Abstract：
OBJECTIVE: Posterior fossa arteriovenous malformations (AVMs) represent 7% to 15% of all intracranial AVMs and are associated with an increased risk of hemorrhage, morbidity, and mortality compared with supratentorial AVMs, thus prompting urgent and definitive treatment. Cerebellopontine angle (CPA) AVMs are a unique group of posterior fossa AVMs incorporating characteristics of brainstem and cerebellar lesions, which are particularly amenable to microsurgical resection. This study reports the clinical, radiological, operative, and outcome features of patients with CPA AVMs in a large cohort.
METHODS: The authors conducted a single-surgeon, 2-institution retrospective cohort study of all consecutive patients with CPA AVMs treated with microsurgical resection during a 25-year period.
RESULTS: CPA AVMs represented 22% (38 of 176) of all infratentorial AVMs resected by the senior author. Overall, 38 patients (22 [58%] male and 16 [42%] female) met the study inclusion criteria and were analyzed. Most patients presented with hemorrhage (n = 29, 76%). The median age at surgery was 56 (range 6-82) years. Subtypes included 22 (58%) petrosal cerebellar AVMs, 11 (29%) lateral pontine AVMs, and 5 (13%) AVMs involving both the brainstem and cerebellum. Most AVM niduses were small (< 3 cm; n = 35, 92%) and compact (n = 31, 82%). Fourteen (37%) patients harbored flow-related aneurysms. Twenty (53%) patients underwent preoperative embolization. Complete angiographic obliteration was achieved with microsurgery in 35 (92%) patients. Five (13%) patients with poor neurological conditions at presentation died before hospital discharge. Of the 7 (18%) patients with new postoperative neurological deficits, 5 had transient deficits. The median (interquartile range) follow-up was 1.7 (0.5-3.2) years; 32 (84%) patients were alive at last follow-up, and 30 (79%) had achieved a favorable neurological outcome (modified Rankin Scale [mRS] score 0-2). The only independent predictor of unfavorable postoperative outcome (mRS score 3-6) was the preoperative mRS score (p = 0.002).
CONCLUSIONS: CPA AVMs are unique posterior fossa lesions, including petrosal cerebellar and lateral pontine AVMs. The \"backdoor resection\" technique provides a safe and efficient strategy with high obliteration rates and a low risk of treatment-related morbidity. Microsurgical resection should be considered the frontline treatment for most CPA AVMs, except for those with a significant diffuse brainstem component.
METHODS: The authors conducted a single-surgeon, 2-institution retrospective cohort study of all consecutive patients with CPA AVMs treated with microsurgical resection during a 25-year period.
RESULTS: CPA AVMs represented 22% (38 of 176) of all infratentorial AVMs resected by the senior author. Overall, 38 patients (22 [58%] male and 16 [42%] female) met the study inclusion criteria and were analyzed. Most patients presented with hemorrhage (n = 29, 76%). The median age at surgery was 56 (range 6-82) years. Subtypes included 22 (58%) petrosal cerebellar AVMs, 11 (29%) lateral pontine AVMs, and 5 (13%) AVMs involving both the brainstem and cerebellum. Most AVM niduses were small (< 3 cm; n = 35, 92%) and compact (n = 31, 82%). Fourteen (37%) patients harbored flow-related aneurysms. Twenty (53%) patients underwent preoperative embolization. Complete angiographic obliteration was achieved with microsurgery in 35 (92%) patients. Five (13%) patients with poor neurological conditions at presentation died before hospital discharge. Of the 7 (18%) patients with new postoperative neurological deficits, 5 had transient deficits. The median (interquartile range) follow-up was 1.7 (0.5-3.2) years; 32 (84%) patients were alive at last follow-up, and 30 (79%) had achieved a favorable neurological outcome (modified Rankin Scale [mRS] score 0-2). The only independent predictor of unfavorable postoperative outcome (mRS score 3-6) was the preoperative mRS score (p = 0.002).
