Arteriovenous Malformations of the Posterior Cranial Fossa: Endovascular Treatment

E.Yu. Buharin, S.B. Yakovlev, A.V. Bocharov, S.R. Arustamyan, S.B. Buklina

Burdenko Research Institute of Neurosurgery, Moscow, Russia

 

The study goal has been to optimize tactics of surgical treatment of such pathology as arteriovenous malformations (AVM) of the posterior cranial fossa by using an endovascular method.

Material and Methods. Endovascular embolization was performed in 53 cases with AVM of the posterior cranial fossa. Their age varied from 7 months up to 54 years. The disease manifested itself in spontaneous intracranial hemorrhage in 38 cases (72%). The rest cases had different focal neurological symptoms or hypertensive-hydrocephalic syndrome. Small, median, big and extended AVMs were revealed in 38.3%, 32% and 29.7% of cases, respectively.

Results. Total, subtotal and partial exclusion of AVM was achieved in 17 (32%), 15 (28%) and 21 (40%) of cases, respectively. Intraoperative complications developed in 4 cases; they were clinically significant in 2 of them. Marked augmentation or appearance of new neurological deficit were watched on the 1st-3rd postoperative day in 8 patients. The rest cases were characterized by transitory changes. There was 1 fatal outcome (1.8%). Liquor-shunting operations were made in 8 cases due to hydrocephalus augmentation. Long-term follow-up (4 months Ė 5 years) was carried out in 16 cases. Stabilization of clinical manifestations or partial regression of symptoms were observed in the majority of cases.

Conclusion. AVM of the posterior cranial fossa is cerebrovascular pathology with a high risk of hemorrhagic complications. An absolute indication for endovascular treatment is intracranial hemorrhage in a patientís history. Partial embolization is not a method of preventing repeated hemorrhage. However, it leads to stabilization of a patientís state and provides conditions for radiosurgery of AVM, which cannot be operated radically.