovenous Malformation with relatively limited adverse events. Infratentorial location did not affect radiosurgery outcomes 17). Proved to be most effective for patients with smaller and previously nonembolized cerebellar malformations. Hemorrhage during the latency period occurred at a rate of 2.0% per year until obliteration occurred 18).

Outcome

Due to the relatively small volume of the posterior fossa and their proximity to the brainstem, rupture of cerebellar AVMs may quickly result in devastating neurological consequences.

Arteriovenous malformation (AVM)-related aneurysms supported by numerous reports is that these aneurysms should regress if the AVM is excluded from the circulation.

A case of 46-year-old man who presented with a posterior fossa AVM with an aneurysm on the posterior inferior cerebellar artery feeding the AVM. The nidus of the AVM was successfully excluded by glue embolization, with initial regression of the PICA aneurysm on serial imaging. Five years after the endovascular treatment, the aneurysm showed significant re-growth necessitating endovascular coiling. This case presents the re-growth of an AVM-related aneurysm and emphasizes the importance of long-term follow-up of such aneurysms even if the AVM is completely excluded 19).

Case reports

Resolution of hemifacial spasm after successful treatment of posterior fossa arteriovenous malformation by gamma knife radiosurgery 20).


A 25-year-old woman was admitted because of frequent vomiting and headache which had lasted over one week. She had initially clear consciousness but slowly progressive mild headache and dysphoria. Emergency cranial CT revealed a 4 cm haematoma in the left cerebellar hemisphere. CT angiography showed a 2×2 cm nidus of an arteriovenous malformation (AVM) in the left hemisphere fed from the left posterior inferior cerebellar artery and draining into the inferior hemispheric vein. We performed a surgical resection of the AVM after decompression therapy to counteract the brain oedema. She recovered completely without any neurological deficits. This case recalls the importance of cooperation between diagnostic neuroradiology and neurosurgery in emergency, considering AVM, even if infrequent, among possible diseases 21).

