gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Cerebellar arteriovenous malformations: frequent association of hemorrhage with aneurysms on feeding vessels

Zerebelläre arteriovenöse Malformationen: gehäuftes Auftreten von Blutungen durch AVM-assoziierten Aneurysmen

Meeting Abstract

  • corresponding author N.O. Schmidt - Klinik und Poliklink für Neurochirurgie, Universitätsklinikum HH-Eppendorf, Hamburg
  • J. Regelsberger - Klinik und Poliklink für Neurochirurgie, Universitätsklinikum HH-Eppendorf, Hamburg
  • T. Martens - Klinik und Poliklink für Neurochirurgie, Universitätsklinikum HH-Eppendorf, Hamburg
  • U. Grzyska - Abteilung für Neuroradiologie, Universitätsklinikum HH-Eppendorf, Hamburg
  • M. Westphal - Klinik und Poliklink für Neurochirurgie, Universitätsklinikum HH-Eppendorf, Hamburg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 09.144

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Schmidt et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: It has been reported that infratentorial arteriovenous malformations (AVMs) appear to occur more frequently in conjunction with feeding vessel pedicle aneurysms and therefore are associated with a higher morbidity than supratentorial AVMs. The goal of this study was to analyze our experience in the treatment of this special subgroup of patients with cerebellar AVMs.

Methods: From our single institution AVM databank (overall number of patients n=424) a cohort of 41 patients with cerebellar AVMs managed between 1990 and 2005 were retrospectively analyzed with regard to clinical presentation, treatment regimens and outcome.

Results: Patient age ranged from 11 to 62 years with an average of 41 years. According to the Spetzler-Martin AVM grading 9 AVMs belonged to grade I, 13 to grade II, 12 to grade III, 6 to grade IV and 1 to grade V. Hemorrhage was the presenting symptom in 68% (n=28); 17% (n=7) presented with a neurological deficit and only 1 patient was asymptomatic. 32% (n=13) of the AVMs were associated with aneurysms. In this subgroup of AVMs the cause of bleeding was related to the aneurysms in 46% (n=6). Treatment regimen consisted in most cases (71%, n=29) of preoperative embolization followed by immediate surgical removal. 20% (n=8) of the patients were operated only and in 5% (n=2) treatment was performed by palliative embolisation of the AVM. No treatment option was recommended in two cases. Overall treatment associated permanent morbidity was 5% (n=2) and mortality 2,6% (n=1).

Conclusions: Our analysis underlines the frequent association of infratentorial AVMs with hemorrhage most likely due to frequent associated aneurysms. Therefore an aggressive therapeutic management is mandatory where we prefer a combined approach of endovascular embolization followed by immediate neurosurgical resection in one anesthesia. This technique enables to completely remove an AVM with minor morbidity or mortality in most cases.