Cerebellar Arteriovenous Malformation Research Articles

Primitive trigeminal artery associated with aterovenous malformation of cerebellum

Persistence of fetal cerebral carotid basilar anastomoses is rare. When it occurs, it is often associated with other vascular malformations, and other pathological conditions. Trigeminal primitive artery persistence is the most often among them. Coincidence of primitive trigeminal artery with cerebellar arteriovenous malformation is extremely rare. We reported a case of a 31-year-old woman with subarachnoid hemorrhage and cerebellar hematoma admitted in serious condition. Angiography demonstrated cerebellar arteriovenous malformation, primitive trigeminal artery and other malformation of Willis circle. After a complete surgical removal of arteriovenous malformation the patient was discharged without neurological or any other deficit. We reported an extremely rare condition, which had been reported very few times in the literature. The importance of primitive artery persistence is in changed anatomical and physiological condition of cerebral circulation, that is especially important in surgical procedures.

Acute anti-emetic withdrawal associated with a hemorrhagic cerebellar arteriovenous malformation

We present a 67-year-old right-handed male with a brachium pontis arteriovenous malformation on continuous anti-emetic therapy who demonstrated acute withdrawal symptoms after the abrupt discontinuation of ondansetron, a 5-HT(3) receptor antagonist. Removal of anti-emetic therapy led to the development of extreme flushing and tremor, but subsequent return of ondansetron resulted in the resolution of these symptoms. This is the first clinical report demonstrating acute withdrawal from an anti-emetic agent and we further highlight the need for future studies evaluating not only arterial supply with pressure gradients and anatomical location, but also the association with periventricular venous drainage, venous drainage stenosis, and mass effect from venous stasis as this may contribute partly to the sensitivity of the serotonergic receptors seen here.

Anesthetic Management of Cesarean Section in a Patient With Rupture of a Cerebellar Arteriovenous Malformation

Obstetric Anesthesia Digest: December 2009 - Volume 29 - Issue 4 - p 231 doi: 10.1097/01.aoa.0000362119.11849.b7

Resolution of Trigeminal Neuralgia Following Cerebellar AVM Embolization With Onyx

Intracranial arteriovenous malformation (AVM) is a rare cause of trigeminal neuralgia (TN). Successful resolution of AVM-related TN following embolization surgery using Onyx has not been reported. In this case report, a posterior fossa AVM was embolized in two separate, staged endovascular surgeries using Onyx. The AVM was reduced in size, and the TN resolved. The patient subsequently underwent radiosurgery for the small, residual AVM, and he has maintained an uneventful follow-up. A thorough literature review was also performed for AVM-associated TN. Fifty-nine reports of AVM-related TN have been described to date, of which only three were treated with embosurgery. None of the prior two embosurgical reports utilized Onyx, and no AVM was obliterated with embosurgery alone. TN secondary to AVM can be resolved with embosurgery utilizing Onyx; however, complete elimination of the underlying AVM requires adjuvant surgery.

Anesthetic management for cesarean section in a patient with rupture of a cerebellar arteriovenous malformation

Intracranial hemorrhage in the pregnant patient is a rare cause of peripartum morbidity, and it presents a diagnostic and management dilemma. The case of a term parturient who presented with headache is presented. Clinical suspicion led to the diagnosis of ruptured cerebellar arteriovenous malformation. Optimal timing of interventions, both neurosurgical and obstetric, are discussed. We chose to pursue Cesarean section prior to definitive neurosurgical intervention in this term parturient. Delivery of the fetus before surgery eliminates concern for adverse pregnancy outcome when interventions for cerebral protection are used, such as hyperventilation, administration of mannitol, barbiturate coma, and induced hypertension or hypotension. Subsequent management options, including general, spinal, epidural, and combined-spinal epidural (CSE) anesthesia for Cesarean delivery, are discussed. We selected CSE anesthesia so as to provide a hemodynamically stable delivery followed by planned endovascular embolization.

