Elsa Magro1,2, Tim E Darsaut3, Elyse Denise Okome Mezui1, Michel W Bojanowski4, Daniela Ziegler5, Jean-Christophe Gentric6,7, Daniel Roy8, Jean Raymond9. 1. Department of Neurosurgery, University Hospital of Brest, Brest, France. 2. LaTIM, INSERM UMR 1101, Brest, France. 3. Department of Surgery, Division of Neurosurgery, University of Alberta Hospital, Mackenzie Health Sciences Center, Edmonton, Alberta, Canada. 4. Department of Surgery, Service of Neurosurgery, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada. 5. Direction de l'Enseignement et de l'Académie CHUM/Bibliothèque, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada. 6. Department of Radiology, Service of Interventional Neuroradiology, University Hospital of Brest, Brest, France. 7. GETBO, EA 3878, Brest, France. 8. Department of Radiology, Service of Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), room D03.5462b, Montreal, Quebec, H2X 0C1, Canada. 9. Department of Radiology, Service of Neuroradiology, Centre Hospitalier de l'Université de Montréal (CHUM), room D03.5462b, Montreal, Quebec, H2X 0C1, Canada. jean.raymond@umontreal.ca.
Abstract
BACKGROUND: Posterior fossa arteriovenous malformations (pfAVMs) can be challenging lesions to manage. AVMs in this location may have distinct features compared with supratentorial AVMs. Our aim was to systematically review the literature on the presenting characteristics of pfAVMs and compare clinical and angiographic outcomes after the various types of treatment employed. METHODS: The review was conducted according to the Cochrane Collaboration guidelines. Electronic databases from 1900 to March 2018 were searched and complemented by hand-searching and cross-referencing. Articles were categorized into (i) AVM studies that included those in the posterior fossa, (ii) those that focused exclusively on pfAVM, and (iii) those that further specified a cerebellar or brainstem location of the AVM. RESULTS: Seventy-seven articles with 4512 pfAVM patients were retained for analyses. Compared with historical supratentorial controls, pfAVMs were reported to more frequently present with rupture, to more commonly have associated arterial aneurysms, and to more frequently lead to poor clinical and angiographic outcomes. The quality of the literature and lack of standardization of outcome reporting precluded performing a meta-analysis on the results of the various different treatment modalities. CONCLUSIONS: Posterior fossa AVMs may have some distinct features compared with supratentorial AVMs. The available reports on pfAVMs are not sufficiently standardized to provide reliable guidance for patient management decisions. This goal will require future studies to be multicentric and to focus on standardized, repeatable clinical and angiographic outcomes.
BACKGROUND: Posterior fossa arteriovenous malformations (pfAVMs) can be challenging lesions to manage. AVMs in this location may have distinct features compared with supratentorial AVMs. Our aim was to systematically review the literature on the presenting characteristics of pfAVMs and compare clinical and angiographic outcomes after the various types of treatment employed. METHODS: The review was conducted according to the Cochrane Collaboration guidelines. Electronic databases from 1900 to March 2018 were searched and complemented by hand-searching and cross-referencing. Articles were categorized into (i) AVM studies that included those in the posterior fossa, (ii) those that focused exclusively on pfAVM, and (iii) those that further specified a cerebellar or brainstem location of the AVM. RESULTS: Seventy-seven articles with 4512 pfAVM patients were retained for analyses. Compared with historical supratentorial controls, pfAVMs were reported to more frequently present with rupture, to more commonly have associated arterial aneurysms, and to more frequently lead to poor clinical and angiographic outcomes. The quality of the literature and lack of standardization of outcome reporting precluded performing a meta-analysis on the results of the various different treatment modalities. CONCLUSIONS: Posterior fossa AVMs may have some distinct features compared with supratentorial AVMs. The available reports on pfAVMs are not sufficiently standardized to provide reliable guidance for patient management decisions. This goal will require future studies to be multicentric and to focus on standardized, repeatable clinical and angiographic outcomes.
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