CONCLUSIONS: CPA AVMs are unique posterior fossa lesions, including petrosal cerebellar and lateral pontine AVMs. The \"backdoor resection\" technique provides a safe and efficient strategy with high obliteration rates and a low risk of treatment-related morbidity. Microsurgical resection should be considered the frontline treatment for most CPA AVMs, except for those with a significant diffuse brainstem component.
摘要：
目的：后颅窝动静脉畸形（AVM）占所有颅内AVM的7％至15％，并与出血风险增加相关，发病率，和死亡率与幕上AVM相比，从而促使紧急和确定的治疗。桥小脑角（CPA）AVM是一组独特的后颅窝AVM，具有脑干和小脑病变的特征，特别适合显微外科手术切除。这项研究报告了临床，放射学,Operative,以及大型队列中CPAAVM患者的结局特征。
方法：作者进行了一个单外科医生，在25年的时间内，对所有连续接受显微外科手术切除的CPAAVM患者进行了2机构回顾性队列研究。
结果：CPAAVM占高级作者切除的所有幕下AVM的22％（176个中的38个）。总的来说,38名患者(22[58%]男性和16[42%]女性)符合研究纳入标准并进行分析。大多数患者出现出血（n=29，76％）。手术年龄中位数为56岁（6-82岁）。亚型包括22（58％）岩脑小脑AVM，11(29%)侧脑桥AVM，和5（13％）涉及脑干和小脑的AVM。大多数AVM凹陷小（<3cm；n=35，92％）和紧凑（n=31，82％）。14例（37％）患者存在与流量相关的动脉瘤。20例（53%）患者接受术前栓塞治疗。35例（92％）患者通过显微外科手术实现了完全的血管造影闭塞。5名（13％）神经系统状况较差的患者在出院前死亡。在7例（18％）术后新出现神经功能缺损的患者中，5有短暂的赤字。中位（四分位距）随访为1.7（0.5-3.2）年；32（84％）患者在最后一次随访时存活，和30（79％）取得了良好的神经系统结局（改良的Rankin量表[mRS]评分0-2）。术后不良结局的唯一独立预测因素（mRS评分3-6）是术前mRS评分（p=0.002）。
结论：CPAAVM是独特的后颅窝病变，包括岩脑小脑和桥脑外侧AVM。“后门切除术”技术提供了一种安全有效的策略，具有高的闭塞率和低的治疗相关发病率风险。显微手术切除应被视为大多数CPAAVM的一线治疗。除了那些有明显弥漫性脑干成分的人。
方法：作者进行了一个单外科医生，在25年的时间内，对所有连续接受显微外科手术切除的CPAAVM患者进行了2机构回顾性队列研究。
结果：CPAAVM占高级作者切除的所有幕下AVM的22％（176个中的38个）。总的来说,38名患者(22[58%]男性和16[42%]女性)符合研究纳入标准并进行分析。大多数患者出现出血（n=29，76％）。手术年龄中位数为56岁（6-82岁）。亚型包括22（58％）岩脑小脑AVM，11(29%)侧脑桥AVM，和5（13％）涉及脑干和小脑的AVM。大多数AVM凹陷小（<3cm；n=35，92％）和紧凑（n=31，82％）。14例（37％）患者存在与流量相关的动脉瘤。20例（53%）患者接受术前栓塞治疗。35例（92％）患者通过显微外科手术实现了完全的血管造影闭塞。5名（13％）神经系统状况较差的患者在出院前死亡。在7例（18％）术后新出现神经功能缺损的患者中，5有短暂的赤字。中位（四分位距）随访为1.7（0.5-3.2）年；32（84％）患者在最后一次随访时存活，和30（79％）取得了良好的神经系统结局（改良的Rankin量表[mRS]评分0-2）。术后不良结局的唯一独立预测因素（mRS评分3-6）是术前mRS评分（p=0.002）。
结论：CPAAVM是独特的后颅窝病变，包括岩脑小脑和桥脑外侧AVM。“后门切除术”技术提供了一种安全有效的策略，具有高的闭塞率和低的治疗相关发病率风险。显微手术切除应被视为大多数CPAAVM的一线治疗。除了那些有明显弥漫性脑干成分的人。
