Spontaneous disappearance of intracranial arterio-venous malformations

Abstract

4 cases of spontaneous disappearance of intracranial arteriovenous malformations are reported. All the malformations were in the rolandic-parietal area, and fed in most cases by the MCA. In one case, the malformation was associated with a proximal aneurysm. One malformation was large, one medium-sized, and two small. Venous drainage was towards the longitudinal sinus in all cases. Presenting symptoms consisted of epilepsy in 2 cases, and intracerebral haemorrhage in 2 cases. Disappearance of the AVM was documented by angiography from 1 to 15 years after diagnosis, and was preceded by a new haemorrhage in 2 cases. Acute or gradual thrombosis of the AVM is suggested as the most likely cause of the disappearance of an AVM. Spontaneous thrombosis of an AVM should be considered as an aspect of the pathological entity known as "thrombosed AVM". Guidelines for the management of patients exhibiting spontaneous disappearance of an AVM are briefly discussed.

Spontaneous regression of cerebral arteriovenous malformations: clinical and angiographic analysis with review of the literature

“…Seventy ®ve percent of our patients had small AVMs and showed single venous drainage. In [2,3,5,6,7,8,9,10,11,12,13,14,15,16,17,18]. However, in our brain AVM database, the spontaneous regression had occurred in only about 0.6% of small (<3 cm) brain AVMs (3/474), and AVMs with multiple draining veins can also progress to spontaneous regression [6,10,11,20].…”

“…Small AVMs [5,14,18] and a single draining vein [15,16] are common radiological features of spontaneousregression patients. Seventy ®ve percent of our patients had small AVMs and showed single venous drainage.…”

“…They include mass eect on the feeding arteries from an intracranial hematoma or associated edema [3,6,7,9,16,18] or feeding arterial occlusion due to atherosclerosis [2], thromboembolism [17] or systemic coagulation disorders [4]. However, if the feeding arteries are completely occluded by any etiological condition, the AVM can recruit arterial collaterals through a non-sprouting angiogenesis if the shunt remains patent [1].…”

Spontaneous angiographic regression of cerebral arteriovenous malformations.-angiographical disappearance is not the real cure-

“…Moreover, a single draining vein and hemodynamic alterations in the intracranial blood flow, including intracranial hemorrhage, were observed in a majority of the patients with SRAVM (44). A mass effect caused by an intracranial hematoma may decrease blood flow in the AVM to the extent that complete thrombosis occurs in the draining vessels (7,16,27,38).…”

“…Angiographically occult AVMs (AOAVMs) occur in less than 3% of AVM cases (33,38,43) and are poorly understood. AOAVMs include spontaneous regression of cerebral AVMs.…”