Hydrocephalus in unruptured brain arteriovenous malformations: pathomechanical considerations, therapeutic implications, and clinical course

Clinical article

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  • 1 Department of Radiology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;
  • | 2 Service de Neuroradiologie Diagnostique et Thérapeutique, Hôpital de Bicêtre, Le Kremlin-Bicêtre, Paris, France; and
  • | 3 Department of Neuroradiology, University Hospital Aachen, Germany
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Object

The goal in this study was to present possible pathological mechanisms, clinical and imaging findings, and to describe the management and outcome in patients with hydrocephalus due to unruptured pial brain arteriovenous malformations (AVMs).

Methods

Medical records and imaging findings in 8 consecutive patients with hydrocephalus caused by AVMs and treated between June 2000 and September 2007 were retrospectively reviewed to determine clinical symptoms, AVM location, venous drainage, level/cause of obstruction, and degree of hydrocephalus. Management of hydrocephalus, AVM treatment, complications, and follow-up results were evaluated.

Results

Headaches were the most common clinical symptom (7 of 8 patients). Deep venous drainage was identified in all patients. Mechanical obstruction by the draining vein or the AVM nidus was seen in 6 patients, in whom obstruction occurred at the interventricular foramen (2 patients) or the aqueduct (4 patients). Hydrodynamic disorders following venous outflow obstruction and venous congestion of the posterior fossa led to hydrocephalus in the remaining 2 patients. Ventriculoperitoneal (VP) shunts were placed in 6 of 8 patients with a moderate to severe degree of hydrocephalus. Regression of hydrocephalus was noted in 4 patients, whereas in 2 the imaging findings were stable, 1 of whom had decreased hydrocephalus only after AVM size reduction. In 2 patients with mild hydrocephalus who were not treated with shunt insertion, 1 improved and 1 was clinically stable after AVM treatment.

Conclusions

The most common cause of hydrocephalus in unruptured brain AVMs is mechanical obstruction by the draining vein if it is located in a strategic position. Management should be aimed at treatment of the AVM; however, VP shunts may be necessary in acute and severe cases of hydrocephalus.

Abbreviations used in this paper:

AVM = arteriovenous malformation; CSF = cerebrospinal fluid; ICV = internal cerebral vein; SDH = subdural hematoma; VP = ventriculoperitoneal.

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  • 1

    Alvarez H, , Garcia Monaco R, , Rodesch G, , Sachet M, , Krings T, & Lasjaunias P: Vein of galen aneurysmal malformations. Neuroimaging Clin N Am 17:189206, 2007

    • Search Google Scholar
    • Export Citation
  • 2

    Bannur U, , Korah I, & Chandy MJ: Midbrain venous angioma with obstructive hydrocephalus. Neurol India 50:207209, 2002

  • 3

    Carleton CC, & Cauthen JC: Vascular (“arteriovenous”) malformations of the choroid plexus. Arch Pathol 99:286288, 1975

  • 4

    Chimowitz MI, , Little JR, , Awad IA, , Sila CA, , Kosmorsky G, & Furlan AJ: Intracranial hypertension associated with unruptured cerebral arteriovenous malformations. Ann Neurol 27:474479, 1990

    • Search Google Scholar
    • Export Citation
  • 5

    Choi JH, & Mohr JP: Brain arteriovenous malformations in adults. Lancet Neurol 4:299308, 2005

  • 6

    Esparza J, , Lobato RD, , Munoz MJ, , Chillon D, , Portillo JM, & Lamas E: Giant cerebral arteriovenous malformation producing a noncommunicating hydrocephalus. Surg Neurol 15:7680, 1981

    • Search Google Scholar
    • Export Citation
  • 7

    Krings T, , Ozanne A, , Chng SM, , Alvarez H, , Rodesch G, & Lasjaunias PL: Neurovascular phenotypes in hereditary haemorrhagic telangiectasia patients according to age. Review of 50 consecutive patients aged 1 day-60 years. Neuroradiology 47:711720, 2005

    • Search Google Scholar
    • Export Citation
  • 8

    Lasjaunias P, , Berenstein A, & ter Brugge K: Surgical Neuroangiography: Clinical and Endovascular Treatment Aspects in Adults ed 2 New York, Springer, 2004

    • Search Google Scholar
    • Export Citation
  • 9

    Liu HM, , Wang YH, , Chen YF, , Tu YK, & Huang KM: Endovascular treatment of brain-stem arteriovenous malformations: safety and efficacy. Neuroradiology 45:644649, 2003

    • Search Google Scholar
    • Export Citation
  • 10

    Lobato RD, , Lamas E, , Cordobes F, , Munoz MJ, & Roger R: Chronic adult hydrocephalus due to uncommon causes. Acta Neurochir (Wien) 55:8597, 1980

    • Search Google Scholar
    • Export Citation
  • 11

    Mindea SA, , Yang BP, & Batjer HH: Unruptured arteriovenous malformation in a patient presenting with obstructive hydrocephalus. Case report and review of the literature. Neurosurg Focus 22:4 E11, 2007

    • Search Google Scholar
    • Export Citation
  • 12

    Pribil S, , Boone SC, & Waley R: Obstructive hydrocephalus at the anterior third ventricle caused by dilated veins from an arteriovenous malformation. Surg Neurol 20:487492, 1983

    • Search Google Scholar
    • Export Citation
  • 13

    Rodesch G, , Malherbe V, , Alvarez H, , Zerah M, , Devictor D, & Lasjaunias P: Nongalenic cerebral arteriovenous malformations in neonates and infants. Review of 26 consecutive cases (1982–1992). Childs Nerv Syst 11:231241, 1995

    • Search Google Scholar
    • Export Citation
  • 14

    Soderman M, , Andersson T, , Karlsson B, , Wallace MC, & Edner G: Management of patients with brain arteriovenous malformations. Eur J Radiol 46:195205, 2003

    • Search Google Scholar
    • Export Citation
  • 15

    Tien R, , Harsh GRt, , Dillon WP, & Wilson CB: Unilateral hydrocephalus caused by an intraventricular venous malformation obstructing the foramen of Monro. Neurosurgery 26:664 666, 1990

    • Search Google Scholar
    • Export Citation
  • 16

    Truwit CL: Venous angioma of the brain: history, significance, and imaging findings. AJR Am J Roentgenol 159:1299 1307, 1992

  • 17

    U HS, & Kerber C: Ventricular obstruction secondary to vascular malformations. Neurosurgery 12:572575, 1983

  • 18

    Willinsky R, , Terbrugge K, , Montanera W, , Mikulis D, & Wallace MC: Venous congestion: an MR finding in dural arteriovenous malformations with cortical venous drainage. AJNR Am J Neuroradiol 15:15011507, 1994

    • Search Google Scholar
    • Export Citation

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