A Case of Ruptured Peripheral Aneurysm of the Anterior Inferior Cerebellar Artery Associated with an Arteriovenous Malformation : A Less Invasive Image-Guided Transcortical Approach

A 47-year-old man presented with a subarachnoid hemorrhage (SAH) and right cerebellar hematoma was referred for evaluation. Cerebral angiography revealed a distal anterior inferior cerebellar artery (AICA) aneurysm associated with an arteriovenous malformation (AVM). Successful obliteration and complete removal of the aneurysm and AVM were obtained using transcortical approach under the guidance of neuronavigation system. The association of a peripheral AICA aneurysm and a cerebellar AVM by the same artery is unique. The reported cases of conventional surgery for this disease complex are not common and their results are variable. Less invasive surgery using image-guided neuronavigation system would be helpful and feasible for a peripheral aneurysm combining an AVM of the posterior fossa in selective cases.

Recurrent Thalamic Haemorrhage Attributed to a Cerebellar Arteriovenous Malformation

Recurrent Thalamic Haemorrhage Attributed to a Cerebellar Arteriovenous Malformation

Unilateral moyamoya disease associated with cerebellar arteriovenous malformation: one case report

Unilateral moyamoya disease associated with cerebellar arteriovenous malformation: one case report

Multimodality treatment of posterior fossa arteriovenous malformations

Posterior fossa arteriovenous malformations (AVMs) are relatively uncommon and often difficult to treat. The authors present their experience with multimodality treatment of 76 posterior fossa AVMs, with an emphasis on Spetzler-Martin Grades III-V AVMs. Seventy-six patients with posterior fossa AVMs treated with radiosurgery, surgery, and endovascular techniques were analyzed. Between 1982 and 2006, 36 patients with cerebellar AVMs, 33 with brainstem AVMs, and 7 with combined cerebellar-brainstem AVMs were treated. Natural history data were calculated for all 76 patients. The risk of hemorrhage from presentation until initial treatment was 8.4% per year, and it was 9.6% per year after treatment and before obliteration. Forty-eight patients had Grades III-V AVMs with a mean follow-up of 4.8 years (range 0.1-18.4 years, median 3.1 years). Fifty-two percent of patients with Grades III-V AVMs had complete obliteration at the last follow-up visit. Three (21.4%) of 14 patients were cured with a single radiosurgery treatment, and 4 (28.6%) of 14 with 1 or 2 radiosurgery treatments. Twenty-one (61.8%) of 34 patients were cured with multimodality treatment. The mean Glasgow Outcome Scale (GOS) score after treatment was 3.8. Multivariate analysis performed in the 48 patients with Grades III-V AVMs showed radiosurgery alone to be a negative predictor of cure (p = 0.0047). Radiosurgery treatment alone was not a positive predictor of excellent clinical outcome (GOS Score 5; p > 0.05). Nine (18.8%) of 48 patients had major neurological complications related to treatment. Single-treatment radiosurgery has a low cure rate for posterior fossa Spetzler-Martin Grades III-V AVMs. Multimodality therapy nearly tripled this cure rate, with an acceptable risk of complications and excellent or good clinical outcomes in 81% of patients. Radiosurgery alone should be used for intrinsic brainstem AVMs, and multimodality treatment should be considered for all other posterior fossa AVMs.

Multimodality treatment of posterior fossa arteriovenous malformations

Object Posterior fossa arteriovenous malformations (AVMs) are relatively uncommon and often difficult to treat. The authors present their experience with multimodality treatment of 76 posterior fossa AVMs, with an emphasis on Spetzler–Martin Grades III–V AVMs. Methods Seventy-six patients with posterior fossa AVMs treated with radiosurgery, surgery, and endovascular techniques were analyzed. Results Between 1982 and 2006, 36 patients with cerebellar AVMs, 33 with brainstem AVMs, and 7 with combined cerebellar–brainstem AVMs were treated. Natural history data were calculated for all 76 patients. The risk of hemorrhage from presentation until initial treatment was 8.4% per year, and it was 9.6% per year after treatment and before obliteration. Forty-eight patients had Grades III–V AVMs with a mean follow-up of 4.8 years (range 0.1–18.4 years, median 3.1 years). Fifty-two percent of patients with Grades III–V AVMs had complete obliteration at the last follow-up visit. Three (21.4%) of 14 patients were cured ...

