gms | German Medical Science

Objective: To determine the clinical presentation, the multimodal interdisciplinary treatment strategies and outcome of posterior fossa arterio-venous malformations (AVM).

Method: Between 1998 and 2012, a total of 53 patients (mean age 43.8 years) with a posterior fossa AVM were treated either alone or in combination with endovascular, microsurgical and radiosurgical procedures (n=42). Eleven patients were treated conservatively. Clinical and radiological data was assessed and analyzed retrospectively. All patients were followed-up with a mean follow-up period of 19 months.

Results: 39 patients (73.5%) presented with intracranial haemorrhage and 14 patients (26.5%) with unspecific or without any symptoms. In 22 patients (56.5%) with haemorrhage, an intracerebellar haematoma was found, whereas 17 patients (43.5%) suffered from subarachnoid haemorrhage. AVMs were located in the cerebellum in 44 patients (85%), in the brainstem in 4 patients (7.5%) and the cerebello-pontine angle in another 4 individuals (7.5%). Among 42 treated patients, 12 patients (28.5%) were treated by embolization, 16 patients (38%) by surgical resection and 12 patients (28.5) by surgical resection with preoperative embolization. Two patients (5%) received radiotherapy. Complete AVM elimination was achieved in 81% of the treated leasons. Both, treatment related morbidity and mortality was 12% with an overall long-term morbidity and mortality of 26% and 15%, respectively.

Conclusions: A multi-modal treatment sequence nowadays represents the gold standard for posterior fossa AVMs. Patients are at high risk for morbidity and mortality, due to the impact of haemorrhage and treatment. Therefore, treatment has to be thoroughly indicated, especially for those patients without bleeding. The initial neurological condition seems to be crucial for the clinical outcome.