AVM of Cerebellum

Contributor:

Dr. Joseph Buwembo

Consultants:

Dr. Mark Bernstein
Dr. R Willinsky

Case 1

Age: 34

Sex: Male

History: March 20, 2001 - 3 weeks history of headaches and vomiting. Examination showed no localizing signs.

Questions:

• What is this lesion?

• Would you do stereotaxic biopsy?

• Would you watch it?

• Would you do an open biopsy?

Dr. Chris Ekong, Neurosurgeon, Toronto - April 5, 2001

Dear Mark and Bob

Dr. Joseph Buwembo has submitted for discussion this 34-year-old man with three weeks of headaches and vommiting. Examination showed no lateralizing signs. He has improved dramatically with VP shunt. The images are posted in the Medi-Fax Atlas. Your comments would be greatly appreciated.

Dr. Mark Bernstein, Neurosurgeon, Toronto - April 6, 2001

Its probably an anaplastic oligo[dendroglioma]. I would do a left frontal "lobectomy" for good tissue and decompression prior to chemo and/or rads. I would do this awake (the brain behaves beautifully awake even with this kind of shift) but awake is certainly not necessary. Say hi to Joe for me and keep me posted.

Cheers.

Dr. Robert Willinsky, Neuroradiologist, Regina - April 6, 2001

Dear Chris,

Interesting case. I feel that the lesion is a primary glial neoplasm but not necessarily a glioblastoma. The post contrast study may be "pseudo-enhancement" related to contrast evident in the DVA (developmental venous anomaly). To be complete, I did consider a giant demyelinating plaque and a venous infarct only to exclude them based on the distribution of this "butterfly" lesion. I would ignore the prominent arterial branch off the right anterior cerebral since I supect it is normal. I will leave the discussion regarding biopsy indications and techniques to Mark.

Note my change of email address.

Best regards,

Bob

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