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Han C, Nguyen CL, Scherschinski L, Schriber TD, Arthur HM, Lawton MT, Oh SP. VEGFR2 Expression Correlates with Postnatal Development of Brain Arteriovenous Malformations in a Mouse Model of Type I Hereditary Hemorrhagic Telangiectasia. Biomedicines 2023; 11:3153. [PMID: 38137374 PMCID: PMC10740421 DOI: 10.3390/biomedicines11123153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/20/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023] Open
Abstract
Brain arteriovenous malformations (BAVMs) are a critical concern in hereditary hemorrhagic telangiectasia (HHT) patients, carrying the risk of life-threatening intracranial hemorrhage. While traditionally seen as congenital, the debate continues due to documented de novo cases. Our primary goal was to identify the precise postnatal window in which deletion of the HHT gene Endoglin (Eng) triggers BAVM development. We employed SclCreER(+);Eng2f/2f mice, enabling timed Eng gene deletion in endothelial cells via tamoxifen. Tamoxifen was given during four postnatal periods: P1-3, P8-10, P15-17, and P22-24. BAVM development was assessed at 2-3 months using latex dye perfusion. We examined the angiogenic activity by assessing vascular endothelial growth factor receptor 2 (VEGFR2) expression via Western blotting and Flk1-LacZ reporter mice. Longitudinal magnetic resonance angiography (MRA) was conducted up to 9 months. BAVMs emerged in 88% (P1-3), 86% (P8-10), and 55% (P15-17) of cases, with varying localization. Notably, the P22-24 group did not develop BAVMs but exhibited skin AVMs. VEGFR2 expression peaked in the initial 2 postnatal weeks, coinciding with BAVM onset. These findings support the "second hit" theory, highlighting the role of early postnatal angiogenesis in initiating BAVM development in HHT type I mice.
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Affiliation(s)
- Chul Han
- Barrow Aneurysm and AVM Research Center, Department of Translational Neuroscience, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA; (C.H.); (C.L.N.); (L.S.); (M.T.L.)
| | - Candice L. Nguyen
- Barrow Aneurysm and AVM Research Center, Department of Translational Neuroscience, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA; (C.H.); (C.L.N.); (L.S.); (M.T.L.)
| | - Lea Scherschinski
- Barrow Aneurysm and AVM Research Center, Department of Translational Neuroscience, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA; (C.H.); (C.L.N.); (L.S.); (M.T.L.)
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA
- Department of Neurosurgery, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Tyler D. Schriber
- Barrow Aneurysm and AVM Research Center, Department of Translational Neuroscience, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA; (C.H.); (C.L.N.); (L.S.); (M.T.L.)
| | - Helen M. Arthur
- Biosciences Institute, Newcastle University, Newcastle NE1 7RU, UK;
| | - Michael T. Lawton
- Barrow Aneurysm and AVM Research Center, Department of Translational Neuroscience, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA; (C.H.); (C.L.N.); (L.S.); (M.T.L.)
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA
| | - Suk Paul Oh
- Barrow Aneurysm and AVM Research Center, Department of Translational Neuroscience, Barrow Neurological Institute, St. Joseph’s Hospital and Medical Center, Phoenix, AZ 85013, USA; (C.H.); (C.L.N.); (L.S.); (M.T.L.)
