Skip to main content

Advertisement

SpringerLink
Log in

Embolization of ruptured arteriovenous malformations in the cerebellopontine angle cistern

  • Original Article
  • Published:
Neurosurgical Review Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Anderson WS, Wang PP, Rigamonti D (2006) Case of microarteriovenous malformation-induced trigeminal neuralgia treated with radiosurgery. J Headache Pain 7:217–221

    Article  PubMed  PubMed Central  Google Scholar 

  2. Choudhri O, Heit JJ, Feroze AH, Chang SD, Dodd RL, Steinberg GK (2015) Persistent trigeminal artery supply to an intrinsic trigeminal nerve arteriovenous malformation: a rare cause of trigeminal neuralgia. J Clin Neurosci 22:409–412

    Article  PubMed  Google Scholar 

  3. Djulejic V, Marinkovic S, Milic V, Georgievski B, Rasic M, Aksic M, Puskas L (2015) Common features of the cerebral perforating arteries and their clinical significance. Acta Neurochir 157:1393

    Article  PubMed  Google Scholar 

  4. Edwards RJ, Clarke Y, Renowden SA, Coakham HB (2002) Trigeminal neuralgia caused by microarteriovenous malformations of the trigeminal nerve root entry zone: symptomatic relief following complete excision of the lesion with nerve root preservation. J Neurosurg 97:874–880

    Article  PubMed  Google Scholar 

  5. Elkordy A, Endo H, Sato K, Matsumoto Y, Kondo R, Niizuma K, Endo T, Fujimura M, Tominaga T (2016) Embolization of the choroidal artery in the treatment of cerebral arteriovenous malformations. J Neurosurg 6:1–9

    Google Scholar 

  6. Ferroli P, Acerbi F, Broggi M, Broggi G (2010) Arteriovenous micromalformation of the trigeminal root: intraoperative diagnosis with indocyanine green videoangiography: case report. Neurosurgery 67:onsE309–onsE310 discussion onsE10

    PubMed  Google Scholar 

  7. Hitotsumatsu T, Matsushima T, Inoue T (2003) Microvascular decompression for treatment of trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia: three surgical approach variations: technical note. Neurosurgery 53:1436–1441 discussion 42-3

    Article  PubMed  Google Scholar 

  8. Karibe H, Shirane R, Jokura H, Yoshimoto T (2004) Intrinsic arteriovenous malformation of the trigeminal nerve in a patient with trigeminal neuralgia: case report. Neurosurgery 55:1433

    Article  PubMed  Google Scholar 

  9. Kobayashi J, Ohara T, Minematsu K, Nagatsuka K, Toyoda K (2014) Etiological mechanisms of isolated pontine infarcts based on arterial territory involvement. J Neurol Sci 339:113–117

    Article  PubMed  Google Scholar 

  10. Krischek B, Yamaguchi S, Sure U, Benes L, Bien S, Bertalanffy H (2004) Arteriovenous malformation surrounding the trigeminal nerve--case report. Neurol Med Chir (Tokyo) 44:68–71

    Article  Google Scholar 

  11. Kumral E, Bayulkem G, Evyapan D (2002) Clinical spectrum of pontine infarction. Clinical-MRI correlations. J Neurol 249:1659–1670

    Article  PubMed  Google Scholar 

  12. Lasjaunias P, Berenstein A, Brugge K (2001) Surgical Neuroangiography, 2nd edn. Springer, Berlin, pp 680–682

    Google Scholar 

  13. Machet A, Aggour M, Estrade L, Chays A, Pierot L (2012) Trigeminal neuralgia related to arteriovenous malformation of the posterior fossa: three case reports and a review of the literature. J Neuroradiol 39:64–69

    Article  CAS  PubMed  Google Scholar 

  14. Maher CO, Atkinson JL, Lane JI (2003) Arteriovenous malformation in the trigeminal nerve. Case report J Neurosurg 98:908–912

    PubMed  Google Scholar 

  15. Marinkovic S, Gibo H, Nikodijevic I (1996) Trigeminocerebellar artery--anatomy and possible clinical significance. Neurol Med Chir (Tokyo) 36:215–219

    Article  CAS  Google Scholar 

  16. Marinkovic SV, Gibo H (1995) The blood supply of the trigeminal nerve root, with special reference to the trigeminocerebellar artery. Neurosurgery 37:309–317

    Article  CAS  PubMed  Google Scholar 

  17. Maruyama K, Koga T, Niranjan A, Kondziolka D, Flickinger JC, Lunsford LD (2013) Radiosurgery for brainstem arteriovenous malformation. Progress in neurological surgery 27:67–72

    Article  PubMed  Google Scholar 

  18. Nishino K, Hasegawa H, Morita K, Fukuda M, Ito Y, Fujii Y, Sato M (2016) Clinical characteristics of arteriovenous malformations in the cerebellopontine angle cistern. J Neurosurg:1–9

  19. Redekop G, TerBrugge K, Montanera W, Willinsky R (1998) Arterial aneurysms associated with cerebral arteriovenous malformations: classification, incidence, and risk of hemorrhage. J Neurosurg 89:539–546

    Article  CAS  PubMed  Google Scholar 

  20. Singh N, Bharatha A, O'Kelly C, Wallace MC, Goldstein W, Willinsky RA, Aviv RI, Symons SP (2010) Intrinsic arteriovenous malformation of the trigeminal nerve. Can J Neurol Sci 37:681–683

    Article  CAS  PubMed  Google Scholar 

  21. Stein KP, Wanke I, Schlamann M, Dammann P, Moldovan AS, Zhu Y, Sure U, Sandalcioglu IE (2014) Posterior fossa arterio-venous malformations: current multimodal treatment strategies and results. Neurosurg Rev 37:619–628

    Article  PubMed  Google Scholar 

  22. Sumioka S, Kondo A, Tanabe H, Yasuda S (2011) Intrinsic arteriovenous malformation embedded in the trigeminal nerve of a patient with trigeminal neuralgia. Neurol Med Chir (Tokyo) 51:639–641

    Article  Google Scholar 

  23. Westphal M, Grzyska U (2000) Clinical significance of pedicle aneurysms on feeding vessels, especially those located in infratentorial arteriovenous malformations. J Neurosurg 92:995–1001

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Mr. Hiroaki Abe, RPT, MSc, for the assessment of postoperative neurological status. We would also like to thank Enago for the English language review.

Author information

Authors and Affiliations

  1. Departments of Neurosurgery, Kohnan Hospital, 4-20-1 Nagamachi-minami, Taihaku-ku, Sendai, 982-8523, Japan

    Hidenori Endo, Shin-ichiro Osawa & Toshiki Endo

  2. Departments of Neuroendovascular therapy, Kohnan Hospital, Sendai, Miyagi, Japan

    Yasushi Matsumoto & Kenichi Sato

  3. Department of Neurosurgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan

    Kuniyasu Niizuma, Miki Fujimura & Teiji Tominaga

Authors
  1. Hidenori Endo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shin-ichiro Osawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yasushi Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Toshiki Endo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kenichi Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kuniyasu Niizuma
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Miki Fujimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Teiji Tominaga
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hidenori Endo.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Financial support and industry affiliations

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Endo, H., Osawa, Si., Matsumoto, Y. et al. Embolization of ruptured arteriovenous malformations in the cerebellopontine angle cistern. Neurosurg Rev 41, 173–182 (2018). https://doi.org/10.1007/s10143-017-0832-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10143-017-0832-1

Keywords

Search

Navigation