Management of posterior fossa arteriovenous malformations.
BACKGROUND
Posterior fossa arteriovenous malformations (AVMs) are rare vascular lesions, representing 7-15% of all intracranial AVMs. Although less frequent than supratentorial AVMs, they present higher rupture, morbidity, and mortality rates. Microsurgery, radiosurgery, and endovascular neurosurgery are treatment options for obliteration of those lesions. In this paper, we present a critical review of the literature about the management of posterior fossa AVM.


METHODS
A MEDLINE-based search of articles published between January 1960 and January 2014 was performed. The search terms: "Posterior fossa arteriovenous malformation," "microsurgery," "radiosurgery," and "endovascular" were used to identify the articles.


RESULTS
Current data supports the role of microsurgery as the gold standard treatment for cerebellar AVMs. Brainstem AVMs are usually managed with radiotherapy and endovascular therapy; microsurgery is considered in cases of pial brainstem AVMs.


CONCLUSIONS
Succsseful treatment of posterior fossa AVMs depend on an integrated work of neurosurgeons, radiosurgeons, and endovascular neurosurgery. Although the development of radiosurgery and endovascular techniques is remarkable, microsurgery remains as the gold standard treatment for most of those lesions.
Department of Neurosurgery, Division of Cerebrovascular Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA.
Joao Paulo
JP
Almeida
Department of Neurosurgery, Division of Cerebrovascular Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA.
Roberto
R
Medina
Department of Neurosurgery, Division of Cerebrovascular Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland, USA.
Rafael J
RJ
Tamargo
Arteriovenous malformation; endovascular; management; microsurgery; posterior fossa; radiosurgery