Surgical management of posterior fossa arteriovenous malformations.

Abstract:

OBJECTIVE:Arteriovenous malformations (AVMs) involving the cerebellum and brainstem are relatively rare lesions that most often present clinically as a result of a hemorrhagic episode. Although these AVMs were once thought to have a more aggressive clinical course in comparison with supratentorial AVMs, recent autopsy data suggests that there may be little difference in hemorrhage rates between the two locations. Although current management of these lesions often involves preoperative embolization and stereotactic radiosurgery, surgical resection remains the treatment of choice, conferring immediate protection to the patient from the risk of future hemorrhage. METHODS:Most symptomatic AVMs that involve the cerebellum and the pial or ependymal surfaces of the brainstem are candidates for surgical resection. Preoperative angiography and magnetic resonance imaging studies are critical to determine suitability for resection and choice of operative exposure. In addition to considering the location of the nidus, arterial supply, and predominant venous drainage, the surgical approach must also be selected with consideration of the small confines of the posterior fossa and eloquence of the brainstem, cranial nerves, and deep cerebellar nuclei. RESULTS:Since the 1980s, progressive advances in preoperative embolization, frameless stereotaxy, and intraoperative electrophysiologic monitoring have significantly improved the number of posterior fossa AVMs amenable to microsurgical resection with minimal morbidity and mortality. CONCLUSION:Future improvements in endovascular technology and stereotactic radiosurgery will likely continue to increase the number of posterior fossa AVMs that can safely be removed and further improve the clinical outcomes associated with microsurgical resection.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Sinclair J,Kelly ME,Steinberg GK

doi

10.1227/01.NEU.0000204641.38419.2D

subject

Has Abstract

pub_date

2006-04-01 00:00:00

pages

ONS-189-201; discussion ONS-201

issue

4 Suppl 2

eissn

0148-396X

issn

1524-4040

pii

00006123-200604002-00001

journal_volume

58

pub_type

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