Single-session Curative Embolization of Unruptured Cerebellar Arteriovenous Malformation with Precipitating Hydrophobic Injectable Liquid

Abstract

Microsurgery is the treatment of choice for cerebellar arteriovenous malformations (AVMs). Nevertheless, endovascular therapy aims to be an effective treatment since the introduction of new embolic agents. Cerebellar AVMs represent a subgroup of vascular lesions with a high rate of hemorrhagic presentation compared with their cerebral counterpart. Moreover, they have a higher incidence of flow-related aneurysms when diagnosed. With this in mind, prompt treatment must be performed to avoid rebleeding with devastating consequences. Herein, we present the case of an unruptured cerebellar AVM treated with precipitating hydrophobic injectable liquid (PHIL) with complete obliteration.

Keywords

cerebellar arteriovenous malformation - precipitating hydrophobic injectable liquid embolization

• References

• 1 Almeida JP, Medina R, Tamargo RJ. Management of posterior fossa arteriovenous malformations. Surg Neurol Int 2015; 6: 31
• 2 Arnaout OM, Gross BA, Eddleman CS, Bendok BR, Getch CC, Batjer HH. Posterior fossa arteriovenous malformations. Neurosurg Focus 2009; 26 (05) E12
• 3 Torné R, Rodríguez-Hernández A, Arikan F. et al. Posterior fossa arteriovenous malformations: Significance of higher incidence of bleeding and hydrocephalus. Clin Neurol Neurosurg 2015; 134: 37-43
• 4 Lai LF, Chen JX, Zheng K. et al. Posterior fossa brain arteriovenous malformations: Clinical features and outcomes of endovascular embolization, adjuvant microsurgery and radiosurgery. Clin Neuroradiol 2018; 28 (01) 17-24
• 5 Dinc N, Platz J, Tritt S. et al. Posterior fossa AVMs: increased risk of bleeding and worse outcome compared to supratentorial AVMs. J Clin Neurosci 2018; 53: 171-176
• 6 Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg 1986; 65 (04) 476-483
• 7 Rodríguez-Hernández A, Kim H, Pourmohamad T, Young WL, Lawton MT. University of California, San Francisco Arteriovenous Malformation Study Project. Cerebellar arteriovenous malformations: anatomic subtypes, surgical results, and increased predictive accuracy of the supplementary grading system. Neurosurgery 2012; 71 (06) 1111-1124
• 8 Dumont TM, Kan P, Snyder KV, Hopkins LN, Siddiqui AH, Levy EI. A proposed grading system for endovascular treatment of cerebral arteriovenous malformations: Buffalo score. Surg Neurol Int 2015; 6 (01) 3
• 9 Vollherbst DF, Sommer CM, Ulfert C, Pfaff J, Bendszus M, Möhlenbruch MA. Liquid embolic agents for endovascular embolization: evaluation of an established (Onyx) and a novel (PHIL) embolic agent in an in vitro AVM model. Am J Neuroradiol 2017; 38 (07) 1377-1382
• 10 Vollherbst DF, Otto R, von Deimling A. et al. Evaluation of a novel liquid embolic agent (precipitating hydrophobic injectable liquid (PHIL)) in an animal endovascular embolization model. J Neurointerv Surg 2018; 10 (03) 268-274
• 11 Cagnazzo F, Brinjikji W, Lanzino G. Arterial aneurysms associated with arteriovenous malformations of the brain: classification, incidence, risk of hemorrhage, and treatment-a systematic review. Acta Neurochir (Wien) 2016; 158 (11) 2095-2104
• 12 Redekop G, TerBrugge K, Montanera W, Willinsky R. Arterial aneurysms associated with cerebral arteriovenous malformations: classification, incidence, and risk of hemorrhage. J Neurosurg 1998; 89 (04) 539-546
• 13 Diren F, Sencer S, Hakan T. Case report of an obstructive hydrocephalus caused by an unruptured mesencephalic arteriovenous malformation in a boy and a review of literature. Open Neuroimaging J 2018; 12: 10-15
• 14 Robert T, Blanc R, Ciccio G. et al. Endovascular treatment of posterior fossa arteriovenous malformations. J Clin Neurosci 2016; 25: 65-68