Cerebellar arteriovenous malformation: with hemorrhage

There is small volume crescentic acute haemorrhage in the posterior lateralposterolateral aspect of the left cerebellar hemisphere with minor hypoattenuating halo. OherOther acute blood extends to the undersurface of the tentorium. There is minimal localised mass-effect. There is no hyperdensity in the adjacent transverse and the sigmoid sinuses.

At the medial and the medial superior aspect of the left cerebellar haematoma, there is a compact niche of vessels measuring 13 mm transverse x 13 mm craniocaudal x 9 mm AP in keeping with a pial arteriovenous malformation. The main arterial feeders are via distal branches of the left superior cerebellar artery with contribution from distal branches of the left PICA. The main venous outflow is through cortical veins draining into the medial aspect of the left transverse sinus and and the torcula herophili. 

There is no aneurysm or severe steno-occlusive lesion in the major intracranial arteries. There is adequate contrast opacification of the major dural venous sinuses and the deep cerebral venous system.

Spontaneous cerebellar haemorrhage in a young patient should prompt imaging to assess for underlying AVM or DAVF.  CTACTA points to the abnormality, catheter angiography characterises the nature of the arteriovenous shunting, differentiates DAVF from AVM, rules out associated flow aneurysms, and indicates whether endovascular intervention is possible.  In

In this case the position of the nidus and relation to veins contribute to moderate surgical difficulty, and the access arteries favoured microcatheter navigation with good arterial, nidal and local vein obliteration.  CloseClose follow up will be required to excludedexclude recurrence.