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

Abstract

Spontaneous regression of cerebral arteriovenous malformation (AVM) is rare and poorly understood. We reviewed the clinical and angiographic findings in patients who had spontaneous regression of cerebral AVMs to determine whether common features were present. The clinical and angiographic findings of four cases from our series and 29 cases from the literature were retrospectively reviewed. The clinical and angiographic features analyzed were: age at diagnosis, initial presentation, venous drainage pattern, number of draining veins, location of the AVM, number of arterial feeders, clinical events during the interval period to thrombosis, and interval period to spontaneous thrombosis. Common clinical and angiographic features of spontaneous regression of cerebral AVMs are: intracranial hemorrhage as an initial presentation, small AVMs, and a single draining vein. Spontaneous regression of cerebral AVMs can not be predicted by clinical or angiographic features, therefore it should not be considered as an option in cerebral AVM management, despite its proven occurrence.

Endovascular treatment of unruptured and ruptured brain arteriovenous malformations with Onyx18: a monocentric series of 84 patients

“…In our experience, however, the flow reduction after subtotal endovascular occlusion may also determine the spontaneous progressive thrombosis of the residual nidus itself that was documented with DSA follow-up in eight cases. This phenomenon is similar to those cases of brain AVMs spontaneously occluded reported in the literature,23 and probably the tendency of Onyx to go through the venous side, determining a progressive slowdown of the venous outlet without a sudden imbalance of intranidal pressure, may explain this poorly known aspect 24…”

Spontaneous regression of a cerebral arteriovenous malformation in a child with hereditary hemorrhagic telangiectasia

“…12 Spontaneous regression of a cerebral AVM, although well recognized, is a rare phenomenon with a reported incidence of 0.5 to 1.3%. 1,9,15 Most case reports have focused on sporadic AVMs; only one previous report contains a description of the regression of a small AVM in an adult patient with HHT. 4…”

Contrast Agent Induced Obliteration of a Spinal Arteriovenous Malformation

“…[6][7][8] Most of these cases were cerebral AVMs that thrombosed after symptomatic intracerebral or subarachnoid hemorrhage. This spontaneous thrombosis of a cerebral AVM may be explained by reduction of blood flow as a result of compression on the proximal draining veins by the hematoma or edema, feeding artery occlusion through vasospasm, thromboembolism, or systemic coagulation disorders.…”