Combined strategies on the treatment of cerebellar arteriovenous malformation.

Marcos Dellaretti,Tancredo Alcântara Ferreira Junior,Diego Da Silveira

doi:10.3171/2020.10.focvid2058

Abstract

Cerebellar arteriovenous malformations (AVMs) comprise 10%–15% of all intracranial AVMs and have a higher risk for morbidity and mortality than supratentorial AVMs. Patients with cerebellar AVMs present with hemorrhage more often than patients with cerebral AVMs, justifying an interventional treatment. Patient outcome can be predicted with specific grade systems, guiding vascular neurosurgeons in decision-making. The authors present the case of a 42-year-old man incidentally diagnosed with an unruptured cerebellar inferior vermian AVM, which was managed through a combined strategy of preoperative endovascular embolization of the main arterial feeders followed by microsurgical resection via midline suboccipital craniotomy, with a favorable outcome.The video can be found here: https://youtu.be/3WESejZbk90

Highlights

Cerebellar arteriovenous malformations (AVMs) comprise 10%–15% of all intracranial AVMs and have a higher risk for morbidity and mortality than supratentorial AVMs
The authors present the case of a 42-year-old man incidentally diagnosed with an unruptured cerebellar inferior vermian AVM, which was managed through a combined strategy of preoperative endovascular embolization of the main arterial feeders followed by microsurgical resection via midline suboccipital craniotomy, with a favorable outcome
0:39 Left vertebral angiography shows the cerebellar AVM’s main arterial supply was the left PICA, and the basilar artery did not fill by the left vertebral artery due to steal phenomena

Summary

Introduction

Cerebellar arteriovenous malformations (AVMs) comprise 10%–15% of all intracranial AVMs and have a higher risk for morbidity and mortality than supratentorial AVMs. The authors present the case of a 42-year-old man incidentally diagnosed with an unruptured cerebellar inferior vermian AVM, which was managed through a combined strategy of preoperative endovascular embolization of the main arterial feeders followed by microsurgical resection via midline suboccipital craniotomy, with a favorable outcome. The blue arrows show that the left PICA had three flow aneurysms. In the figure on the right, we see the arterial supply of the AVM.

Results

Conclusion