Cerebral microarteriovenous malformations: a series of 28 cases

Clinical article

José F. Alén M.D., Ph.D. 1 , Alfonso Lagares M.D., Ph.D. 1 , Igor Paredes M.D. 1 , Jorge Campollo M.D. 2 , Pedro Navia M.D. 2 , Ana Ramos M.D., Ph.D. 2 and Ramiro D. Lobato M.D., Ph.D. 1
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  • 1 Department of Neurosurgery and
  • 2 Division of Neuroradiology, Hospital 12 de Octubre, Universidad Complutense de Madrid, Spain
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Object

Microarteriovenous malformations (micro-AVMs) are a rare subgroup of brain AVMs characterized by a nidus smaller than 1 cm. The authors' purpose in this study was to assess the clinical presentation, radiological features, therapeutic management, and outcome of these lesions.

Methods

All angiography studies performed at the authors' institution since 2000 for the diagnosis of AVM were retrospectively reviewed. Clinicoradiological findings, therapeutic management, and outcome were evaluated.

Results

Twenty-eight patients had presented with AVMs having a nidus diameter smaller than 1 cm or no clearly identifiable nidus but an early draining vein. All patients, except 2, presented with intracranial hemorrhage, and 12 patients had a focal deficit. Supratentorial hematomas were large (mean volume 25 ml), and in 8 patients hematomas were evacuated urgently. In 6 patients cerebral digital subtraction angiography studies were normal. Magnetic resonance imaging and dynamic MR angiography revealed an AVM in 4 of these 6 patients. Treatment of the AVM consisted of surgery in 16 cases, radiosurgery in 6, and endovascular embolization in 2, and there were no posttreatment deficits. Four patients received no treatment because of their poor condition. The AVM was occluded at the follow-up in all patients treated with surgery or embolization and in 4 of the 6 patients treated with radiosurgery. The Glasgow Outcome Scale (GOS) score was good (GOS 4–5) in 23 patients (82%) and poor (GOS 3–2) in 5 (18%).

Conclusions

Patients with micro-AVMs generally present with large intracranial hemorrhages and neurological deficits. If the initial angiography is negative, then delayed or superselective angiography is recommended. Magnetic resonance imaging may reveal the existence of these lesions. Surgery is the treatment of choice for superficial micro-AVMs, and radiosurgery or embolization can be considered for deep lesions.

Abbreviations used in this paper:AVM = arteriovenous malformation; DSA = digital subtraction angiography; GOS = Glasgow Outcome Scale; MIP = maximum intensity projection; MRA = MR angiography; TOF = time-of-flight.

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Contributor Notes

Address correspondence to: Jose F. Alén, M.D., Ph.D., Department of Neurosurgery, Hospital 12 de Octubre, Universidad Complutense de Madrid, Avda de Cordoba s/n, Madrid 28041, Spain. email: jafalen@gmail.com.

Please include this information when citing this paper: published online May 10, 2013; DOI: 10.3171/2013.4.JNS121740.

  • 1

    Andreou A, , Ioannidis I, , Lalloo S, , Nickolaos N, & Byrne JV: Endovascular treatment of intracranial microarteriovenous malformations. Clinical article. J Neurosurg 109:10911097, 2008

    • Search Google Scholar
    • Export Citation
  • 2

    Brown RD Jr, , Wiebers DO, , Forbes G, , O'Fallon WM, , Piepgras DG, & Marsh WR, : The natural history of unruptured intracranial arteriovenous malformations. J Neurosurg 68:352357, 1988

    • Search Google Scholar
    • Export Citation
  • 3

    Cellerini M, , Mangiafico S, , Villa G, , Nistri M, , Pandolfo C, & Noubari H, : Cerebral microarteriovenous malformations: diagnostic and therpeutic features in a series of patients. AJNR Am J Neuroradiol 23:945952, 2002

    • Search Google Scholar
    • Export Citation
  • 4

    Crawford JV, & Russell DS: Cryptic arteriovenous and venous hamartomas of the brain. J Neurol Neurosurg Psychiatry 19:111, 1956

  • 5

    Crawford PM, , West CR, , Chadwick DW, & Shaw MD: Arteriovenous malformations of the brain: natural history in unoperated patients. J Neurol Neurosurg Psychiatry 49:110, 1986

    • Search Google Scholar
    • Export Citation
  • 6

    Elhammady MS, , Baskaya MK, & Heros RC: Early elective surgical exploration of spontaneous intracerebral hematomas of unknown origin. Clinical article. J Neurosurg 109:10051011, 2008

