title: Embolization of ruptured arteriovenous malformations in the cerebellopontine angle cistern.
abstract: Among brainstem arteriovenous malformations (AVMs), there exist small AVMs predominantly located in the cerebellopontine angle cistern (CPAC) with minimal extension into the pial surface of the brainstem. However, previous studies of CPAC AVMs did not particularly discuss the role of embolization in the treatment of these lesions. This study was conducted to clarify the effectiveness and validity of embolization in the treatment of CPAC AVMs. We retrospectively reviewed five patients with CPAC AVMs who underwent endovascular treatment. These patients were treated with embolization followed by open surgery or gamma knife (GK) radiosurgery. Radiological findings and clinical course for these patients were then assessed. All five patients presented with a hemorrhage. Angiography revealed that the main feeder contained a dilated pontine perforating artery in all cases. Embolization through the dilated pontine perforating artery effectively reduced shunt flow within the nidus or obliterated associated aneurysms. Magnetic resonance imaging showed infarction on the lateral pons in four patients, one of which developed transient mild dizziness and mild ataxia of the right side. Subsequent open surgery was performed in three patients, and GK radiosurgery was performed in two patients without complications. At the end of the follow-up period, all patients demonstrated favorable outcomes. Postoperative rebleeding did not occur in any of the patients. Disappearance of the AVM was confirmed in four patients, except in the one patient treated with GK. Although ischemic complications should be noted, embolization of CPAC AVMs may be an appropriate treatment option to reduce the risk of subsequent surgery or radiosurgery.
authors.affiliation: Departments of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachi-minami, Taihaku-ku, Sendai, 982-8523, Japan. hideendo@gmail.com.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Endo
authors.affiliation: Departments of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachi-minami, Taihaku-ku, Sendai, 982-8523, Japan.
authors.forename: Shin-Ichiro
authors.initials: SI
authors.lastname: Osawa
authors.affiliation: Departments of Neuroendovascular therapy, Kohnan Hospital, Sendai, Miyagi, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsumoto
authors.affiliation: Departments of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachi-minami, Taihaku-ku, Sendai, 982-8523, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Endo
authors.affiliation: Departments of Neuroendovascular therapy, Kohnan Hospital, Sendai, Miyagi, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sato
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Kuniyasu
authors.initials: K
authors.lastname: Niizuma
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Miki
authors.initials: M
authors.lastname: Fujimura
authors.affiliation: Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
authors.forename: Teiji
authors.initials: T
authors.lastname: Tominaga
mesh_terms: D000328:Adult; D000368:Aged; D002526:Cerebellar Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D002530:Cerebellopontine Angle; D004621:Embolization, Therapeutic; D057510:Endovascular Procedures; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000000981:diagnostic imaging / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D016896:Treatment Outcome
keywords: Arteriovenous malformation; Cerebellopontine angle; Embolization; Endovascular treatment; Hemorrhage