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J Neurol Surg A Cent Eur Neurosurg 2020; 81(02): 170-176
DOI: 10.1055/s-0039-1691820
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Posterior Fossa Arteriovenous Malformations: Experience with 14 Patients and a Systematic Review of the Literature

Marco V. Corniola
1   Department of Neurosurgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
,
Torstein R. Meling
1   Department of Neurosurgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
,
Philippe Bijlenga
1   Department of Neurosurgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
,
Gianmarco Bernava
2   Department of Neuroradiology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
,
Paolo Machi
2   Department of Neuroradiology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
,
Karl Schaller
1   Department of Neurosurgery, Hôpitaux Universitaires de Genève, Geneva, Switzerland
› Author Affiliations
Further Information

Publication History

16 December 2018

25 February 2019

Publication Date:
28 October 2019 (online)

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Abstract

Background The optimal management of posterior fossa arteriovenous malformations (pfAVMs) is a matter of debate. To advance this discussion, we present our clinical series and the results of a systematic literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines.

Methods Fourteen consecutive patients with pfAVMs were admitted between 2007 and 2018. Preoperative status, radiologic parameters, and outcome were assessed. A systematic literature review was performed according to the PRISMA-P guidelines.

Results Ten patients presented with rupture (71%), of whom three had associated aneurysms (AAs). The treatments were microsurgery (n = 4), endovascular (n = 3), radiosurgery (n = 2), a combination of two or three treatment modalities (n = 3), or conservative (n = 2). At discharge, all four patients (100%) with unruptured pfAVMs had a good outcome (modified Rankin Scale [mRS]: 0–2). In contrast, in ruptured pfAVM cases, mRS was 0 to 2 in four patients (40%), mRS 3 to 4 in two (20%), mRS 5 in three (30%), and one patient (10%) died within 30 days after gamma knife treatment due to pancreatitis secondary to chronic alcohol abuse. At discharge, four patients (29%) had persistent preinterventional cranial nerve and/or focal neurologic deficits. The literature review identified 63 articles with 1,753 pfAVM patients. Overall, 66% of pfAVMs presented with rupture, and AAs were found in 20% of the cases, which is higher than in supratentorial AVMs (stAVMs).

Conclusions Because pfAVMs are associated with higher rates of hemorrhagic presentation, higher rates of morbidity and mortality when ruptured, and have a higher incidence of AAs compared with stAVMs, early curative treatment is recommended as soon as the diagnosis is established, regardless of rupture status.

Keywords

posterior fossa - arteriovenous malformations - endovascular therapy - microsurgery - intracerebral hemorrhage - angioarchitecture

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.


 

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