Progressive spontaneous occlusion of a cerebellar AVM: Pathogenetic hypothesis and review of literature

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作者：P.P. Panciani ; M. Fontanella ; C. Carlino ; M. Bergui ; A. Ducati
关键词：Cerebral arteriovenous malformation ; AVM ; Thrombosis ; Spontaneous regression ; Cerebral angiography ; Vascular malformations ; Venous drainage impairment
刊名：Clinical Neurology and Neurosurgery
出版年：2008
期刊代码：60_03038467
类别：med
出版时间：May 2008
卷：110
期：5
页码：502-510
文件大小：832 K

摘要

Case: The patient was a 53 yrs old male. He had a cerebral hemorrhage in the left parietal lobe and the hematoma was removed. Eight month after the first attack a 2nd hemorrhage occurred in the same area. He got an acute hydrocephalus and the hematoma was very small, so only ventricular drainage was performed. First angiography was done after the drainage and it showed a left parietal AVM feeded from MCA. The 2nd angiography performed one year after the 2nd attack showed that the nidus was unchanged but that the parent artery (MCA) had developed a partial stenosis. Percutaneous transarterial balloon angioplasty was done for the stenosis and surgical removal of the nidus followed. He was discharged in good condition.

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Distributions of cerebral aneurysms by site were compared statistically in 78 reported cases associated with arteriovenous malformation, including our five cases, and cases with solitary intracranial aneurysms without arteriovenous malformation. When the feeder of an arteriovenous malformation was one of the branches of anterior, middle, or posterior cerebral arteries, the aneurysms were located on these respective arteries much more frequently than expected in the general aneurysmal population. This was statistically significant. Our results strongly suggest that abnormal hemodynamic stresses on the arteries from which the feeders branch out to arteriovenous malformations play a significant role in the development of intracranial aneurysms on these arteries.

The treatment of arteriovenous malformation (AVM) is still a challenging problem in the neurosurgical field. The usual operative procedure has been the removal of the AVM by sucking the gliosis which surrounds it. However, by using such a method in the functional area, especially the sensory and motor cortex, it has been impossible to remove the AVM without postoperative neurological deficit. Recent reports have shown that a 1 mm thickness of the brain around a large AVM is non-functioning;^1,2 therefore, we aimed to remove only the AVM without sucking the brain.

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Case report