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2
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Koester SW, Batista S, Bertani R, Yengo-Kahn A, Roth S, Chitale R, Dewan M. Angiographic factors leading to hemorrhage in AVMs: A systematic review and meta-analysis. Neurosurg Rev 2023; 46:72. [PMID: 36935466 DOI: 10.1007/s10143-023-01971-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/18/2022] [Accepted: 02/27/2023] [Indexed: 03/21/2023]
Abstract
For patients with unruptured intracranial arteriovenous malformations (AVMs), the risk of a hemorrhagic event is approximately 2% to 4% annually. These events have an associated 20-50% morbidity and 10% mortality rate. An understanding of risk factors that predispose these lesions to rupture is important for optimal management. We aimed to pool a large cohort of both ruptured and unruptured AVMs from the literature with the goal of identifying angiographic risk factors that contribute to rupture. A systematic review of the literature was conducted in accordance with the PRISMA guidelines using Pubmed, Embase, Scopus, and Web of Science databases. Studies that presented patient-level data from ruptured AVMs from January 1990 to January 2022 were considered for inclusion. The initial screening of 8,304 papers resulted in a quantitative analysis of 25 papers, which identified six angiographic risk factors for AVM rupture. Characteristics that significantly increase the odds of rupture include the presence of aneurysm (OR = 1.45 [1.19, 1.77], p < 0.001, deep location (OR = 3.08 [2.56, 3.70], p < 0.001), infratentorial location (OR = 2.79 [2.08, 3.75], p < 0.001), exclusive deep venous drainage (OR = 2.50 [1.73, 3.61], p < 0.001), single venous drainage (OR = 2.97 [1.93, 4.56], p < 0.001), and nidus size less than 3 cm (OR = 2.54 [1.41, 4.57], p = 0.002). Although previous literature has provided insight into AVM rupture risk factors, obscurity still exists regarding which risk factors pose the greatest risk. We have identified six major angiographic risk factors (presence of an aneurysm, deep location, infratentorial location, exclusive deep venous drainage, single venous drainage, and nidus size less than 3 cm) that, when identified by a clinician, may help to tailor patient-specific approaches and guide clinical decisions.
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Affiliation(s)
| | - Savio Batista
- Hospital Miguel Couto Neurological Surgery, Rio de Janeiro, Brazil
| | - Raphael Bertani
- Hospital Miguel Couto Neurological Surgery, Rio de Janeiro, Brazil
| | - Aaron Yengo-Kahn
- Department of Neurosurgery, Vanderbilt University Medical Center, 1161 21st Ave. So., T4224 Medical Center North, Nashville, TN, 37232-2380, USA
| | - Steven Roth
- Department of Neurosurgery, Vanderbilt University Medical Center, 1161 21st Ave. So., T4224 Medical Center North, Nashville, TN, 37232-2380, USA
| | - Rohan Chitale
- Department of Neurosurgery, Vanderbilt University Medical Center, 1161 21st Ave. So., T4224 Medical Center North, Nashville, TN, 37232-2380, USA
| | - Michael Dewan
- Department of Neurosurgery, Vanderbilt University Medical Center, 1161 21st Ave. So., T4224 Medical Center North, Nashville, TN, 37232-2380, USA.
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Fernandez-Flores A, Cassarino D, Colmenero I. Vascular Malformations: A Histopathologic and Conceptual Appraisal. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:T213-T228. [PMID: 36690143 DOI: 10.1016/j.ad.2022.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 01/22/2023] Open
Abstract
In the field of vascular anomalies, distinguishing between vascular malformations and tumors has become crucial for a correct therapeutic approach. However, the differential diagnosis between these two groups is not always well explained in classical texts, mainly because many vascular malformations are still known with old names that suggest a tumoral nature. Also, genetic and pathogenic knowledge of these entities has greatly increased in recent decades, so researchers and clinicians now have a better understanding of vascular malformations. In this paper, we present the main histopathological tips to recognize and identify a vascular malformation as such. We also contextualize such information in the clinical and pathogenic knowledge for a better understanding of these entities.
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Affiliation(s)
- A Fernandez-Flores
- Departamento de Histopatología, Hospital Universitario El Bierzo, Ponferrada, León, España; Departamento de Patología Celular, Hospital de la Reina, Ponferrada, León, España; Departamento de Investigación, Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidad de A Coruña, A Coruña, España.
| | - D Cassarino
- Los Angeles Medical Center (LAMC), Southern California Kaiser Permanente, Department of Dermatology, Los Ángeles, CA, EE. UU
| | - I Colmenero
- Departamento de Histopatología Pediátrica, Hospital Universitario Niño Jesús, Madrid, España
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4
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Fernandez-Flores A, Cassarino D, Colmenero I. Vascular Malformations: A Histopathologic and Conceptual Appraisal. ACTAS DERMO-SIFILIOGRAFICAS 2023; 114:213-228. [PMID: 36309042 DOI: 10.1016/j.ad.2022.10.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 12/13/2022] Open
Abstract
In the field of vascular anomalies, distinguishing between vascular malformations and tumors has become crucial for a correct therapeutic approach. However, the differential diagnosis between these two groups is not always well explained in classical texts, mainly because many vascular malformations are still known with old names that suggest a tumoral nature. Also, genetic and pathogenic knowledge of these entities has greatly increased in recent decades, so researchers and clinicians now have a better understanding of vascular malformations. In this paper, we present the main histopathological tips to recognize and identify a vascular malformation as such. We also contextualize such information in the clinical and pathogenic knowledge for a better understanding of these entities.
