Anatomic and angiographic findings of cerebellar arteriovenous malformations: Report of a single center experience

Cerebellar arteriovenous malformations (AVM) are rare and comprise only 5-10% of cerebral AVM. The concentration of eloquent neurological systems and the high rate of bleeding presentation of AVMs particularly in this location complicate the management of such lesions. New therapeutic options, especially in endovascular neurosurgery, have fundamentally modified the strategy and, also, the outcome of cerebellar AVMs. Between 1995 and 2013, demographic, clinical and angiographic data of cerebral AVMs have been prospectively collected. We analyzed data of patients treated for a cerebellar AVM, focusing on the angiographic anatomy. Fifty-nine patients (mean age : 35 years, male to female ratio : 2) were consecutively treated for a cerebellar AVM. 81.4% of them presented bleeding at admission. 20 AVMs (33.9%) were in eloquent areas. The Spetzler-Martin grade was I or II in 36 cases (51%). An associated aneurysm was noted in more than 40% of cases and a venous drainage anomaly in 70%. The vast majority of cases of this series presented an anatomical risk factor of bleeding. Patients with cerebellar AVMs presented with bleeding more often than patients with supratentorial AVMs, justifying an aggressive management. The analysis of angio-architecture highlighted the high rate of associated aneurysm and/or venous drainage anomalies that could explain the tendency to bleed of such lesion.