    • Search Google Scholar
    • Export Citation
  • 7

    Guidetti B, & Delitala A: Intracranial arteriovenous malformations. Conservative and surgical treatment. J Neurosurg 53:149152, 1980

  • 8

    Hino A, , Fujimoto M, , Yamaki T, , Iwamoto Y, & Katsumori T: Value of repeat angiography in patients with spontaneous subcortical hemorrhage. Stroke 29:25172521, 1998

    • Search Google Scholar
    • Export Citation
  • 9

    Jennett B, & Bond M: Assessment of outcome after severe brain damage. Lancet 1:480484, 1975

  • 10

    Jensen HP, , Brumlik J, & Boshes B: The application of serial angiography to diagnosis of the smallest cerebral angiomatous malformations. J Nerv Ment Dis 136:114, 1963

    • Search Google Scholar
    • Export Citation
  • 11

    Kader A, , Young WL, , Pile-Spellman J, , Mast H, , Sciacca RR, & Mohr JP, : The influence of hemodynamic and anatomic factors on hemorrhage from cerebral arteriovenous malformations. Neurosurgery 34:801808, 1994

    • Search Google Scholar
    • Export Citation
  • 12

    Margolis G, , Odom GL, & Woodhall B: Further experiences with small vascular malformations as a cause of massive intracerebral bleeding. J Neuropathol Exp Neurol 20:161167, 1961

    • Search Google Scholar
    • Export Citation
  • 13

    Ogilvy CS, , Heros RC, , Ojemann RG, & New PF: Angiographically occult arteriovenous malformations. J Neurosurg 69:350355, 1988

  • 14

    Perrini P, , Scollato A, , Cellerini M, , Mangiafico S, , Ammannati F, & Mennonna P, : Results of surgical and endovascular treatment of intracranial micro-arteriovenous malformations with emphasis on superselective angiography. Acta Neurochir (Wien) 146:755766, 2004

    • Search Google Scholar
    • Export Citation
  • 15

    Stiver SI: Microarteriovenous malformations. Neurosurg Clin N Am 10:485501, 1999

  • 16

    Stiver SI, & Ogilvy CS: Micro-arteriovenous malformations: significant hemorrhage from small arteriovenous shunts. Neurosurgery 46:811819, 2000

    • Search Google Scholar
    • Export Citation
  • 17

    Tanaka Y, , Furuse M, , Iwasa H, , Masuzawa T, , Saito K, & Sato F, : Lobar intracerebral hemorrhage: etiology and a long-term follow-up study of 32 patients. Stroke 17:5157, 1986

    • Search Google Scholar
    • Export Citation
  • 18

    Tung H, , Giannotta SL, , Chandrasoma PT, & Zee CS: Recurrent intraparenchymal hemorrhages from angiographically occult vascular malformations. J Neurosurg 73:174180, 1990

    • Search Google Scholar
    • Export Citation
  • 19

    Wakai S, , Ueda Y, , Inoh S, & Nagai M: Angiographically occult angiomas: a report of thirteen cases with analysis of the cases documented in the literature. Neurosurgery 17:549556, 1985

    • Search Google Scholar
    • Export Citation
  • 20

    Willinsky R, , Lasjaunias P, , Comoy J, & Pruvost P: Cerebral micro arteriovenous malformations (mAVMs). Review of 13 cases. Acta Neurochir (Wien) 91:3741, 1988

    • Search Google Scholar
    • Export Citation
  • 21

    Willinsky R, , TerBrugge K, , Montanera W, , Wallace C, & Aggarwal S: Micro-arteriovenous malformations of the brain: superselective angiography in diagnosis and treatment. AJNR Am J Neuroradiol 13:325330, 1992

    • Search Google Scholar
    • Export Citation
  • 22

    Yaşargil MG: Microneurosurgery. Volume IIIA. AVM of the Brain, History, Embryology, Pathological Considerations, Hemodynamics, Diagnostic Studies, Microsurgical Anatomy New York, Thieme, 1987

    • Search Google Scholar
    • Export Citation
  • 23

    Yu SC, , Chan MS, , Lam JM, , Tam PH, & Poon WS: Complete obliteration of intracranial arteriovenous malformation with endovascular cyanoacrylate embolization: initial success and rate of permanent cure. AJNR Am J Neuroradiol 25:11391143, 2004

    • Search Google Scholar
    • Export Citation

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