Surgical Treatment of Cerebellar Arteriovenous Malformations

Cerebellar arteriovenous malformations (AVMs) represent approximately 10% of all intracranial AVMs. Although less common, these lesions are associated with rates of hemorrhage, morbidity, and mortality higher than supratentorial AVMs. In this chapter, we evaluate the anatomical characteristics of the cerebellum and cerebellar AVMs and discuss the application of a new classification of cerebellar AVMs based on the microsurgical anatomy of this region. The smaller size of the cerebellum, the lack of perforating arteries and deep venous drainage system, and few eloquent areas when compared to the brain hemispheres are important characteristics to be considered for planning and treatment of cerebellar AVMs. Therefore, we propose an anatomical classification system for cerebellar AVMs based on size (< 2 cm: I; 2-4 cm: II; > 4 cm: III), location (superficial: A; deep: B; mixed: C), and extension to the dentate nucleus and superior cerebellar peduncles. The anatomical classification of cerebellar AVMs may be used for planning of microsurgical treatment of different types of AVMs in this region.