Artikel
Cerebellar arteriovenous malformations: frequent association of hemorrhage with aneurysms on feeding vessels
Zerebelläre arteriovenöse Malformationen: gehäuftes Auftreten von Blutungen durch AVM-assoziierten Aneurysmen
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Veröffentlicht: | 8. Mai 2006 |
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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.