Abstract
Posterior fossa arteriovenous malformations represent 7-15% of all intracranial AVMs. They carry a higher risk of rupture than supratentorial AVMs and are associated with considerable rates of morbidity and mortality. Available treatment options include conservative management, microsurgical resection, radiosurgery, endovascular embolization, or combinations of these modalities. Recent advances in endovascular techniques have revolutionized their management with better clinical outcomes. We illustrate two cases of posterior fossa AVMs treated by endovascular techniques with good clinical outcomes. The first patient also had associated flow-related aneurysms. One of these aneurysms had already ruptured, so it was coiled first followed by AVM nidus embolization using the same microcatheter. The second patient had a diffuse type of posterior fossa AVM for which staged-embolization was planned and the first-stage partial embolization was successfully performed.
Highlights
Posterior fossa arteriovenous malformations constitute only 7 to 15% of all intracranial AVMs.1 Conventional surgical treatment of posterior fossa AVM is associated with significant mortality (6%) and morbidity (16%) due to the complex surgical anatomy and its proximity to important neural and vascular structures.2 recent advances in endovascular techniques have transformed conventional management and improved outcome
Endovascular embolization is an effective treatment option, multiple sessions are sometimes necessary to achieve complete obliteration. We report two such cases of posterior fossa AVMs that were successfully treated by endovascular techniques for the first time in Nepal with good postprocedure outcomes
The diagnostic cerebral angiogram (DSA) confirmed the presence of left cerebellar fossa AVM with feeders from the left superior cerebellar artery (SCA) and left posterior inferior cerebellar artery (PICA)
Summary
Posterior fossa arteriovenous malformations constitute only 7 to 15% of all intracranial AVMs.1 Conventional surgical treatment of posterior fossa AVM is associated with significant mortality (6%) and morbidity (16%) due to the complex surgical anatomy and its proximity to important neural and vascular structures.2 recent advances in endovascular techniques have transformed conventional management and improved outcome. We report two such cases of posterior fossa AVMs that were successfully treated by endovascular techniques for the first time in Nepal with good postprocedure outcomes.
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