Angioarchitecture associated with haemorrhage in cerebral arteriovenous malformations: a prognostic statistical model

Nataf, F.; Méder, J. F.; Roux, François‐Xavier; Blustajn, J.; Merienne, L; Merland, J. J.; Schlienger, M.; Chodkiewicz, J. P.

doi:10.1007/s002340050367

Cited by 120 publications

(59 citation statements)

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“…Studies have also shown that the presence of venous stenosis on angiography increases the rate of intracranial hemorrhage. 85,104 It is estimated that for unruptured AVMs, regardless of the other risk factors, the average annual rate of bleeding ranges from 2% to 4%. 13,107 Kondziolka et al 73 proposed the following formula taking into account the patient's age to estimate the lifetime risk of hemorrhage for an AVM: It is also estimated that the average annual case fatality rate is around 1% for AVMs.…”

Section: Natural Historymentioning

confidence: 99%

Management of incidentally discovered intracranial vascular abnormalities

Chalouhi¹,

Dumont²,

Randazzo³

et al. 2011

FOC

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With the widespread use of brain imaging studies, neurosurgeons have seen a marked increase in the number of incidental intracranial lesions, including vascular abnormalities. Specifically, the detection of incidentally discovered aneurysms, arteriovenous malformations, cavernous angiomas, developmental venous anomalies, and capillary telangiectasias has increased. The best management strategy for most of these lesions is controversial. Treatment options include observation, open surgery, endovascular procedures, and radiosurgery. Multiple factors should be taken into account when discussing treatment indications, including the natural history of the disease and the risk of the treatment. In this article, the authors focus on the natural history of these lesions and the risk of the treatment, and they give recommendations regarding the most appropriate management strategy based on the current evidence in the literature and their experience with intracranial vascular abnormalities.

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Section: Natural Historymentioning

confidence: 99%

Management of incidentally discovered intracranial vascular abnormalities

Chalouhi¹,

Dumont²,

Randazzo³

et al. 2011

FOC

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“…Likewise, venous ectasia/varix is defined as at least a doubling of the diameter of the draining vein. Venous ectasia is predicted to be associated with increased haemorrhagic risk [15]. Presence of angiogenesis (moya moya type phenomenon) also appears to increase the risk of haemorrhage associated with venous stenosis [13].…”

Section: S Chakraborty P Eldridge and H C Nahser E130mentioning

confidence: 99%

Cerebral haemorrhage from a remote varix in the venous outflow of an arteriovenous malformation treated successfully by embolisation

Chakraborty¹,

Eldridge²,

Nahser³

2010

BJR

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ABSTRACT. The ''spot sign '', described in 2007, has shown that a focal area of contrast extravasation within an intracerebral haematoma (ICH) can be correlated with haematoma expansion. Here we describe a case where time-resolved dynamic CT angiography (dCTA) shows the appearance of the ''spot sign'' only in later images. This shows the importance of timing of static CT angiogram that, if performed too early, might result in a false negative diagnosis. Haemorrhage in patients with intracranial arteriovenous malformation (AVM) usually occurs from the AVM itself or from an associated arterial aneurysm. We report a case of intracerebral haemorrhage arising from a remote varix related to the venous outflow of an ipsilateral frontal AVM. Case reportA 63-year-old male was admitted following a sudden onset of headache associated with neck stiffness and visual disturbances. There was no history of loss of consciousness or focal neurological deficit. On examination, the patient was photophobic and had nuchal rigidity. A visual field test showed a right homonymous hemianopsia but there were no other focal neurological signs.A non-enhanced CT of the brain ( Figure 1a) showed a large left temporal lobe intracerebral haemorrhage with secondary intraventricular and subarachnoid haemorrhage. There was also a calcified lesion in the left frontal lobe (Figure 1b), consistent with calcification within an AVM. A CT angiogram confirmed the presence of a left frontal AVM. An enhancing vascular structure adjacent to the left temporal lobe haematoma (Figure 1c) was demonstrated, representing either a flow aneurysm or a varix. MRI brain (Figure 1d) showed a left temporal intracerebral haematoma with an adjacent spherical area of flow void (Figure 1e), consistent with an aneurysm or varix. An AVM was noted in the left middle frontal gyrus (Figure 1d), distal from the area of haemorrhage. MR angiography (Figure 1f) showed enlarged arterial feeders arising from the left anterior and middle cerebral arteries.The conventional cerebral angiogram (Figure 2) confirmed the presence of a left frontal AVM (SpetzlerMartin grade 1-0-0) that was mainly supplied by branches of the left internal carotid artery. No arterial flow aneurysm was noted. The AVM had a peculiar way of draining. A primary single large collecting vein was divided into several smaller veins, majority of which were draining into the superior sagittal sinus via communication with superficial cortical veins. There was a single vein with a posteroinferior course. During late venous phase, two varices were seen on this vein (Figure 2c, f). Various degrees of stenoses were seen in the peripheral draining veins. The varix, adjacent to the area of haemorrhage, showed impaired outflow because of stenosed segments ( Figure 2f) and was probably the most vulnerable part of this AVM with regard to haemorrhage.During embolisation, the major right prefrontal middle cerebral artery feeder was initially catheterised and the tip of the microcatheter was placed intranidally within the AVM (Figur...

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“…[6][7][8] Studies in adults have identified radiological features that are associated with haemorrhagic presentation and future haemorrhage. [9][10][11] Similar studies on AVM in children are, however, scarce and mostly based on studies from Europe and North America. 12,13 Whether those angiographic features that predict haemorrhage in Caucasian children with AVM similarly predict haemorrhage in Chinese children with AVM is unknown.…”

Section: Introductionmentioning

confidence: 99%

Angiographic factors associated with haemorrhagic presentation of brain arteriovenous malformation in a Chinese paediatric population

et al. 2015

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Objective: To identify specific angiographic factors associated with haemorrhagic presentation of brain arteriovenous malformation in Chinese paediatric patients. Design:Retrospective cross-sectional observational study. Setting Main outcome measures:The following parameters were evaluated for their association with haemorrhagic presentation by univariate and multivariate analyses: nidus location, nidus size, nidus morphology (diffuse or compact); origin and number of arterial feeders; venous drainage; number of draining veins; presence of aneurysms, venous varices, and venous stenosis.Results: A total of 67 children and adolescents (28 male, 39 female) with a mean age of 12 years were included. Of them, 52 (78%) presented with haemorrhage. Arteriovenous malformation size (P=0.004) and morphology (P=0.05) were found to be associated with haemorrhagic presentation by univariate analysis. Small arteriovenous Angiographic factors associated with haemorrhagic presentation of brain arteriovenous malformation in a Chinese paediatric population New knowledge added by this study • Studies on paediatric arteriovenous malformation (AVM) are scarce and mostly based in Caucasian populations. This multicentre study involving Chinese paediatric patients found that small AVM nidus size and diffuse nidal morphology are independent risk factors for haemorrhage. Implications for clinical practice or policy • These two angiographic features associated with haemorrhagic presentation can help local clinicians to assess bleeding risk and determine the therapeutic approach (aggressive vs conservative) and treatment timeframe in paediatric patients with cerebral AVM.

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Angioarchitecture associated with haemorrhage in cerebral arteriovenous malformations: a prognostic statistical model

Cited by 120 publications

References 0 publications

Management of incidentally discovered intracranial vascular abnormalities

Management of incidentally discovered intracranial vascular abnormalities

Cerebral haemorrhage from a remote varix in the venous outflow of an arteriovenous malformation treated successfully by embolisation

Angiographic factors associated with haemorrhagic presentation of brain arteriovenous malformation in a Chinese paediatric population

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