Introduction: Posterior fossa arteriovenous malformations (pAVM) are rare neurovascular lesions that have an increased risk of rupture in comparison to their supratentorial counterparts. They also tend to develop flow-related aneurysms along the course of their main arterial supply, imposing a further risk of bleeding. Most of these vascular lesions were observed in the territory of PICA while the involvement of AICA is extremely rare. Herein, we present an unusual case of a cerebellar AVM supplied by AICA with a proximal aneurysm on the same artery. This specific combination of vascular lesions was described only in four cases previously, with no clear consensus, among the previous studies, about best therapeutic interventions.
Methods: Data were collected through chart review and active patient encounter.
Results: A 59 year old female presented with a compromised level of consciousness following two days of a severe headache and vomiting. CT angiography revealed a ruptured AVM located on right
cerebellar hemisphere (14×20 mm), draining superficially to sigmoid and transverse sinuses (SpitzlerMartin grade II). The arterial supplier was AICA, with a proximal aneurysm (7×3mm). Endovascular intervention was decided for this patient. The aneurysm was coiled first, then 70 percent of AVM was obliterated in the same session. The remaining 30 percent was obliterated 6 months later. Subsequent angiography confirmed successful resolution of both lesions. The patient maintained uneventful course at three-month follow up.
Conclusions: The endovascular intervention adopted for this patient was less invasive with a good clinical outcome. In comparison, all previously reported cases with exactly similar lesions were managed surgically, with highly variable outcomes. Current literature suggests that lower cranial nerve palsies are common with similarly located lesions, either pre/post intervention. However, the index case maintained normal neurological examination throughout her course. A larger intervention-based study is warranted to clearly delineate the utility of endovascular interventions for such vascular lesions.
Patient Care: -enhance physician awareness about such atypical cerebrovascular lesions.
-open further area of research to determine the utility of endovascular VS. surgical approach for these specific vascular lesions.
Learning Objectives: by the conclusion of this session, participaants are expected to:
- be able to describe the unusual pattern/location of cerebrovascular lesion presented in the study.
-discuss the endovascular intervention used.
-discuss applied management approach in comparison to other approaches currently available in the literature.