Progressive spontaneous occlusion of a cerebellar AVM: Pathogenetic hypothesis and review of literature

Cerebral arteriovenous malformation (AVM) is a complex network of vascular channels consisting of arterial feeders, a nidus and enlarged venous drainage. AVMs usually increase in size with time, but may rarely obliterate; spontaneous angiographic regression occurs in less than 1.5% of cerebral AVMs. Several causes of spontaneous regression have been postulated such us hemodynamic alterations due to hemorrhage, hypercoagulability, atherosclerosis, and tromboembolism from associated aneurysms. In this report we describe a case of spontaneous, complete and asymptomatic occlusion of a left cerebellar hemispheric AVM; angiograms clearly demonstrate a progressive decrease in size of the AVM at follow-up. Thrombosis of the dominant-draining vein caused by turbulent blood flow seemed to be the main driver. Possible mechanisms leading to the occlusion are discussed and a review of the literature is reported.

めまいが初発症状であった巨大小脳動静脈奇形例

We report a 21-year-old female who complained of dizziness with cerebellar arteriovenous malformation (AVM). At her first visit, she complained only of dizziness and did not show any other cranial nerve symptoms. She was therefore diagnosed with peripheral vertigo and started treatments. Two weeks after the first examination, she was examined by electronystagmograph (ENG) because her dizziness had not improved. The ENG result suggested that the dizziness was caused by a central lesion disorder and a MRI scan revealed a large AVM in the cerebellum and brainstem. Although AVM commonly shows cerebral hemorrhage or convulsion as the first symptom, we experienced a case of AVM with only mild symptoms of dizziness and headache.

Masson's tumour in the right parietal lobe after stereotactic radiosurgery for cerebellar AVM: Case report and review

We present a 50-year-old patient who had undergone stereotactic radiosurgery for a cerebellar vermian arteriovenous malformation. On routine surveillance MR imaging a lesion suggestive of a meningioma was demonstrated and removed. Histologically it was found to be intravascular papillary endothelial hyperplasia (Masson's tumour). The characteristic radiological and histological findings are presented. Aspects of management of this rare tumour are discussed. Given that cases are often found in combination with a vascular abnormality, we discuss the possibility of a change in local haemodynamics after radiosurgery promoting development of this tumour.

Postnatal growth and development of a cerebral arteriovenous malformation on serial magnetic resonance imaging in a child with hemangiomatosis

The authors report the case of a 3-week-old girl with two enhancing extraaxial masses in the posterior fossa, one in the left cerebellopontine angle (CPA) and the other to the right of the vein of Galen. Serial magnetic resonance images obtained in this patient at 3 months and then at 2.5 years of age documented regression of the enhancing mass in the left CPA and development of a cerebellar brain arteriovenous malformation (AVM) in the same CPA location. Also documented were regression of the pineal region mass and formation of the major draining vein of the AVM. The findings in this case support the theory that cerebral AVMs have early postnatal growth potential.

2-Hexyl Cyanoacrylate (Neuracryl M) Embolization of Cerebral Arteriovenous Malformations

Neuracryl M is a newly designed liquid embolic agent. In an attempt to verify the safety and efficacy of neuracryl M, we participated in the PROVASIS Trial, a pilot study using this agent in the preoperative treatment of cerebral arteriovenous malformations (AVMs). Because the trial was prematurely terminated by the sponsoring company because of financial considerations, we now present our data as a single center series. Between November 2002 and December 2003, six patients were enrolled in the PROVASIS trial at our institution, and four of these patients were randomized to treatment with neuracryl M. The patients were a 30-year-old man with a right frontal lobe AVM, a 20-year-old man with a right cerebellar AVM, a 26-year-old woman with a midline cerebellar AVM, and a 47-year-old man with a left parietotemporal lobe AVM. All patients underwent AVM embolization with neuracryl M, followed by definitive treatment, either open surgery or radiosurgery. In each case, there were no permanent complications, and blood loss was minimal. Follow-up imaging demonstrated either complete AVM obliteration (open surgery) or substantial diminution in AVM size (radiosurgery). Our data provide preliminary evidence supporting the thesis that neuracryl M is a safe and effective liquid embolic agent for the preoperative embolization of cerebral AVMs. Larger trials and continued experience using this novel liquid embolic agent are warranted.

