Postnatal Development of Arteriovenous Malformations

Abstract

Background: Arteriovenous malformations (AVMs) are commonly thought to be congenital malformations; however, patients usually present in adolescence or adulthood. This study was carried out to better understand the development of AVMs between birth and presentation. Methods: A retrospective review was performed of the medical records of all patients under 25 presenting to a single institution with an AVM or spontaneous intracerebral hemorrhage from 2000 to 2007. Results: Out of a total of 34 cases, 3 children were identified with delayed de novo appearance of an AVM after an intracerebral hemorrhage and normal initial angiography. The clinical and angiographic features are presented for these 3 patients and for an additional patient with AVM recurrence after complete surgical excision. Conclusions: In the light of these cases and a review of the literature, we suggest a hypothesis that AVMs develop postnatally, undergoing a period of growth in childhood or early adulthood, and that they may become symptomatic from the time of their earliest development. The trigger to growth may be shear stress stimulating growth factor expression by endothelial cells lining an arteriovenous fistula. Alternative stimuli, such as venous hypertension, cannot be ruled out.

Live-cell imaging to detect phosphatidylserine externalization in brain endothelial cells exposed to ionizing radiation: implications for the treatment of brain arteriovenous malformations

“…However, this does not mean a 15-Gy dose of radiation is enough for vascular obliteration in AVMs. Clinical work has demonstrated that a margin dose of [16][17][18][19][20][21][22][23][24][25] Gy is necessary to achieve a satisfactory occlusion rate. 10,44 More work with smaller titrations of radiation doses and larger animal numbers per group is required to find the optimal radiation dose for vascular targeting.…”

“…16,37 The aim of AVM treatment is to prevent hemorrhage. 29 Treatment is effective only with complete AVM removal or obliteration.…”

Development of a de novo arteriovenous malformation after severe traumatic brain injury

“…13,19 In a study of younger patients with AVMs, almost 10% of the patients had undergone previous angiography without evidence of vascular malformation. 11 There are also multiple case reports of AVMs presenting with subdural hemorrhage, 5,17 but no reports that we are aware of attribute an acute supratentorial subdural hemorrhage to an AVM.…”

Central Nervous System Vascular Malformations

“…Although an initiating event has yet to be defined, possible candidates include trauma, tissue hypoxia, venous hypertension, infection, inflammation, irradiation, or compression [14,15]. The primary vascular defect may be the development of a simple arteriovenous fistula [16], with altered hemodynamic stresses occurring in the affected vessels. Further pro-angiogenic vascular remodeling and secondary vascular changes would occur secondary to the hemodynamic stress, producing the characteristic AVM seen in clinical practice [17].…”