Mpotsaris A, Loehr C, Harati A, Lohmann F, Puchner M, Weber W
Klinik für Radiologie, Neuroradiologie und interventionelle Therapie, Recklinghausen, Germany.
Interv Neuroradiol. 2010 Dec;16(4):400-8. doi: 10.1177/159101991001600406. Epub 2010 Dec 17.
Posterior fossa arteriovenous malformations are rare entities and treatment modalities technically challenging. In recent years new therapeutic options have emerged through microsurgical and endovascular means. Based on a series of six cases we describe combined interdisciplinary treatment strategies and report the outcome in a midterm follow-up interval of 12 months. Clinical case data were collected during acute phase and follow-up including standardized angiographic control intervals during follow-up and assessment of the outcome. Treatment options included endovascular techniques as well as microsurgical techniques. All reported cases had SAH based on ruptured flow-related aneurysms in posterior fossa AVM; three out of six had multiple aneurysms. In one case we observed a de novo formation of two flow-associated distal aneurysms in an interval of ten years. Two patients were treated only endovascularly, one patient only surgically and three patients with combined methods. Five out of six patients had a good outcome (GOS 4 or 5). One died in the acute phase. Infratentorial AVMs are rare but characterized by a high risk of rupture and SAH, especially in conjunction with flow related aneurysms, which are predictors of poor outcome. The anatomic conditions of the posterior fossa may lead quickly to life-threatening complications due to mass effects. The present study indicates that treatment strategies in the acute phase should focus on flow-related aneurysms, followed by an elective AVM embolization and ectomy whenever possible. An experienced interdisciplinary team and the combination of techniques contribute to a reduction of complications and to a better outcome.
后颅窝动静脉畸形较为罕见，其治疗方式在技术上具有挑战性。近年来，通过显微外科和血管内治疗手段出现了新的治疗选择。基于一系列6例病例，我们描述了联合多学科治疗策略，并报告了12个月中期随访的结果。在急性期和随访期间收集临床病例数据，包括随访期间标准化血管造影控制间隔和结果评估。治疗选择包括血管内技术以及显微外科技术。所有报告病例均因后颅窝动静脉畸形破裂的血流相关动脉瘤导致蛛网膜下腔出血；6例中有3例有多个动脉瘤。在1例病例中，我们观察到在10年的间隔内出现了2个新的血流相关远端动脉瘤。2例患者仅接受血管内治疗，1例仅接受手术治疗，3例采用联合方法治疗。6例患者中有5例预后良好（格拉斯哥预后评分4或5分）。1例在急性期死亡。幕下动静脉畸形罕见，但破裂和蛛网膜下腔出血风险高，尤其是与血流相关动脉瘤相关时，后者是预后不良的预测因素。后颅窝的解剖条件可能因占位效应迅速导致危及生命的并发症。本研究表明，急性期的治疗策略应侧重于血流相关动脉瘤，随后尽可能进行择期动静脉畸形栓塞和切除术。经验丰富的多学科团队和技术组合有助于减少并发症并获得更好的预后。
