Posterior fossa arteriovenous malformations: Case report

Abstract

The posterior fossa arteriovenous malformation (AVM) is uncommon and different from other intracranial AVM in its natural history, diagnosis, treatment, prognosis, and other features. The authors present the case a 19 years old woman admitted for comatose state, GCS=6 points, left hemiparesis, flexion of right limbs on noxious stimuli, mydriasis with bilaterally preservation of oculomotor reflex and acute respiratory failure. Cerebral CT scan showed an intraparenchymal hematoma, located into the posterior cranial fossa, within the vermin, measuring 2.8/3.2 cm, with important surrounding edema, intraventricular bleeding within the third and fourth ventricle, massive infratentorial subarachnoid hemorrhage and acute hydrocephalus. Cerebral four vessels angiography showed an infratentorial AVM (arteriovenous malformation), located within the right cerebellar hemisphere, with a nidus, measuring around 3 cm maximal diameter, in the craniocaudal direction. The AVM had arterial feeders coming from the right posterior cerebral artery and superior cerebellar artery and venous drainage into the Galen vein, Herophil torculla, and right lateral sinus. We conclude the diagnosis of right ruptured cerebellar hemisphere AVM, grade Martin-Spetzler III, Hunt and Hess 5 and the choice treatment was open surgery. Authors insist on neurosurgical strategy for treatment which in our case conducted to excellent results.