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
