Abstract
In this paper, the case of a large-high flow cerebellar AVM, which was totally removed in a two-stage operation, is reported. The patient, a thirteen-year-old girl complaining of headache, vomiting and unconsciousness, was admitted to our hospital in a coma and suffering from decerebrate rigidity.
Computerized tomography (CT) scans demonstrated a massive hematoma in the vermis and the forth ventricle. Posterior fossa craniectomy and removal of the hematoma were performed immediately. Then a V-P shunt was performed for hydrocephalus. The patient gradually improved. Cerebral angiography showed a large high-flow AVM occupying the whole left cerebellar hemisphere, which was fed by Lt AICA and Lt SCA. Bilat PCA and Rt SCA could not be found. The two-stage operation was designed to protect against normal perfusion pressure breakthrough. Total removal of the AVM was decided on. At first artifical embolization was undertaken, until normal circulation was seen. Then by reopening the previous suboccipital craniectomy the AVM was totally removed. Thus the left cerebellar hemisphere, including the deep cerebellar nuclei, was lost. Postoperative neurological positive findings were slightly Lt limb ataxia and trunchal ataxia, but she can walk alone and now is going to school again.
The surgical indication and operative technique for posterior fossa AVMs are discussed, and the literature on these subjects is reviewed in this paper