1)
Olivecrona H, Riives J. Arteriovenous aneurysms of the brain, their diagnosis and treatment. Arch Neurol Psychiatry. 1948;59:567–602.
2)
Arnaout OM, Gross BA, Eddleman CS, Bendok BR, Getch CC, Batjer HH. Posterior fossa arteriovenous malformations. Neurosurg Focus. 2009;26(5):E12.
3)
Batjer H, Samson D. Arteriovenous malformations of the posterior fossa: clinical presentation, diagnostic evaluation and surgical treatment. Neurosurg Rev. 1986;9:287–296.
4)
Da Costa L, Thines L, Dehdashti AR, Wallace MC, Willinsky RA, Tymianski M, Schwartz ML, ter Brugge KG. Management and clinical outcome of posterior fossa arteriovenous malformations: report on a single-centre 15-year experience. J Neurol Neurosurg Psychiatry. 2009;80(4):376–379.
5)
Drake CG, Friedman AH, Peerless SJ. Posterior fossa arteriovenous malformations. J Neurosurg. 1986;64:1–10.
6)
Kelly ME, Guzman R, Sinclair J, Bell-Stephens TE, Bower R, Hamilton S, Marks MP, Do HM, Chang SD, Adler JR, Levy RP, Steinberg GK. Multimodality treatment of posterior fossa arteriovenous malformations. J Neurosurg. 2008;108(6):1152–1161.
7)
Khaw AV, Mohr JP, Sciacca RR, Schumacher HC, Hartmann A, Pile-Spellman J, et al. Association of infratentorial brain arteriovenous malformations with hemorrhage at initial presentation. Stroke. 2004;35:660–663.
8)
Neacsu A, Ciurea AV. General considerations on posterior fossa arteriovenous malformations (clinics, imaging and therapy). Actual concepts and literature review. J Med Life. 2010;3(1):26–35.
9)
O'Shaughnessy BA, Getch CC, Bendok BR, Batjer HH. Microsurgical resection of infratentorial arteriovenous malformations. Neurosurg Focus. 2005;19(2):E5.
10)
Sinclair J, Kelly ME, Steinberg GK. Surgical management of posterior fossa arteriovenous malformations. Neurosurgery. 2006;58(4 Suppl 2):189–201.
11)
Symon L, Tacconi L, Mendoza N, Nakaji P. Arteriovenous malformations of the posterior fossa: a report on 28 cases and review of the literature. Br J Neurosurg. 1995;9:721–732.
12)
Vilalta J, Topezewski T, Añez JD, Arikan F, Guitart JM, Rubio E. Arteriovenous malformations of the posterior fossa. Clinical features, treatment and results. Rev Neurol. 2001;32(12):1124–1128. Spanish.
13)
Delye H, Thines L, Zairi F, Allaoui M, Lejeune JP. Rupture of a cerebellar arteriovenous malformation following thrombosis of the ipsilateral transverse sinus. Rev Neurol (Paris). 2014 Jun-Jul;170(6-7):464-5. doi: 10.1016/j.neurol.2013.12.007. Epub 2014 Apr 13. PubMed PMID: 24726039.
14)
Li JP, Zhao QH, Wang Y, Li T, Guo P, Zhao JZ. [Surgical treatment of ruptured cerebellar arteriovenous malformations]. Zhonghua Yi Xue Za Zhi. 2013 Jun 4;93(21):1660-3. Chinese. PubMed PMID: 24125678.
15)
McLaughlin N, Martin NA. The occipital interhemispheric transtentorial approach for superior vermian, superomedian cerebellar, and tectal arteriovenous malformations: advantages, limitations, and alternatives. World Neurosurg. 2014 Sep-Oct;82(3-4):409-16. doi: 10.1016/j.wneu.2013.07.075. Epub 2013 Jul 27. Review. PubMed PMID: 23895929.
16)
Zhao J, Tao Y. The occipital transtentorial approach for cerebellar and midbrain arteriovenous malformation. World Neurosurg. 2014 Sep-Oct;82(3-4):316-7. doi: 10.1016/j.wneu.2013.08.043. Epub 2013 Sep 4. PubMed PMID: 24012552.
17)
Ding D, Starke RM, Yen CP, Sheehan JP. Radiosurgery for cerebellar arteriovenous malformations: does infratentorial location affect outcome? World Neurosurg. 2014 Jul-Aug;82(1-2):e209-17. doi: 10.1016/j.wneu.2014.02.007. Epub 2014 Feb 14. PubMed PMID: 24530455.
18)
Bowden G, Kano H, Tonetti D, Niranjan A, Flickinger J, Lunsford LD. Stereotactic radiosurgery for arteriovenous malformations of the cerebellum. J Neurosurg. 2014 Mar;120(3):583-90. doi: 10.3171/2013.9.JNS131022. Epub 2013 Oct 25. PubMed PMID: 24160482.
19)
Al-Jehani H, Tampieri D, Cortes M, Melançon D. Re-growth of a posterior inferior cerebellar artery aneurysm after resection of the associated posterior fossa arteriovenous malformation. Interv Neuroradiol. 2014 Jan-Feb;20(1):61-6. Epub 2014 Feb 10. PubMed PMID: 24556301; PubMed Central PMCID: PMC3971143.
20)
Bayri Y, Tanrıkulu B, Yener U, Şeker A, Kılıç T. Resolution of hemifacial spasm after successful treatment of posterior fossa arteriovenous malformation by gamma knife radiosurgery. Clin Neurol Neurosurg. 2014 Apr;119:121-4. doi: 10.1016/j.clineuro.2014.01.014. Epub 2014 Jan 27. PubMed PMID: 24635940.
21)
Rispoli R, Di Chirico A, Sibille M, Carletti S. A juvenile case of cerebellar arteriovenous malformation with gradual onset of dysphoria and headache. Neuroradiol J. 2013 Jun;26(3):333-7. Epub 2013 Jul 16. PubMed PMID: 23859292.
cerebellar_arteriovenous_malformation.txt · Last modified: 2019/03/09 13:00 by administrador