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Arteriovenous malformations of the posterior fossa
B George1, M Celis-Lopez, T Kato
1Department of Neurosurgery, Hôpital Lariboisière, Paris, France.
Abstract:
AVMs of the posterior fossa are reviewed on the basis of personal experience of 47 cases including 2 venous angiomas, 7 cavernous angiomas, 5 arteriovenous fistulas and 33 true arteriovenous malformations and of the few series reported in the literature. MRI is now an indispensable tool to define the exact localization of any malformation. Combined with angiography, it permits one to choose the most adequate therapeutic strategy and the best surgical approach. Radical cure is to be contemplated in most cases considering the often dramatic consequences of bleeding at the infratentorial level. Deep AVMs and moreover cavernous angiomas, even those located in highly functional structures such as the brain stem, can now be discussed for treatment. Encouraging results have already been obtained using, alone or in association, the recently advanced modalities of treatment: interventional neuroradiology, radiosurgery, and microsurgery.
Insights
Posterior fossa arteriovenous malformations (AVMs) require prompt treatment due to severe bleeding risks. Advanced imaging and multimodal therapies, including microsurgery, offer improved outcomes for these complex vascular lesions.
Area of Science:
- Neurology
- Neurosurgery
- Neuroradiology
Background:
- Posterior fossa arteriovenous malformations (AVMs) present significant management challenges.
- Hemorrhage from these lesions can have devastating neurological consequences.
Purpose of the Study:
- To review experience with posterior fossa AVMs.
- To evaluate the role of modern diagnostic and therapeutic modalities.
Main Methods:
- Review of 47 personal cases of posterior fossa AVMs (including venous angiomas, cavernous angiomas, arteriovenous fistulas, and true AVMs).
- Analysis of literature reports.
- Utilization of Magnetic Resonance Imaging (MRI) and angiography for diagnosis and treatment planning.
Main Results:
- MRI is crucial for precise localization of AVMs.
- Combined imaging facilitates optimal therapeutic strategy and surgical approach selection.
- Treatment of deep AVMs and cavernous angiomas, even in the brainstem, is now feasible.
Conclusions:
- Radical cure should be considered for most posterior fossa AVMs due to high bleeding risks.
- Interventional neuroradiology, radiosurgery, and microsurgery show encouraging results in treating these complex lesions.