未破裂脳動静脈奇形 小脳未破裂動静脈奇形の治療戦略

We report a retrospective analysis of 11 cases of non-ruptured cerebellar arteriovenous malformations (AVMs) among 294 cases of intracranial AVMs between 1981 and 2004. Eight of 11 cases were surgically treated. Seven patients had good outcomes (modified Rankin scale 0-2) and 1 patient was dead because of brainstem dysfunction after the removal of a giant cerebellar AVM. Surgical treatment is indicated for symptomatic cases, particularly for pediatric cases and cases associated with intracranial aneurysms because of the high bleeding rate and poor outcome after the hemorrhage. However, surgical treatment is contraindicated for arteriovenous malformations that extend to the cerebellar peduncle or brainstem, particularly for giant cerebellar AVM because of the high morbidity and mortality rates.

Cerebellar arteriovenous malformation and vertebral artery aneurysm in a CADASIL patient

The presence of large vessels malformations has not been reported in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). We describe a CADASIL patient in whom a brain cerebellar arteriovenous malformation was revealed by magnetic resonance (MR) imaging. An MR angiogram documented also an aneurysm along the right intracranial vertebral artery at the junction with the posterior-inferior cerebellar artery. The aneurysm was successfully treated by means of endovascular coil embolization. No neurological complication occurred in our patient during the angiographic procedure. In this case, in addition to an incidental coexistence of CADASIL and large vessels abnormalities, a causal role of the Notch pathway alteration could be hypothesized. Dysregulation of the Notch pathway is linked to several human diseases besides CADASIL. In one of these (the Alagille syndrome) intracranial aneurysms are reported. This hypothesis contrasts however with the absence of similar reports in other CADASIL cases and needs corroboration in large series.

Cerebellar arteriovenous malformation presenting with bilateral proptosis mimicking caroticocavernous fistula

A 21-year-old man presented with a 3-year history of bulging and redness of his right eye associated with double vision. He had a history of facial trauma 5 years previously. These symptoms, which had progressed over the year preceding the presentation, were accompanied by a bilateral pounding headache and gait unsteadiness with veering to the right. On examination, he had bilateral pulsating exophthalmos that was more marked on the right with a loudly audible orbital bruit. Mild soft tissue swelling of the right eyelid along with dilated veins in the right conjunctival fornices was observed. His visual acuity was 20/20 and there was no papilloedema. Eye movement examination showed restricted up-gaze, in conjunction with skew deviation, the right eye being hypertropic. Although impaired convergence was observed, there was no convergence retraction nystagmus. Right lateral rectus palsy and right sensorineural hearing loss were noted. Coordination testing revealed right finger to nose and heel to shin ataxia associated with a slightly wide based gait. The magnetic resonance images showed several findings of interest. There was a massive right cerebellar arteriovenous malformation, with a large tangle of vessels extending into the quadrigeminal plate and perimesencephalic cistern with mass effect on the right aspect of the midbrain (Figure 1). There was bilateral proptosis, significantly more pronounced on the right, with enlargement of the left lateral rectus muscle and bulging of the right cavernous sinus. Surprisingly, no significant enlargement of the right superior ophthalmic vein was noted (Figure 2). Cerebral angiography showed a massive right cerebellar arteriovenous malformation, fed by the bilateral posterior inferior cerebellar arteries, anterior inferior cerebellar arteries and superior cerebellar arteries, as well as direct branches from the basilar artery and right posterior cerebral artery. Superficial venous drainage was observed directly to the right transverse and sigmoid sinuses, as well as to the deep venous system, with an enlarged straight sinus, vein of Galen and internal cerebral veins. There was also retrograde forward-directed venous flow filling the right cavernous sinus and the inferior petrosal sinus. Emanating from the right cavernous sinus (Figure 3), there were two anterior directed veins: a smaller superior one, representing a cortical vein and a larger inferior vein, representing the right superior ophthalmic vein, which was only mildly dilated. The inferior ophthalmic vein was not visualized. No fistulous communication between the carotid artery and cavernous sinus was seen.

Coexistence of Mandibular Arteriovenous Malformation and Cerebellar Arteriovenous Malformation

We describe a patient with cerebellar and mandibular arteriovenous malformations who initially presented with oral haemorrhage and then subsequently had a cerebellar haemorrhage. This is the second reported case of cerebrofacial arteriovenous metameric syndrome type III (CAMS III) in the literature and we discuss the role of homeobox genes in craniofacial development and angiogenesis.

Vitreous Hemorrhage Due to Ruptured Cerebellar Arteriovenous Malformation

Vitreous Hemorrhage Due to Ruptured Cerebellar Arteriovenous Malformation