Posterior Fossa Arteriovenous Malformations: Endovascular Management Challenges

Background: Posterior fossa arteriovenous malformations (AVMs) are complex neurovascular lesions, relatively infrequent and difficultly is encountered not uncommonly during their treatment. Although they represent less than 15% of all AVMs, studies showed that they have more aggressive natural history. The authors present their initial experience with multimodality management of 20 posterior fossa AVMs, with an emphasis on endovascular treatment in Egypt. Method(s): From January 2012 to august 2015; twenty patients with posterior fossa AVMs treated with endovascular techniques, radiosurgery and/or surgery were analyzed. Result(s): Out of the twenty cases; 15 cases were treated with onyx embolisation through 27 sessions, one case with glue NBCA. Out of these cases 3 were embolised over 90%, the rest of cases were partially embolised and referred for complementary treatment with surgery or gama knife. The most frequent difficulties encountered during endovascular treatment were catheter navigation in the tortuousity of SCA (2 territories), AICA (2 territories), PICA (1 territory). Identification of onyx flow to the vein in the working angle (3 cases), extravasation of onyx (2 cases). The average occlusion rate of the AVM embolised after an average 1.8 (range 1-7) procedure per case was 52.66%. The average size of AVM embolised was 2.6 cm in maximum diameter. 4 cases (20%) complicated by cerebellar tremors and ataxia 2 of them were transitory and 2 were permanent, one case died from pulmonary embolism. Pod2 and two cases with hemihypothesia, one was permanent. Conclusion(s): Considering our early experience, onyx embolisation to posterior fossa AVMs is feasible and can lead considerable obliteration rate when the AVM has single feeder, although the consideration of deep supply to the cerebellar nuclei and brain stem perforators is of utmost importance to diminish the possible untowarded consequences.

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Artikel online veröffentlicht:
11. Mai 2021