The Clinical Features And Treatment Analysis Of Cerebellar Arteriovenous Malformation In Patients

Bcakground:Cerebellar Arteriovenous Malformation(AVM)accounts for 7-15%of Brain Arteriovenous Malformation.The current literatures mostly analyse it combined with brain stem,cerebellopontine angle AVM as postfossa AVM.The safety and efficacy of various treatment modalities in cerebellar AVM still needs further comparison.Objective:To identify the clinical features of cerebellar AVM,and the risk factors for bleeding and poor prognosis.To analysis the safety and effectiveness of each treatment method through comparison between different treatment methods.Methods:A total of 54 cases of cerebellar AVM were collected and their clinical characteristics and treatment outcomes were analyzed to compare the safety and effectiveness of different treatment methods.The mRS(modified Rankin Scale)score was used as a prognostic indicator,and the elimination rate of lesion was used for validity analysis.Results:Coma is a risk factor for poor prognosis(mRS>3 points).A total of 47 patients presented with hemorrhage.Age(P = 0.033),and AVM size(P = 0.022)were risk factors for bleeding.In case patients with ruptured AVM,hydrocephalus in CT or MRI indicates poor prognosis.Bilateral arterial blood supply(P<0.001),superior cerebellar arterial artery(P=0.038),and posterior inferior cerebellar artery(P=0.013)had significantly differences between the consist of cerebellar hemisphere and midline region lesion.In the treatment of AVM in the cerebellar hemisphere and cerebellum midline region,there was no significant difference in the embolization rate,postoperative complications,and prognosis of patients undergoing endovascular treatment.Cerebellar AVM with multiple arterial blood supply,compared with cerebellar AVM with single arterial blood supply,occur more in the midline region of cerebellum(P=0.029),and contain more proportion of superior cerebellar artery(P=0.024).The incidence of hemorrhage of AVM arise from superior cerebellar artery is higher than which arise from the posterior inferior cerebellar artery(P=0.002).Embolization rate of cerebellar AVM which has multiple arterial blood supply is significantly lower than which arise from single artery(P=0.033).And microsurgical resection evacuation rate is higher than endovascular treatment embolization rate of AVM which has single arterial blood supply(P=0.002).Postoperative complications and prognosis don't have any difference between microsurgical and endovascular treatment of AVM which has Spetzler-Martin Grade 2-3.But the microsurgical treatment has higher evacuation rate(P=0.004;P=0.003).When Spetzler-Martin is grade 4,the average embolization rate for endovascular treatment is 46.67%.Conclusions:Cerebellar arteriovenous malformation is easy to rupture.And the blood supply is complex,often accompanied by the occurrence of intracranial aneurysms.According to the Spetzler-Martin Grade,microsurgical resection should still be the first choice for patients of low grades because of its efficacy,and no significant difference in complications compared with endovascular treatment.When the AVM is located in the cerebellum midline region,Spetzler-Martin grade is high or there are multiple arterial blood supply,the surgical risk become larger,and the endovascular treatment is not effective.In this case,the preoperative embolization can be selected for hybrid surgical treatment,which can achieve good therapeutic effect while reducing the corresponding surgical risk.