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Affiliation(s)
- A Fernandez-Flores
- Department of Histopathology, University Hospital El Bierzo, Ponferrada, Spain; Department of Cellular Pathology, Hospital de la Reina, Ponferrada, Spain; Research Department, Institute for Biomedical Research of A Coruña (INIBIC), University of A Coruña (UDC), A Coruña, Spain.
| | - D Cassarino
- Los Angeles Medical Center (LAMC), Southern California Kaiser Permanente, Department of Dermatology, Los Angeles, CA, USA
| | - I Colmenero
- Department of Pediatric Histopathology, University Hospital Niño Jesús, Madrid, Spain
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Mukhtarova K, Zholdybayeva E, Kairov U, Akhmetollayev I, Nurimanov C, Kulmirzayev M, Makhambetov Y, Ramankulov Y. Whole-Exome Sequencing Reveals Pathogenic SIRT1 Variant in Brain Arteriovenous Malformation: A Case Report. Genes (Basel) 2022; 13:1689. [PMID: 36292575 PMCID: PMC9601721 DOI: 10.3390/genes13101689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/16/2022] [Accepted: 09/19/2022] [Indexed: 11/29/2022] Open
Abstract
Arteriovenous malformations of the brain (bAVMs) are plexuses of pathological arteries and veins that lack a normal capillary system between them. Intracranial hemorrhage (hemorrhagic stroke) is the most frequent clinical manifestation of AVM, leading to lethal outcomes that are especially high among children and young people. Recently, high-throughput genome sequencing methods have made a notable contribution to the research progress in this subject. In particular, whole-exome sequencing (WES) methods allow the identification of novel mutations. However, the genetic mechanism causing AVM is still unclear. Therefore, the aim of this study was to investigate the potential genetic mechanism underlying AVM. We analyzed the WES data of blood and tissue samples of a 30-year-old Central Asian male diagnosed with AVM. We identified 54 polymorphisms in 43 genes. After in-silica overrepresentation enrichment analysis of the polymorphisms, the SIRT1 gene variant (g.67884831C>T) indicated a possible molecular mechanism of bAVM. Further studies are required to evaluate the functional impact of SIRT1 g.67884831C>T, which may warrant further replication and biological investigations related to sporadic bAVM.
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Affiliation(s)
- Kymbat Mukhtarova
- National Center for Biotechnology, 13/5 Kurgalzhynskoye Road, Astana 010000, Kazakhstan
| | - Elena Zholdybayeva
- National Center for Biotechnology, 13/5 Kurgalzhynskoye Road, Astana 010000, Kazakhstan
| | - Ulykbek Kairov
- Laboratory of Bioinformatics and Systems Biology, Center for Life Science, National Laboratory Astana, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana 010000, Kazakhstan
| | - Ilyas Akhmetollayev
- National Center for Biotechnology, 13/5 Kurgalzhynskoye Road, Astana 010000, Kazakhstan
| | - Chingiz Nurimanov
- National Center of Neurosurgery, 34/1 Turan Street, Astana 010000, Kazakhstan
| | - Marat Kulmirzayev
- National Center of Neurosurgery, 34/1 Turan Street, Astana 010000, Kazakhstan
| | - Yerbol Makhambetov
- National Center of Neurosurgery, 34/1 Turan Street, Astana 010000, Kazakhstan
| | - Yerlan Ramankulov
- National Center for Biotechnology, 13/5 Kurgalzhynskoye Road, Astana 010000, Kazakhstan
- School of Science and Technology, Nazarbayev University, 53 Kabanbay Batyr Ave., Astana 010000, Kazakhstan
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6
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Pérez-Alfayate R, Grasso G. State of the Art and Future Direction in Diagnosis, Molecular Biology, Genetics, and Treatment of Brain Arteriovenous Malformations. World Neurosurg 2022; 159:362-372. [PMID: 35255635 DOI: 10.1016/j.wneu.2021.08.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
Brain arteriovenous malformations (bAVMs) are uncommon and represent a heterogeneous group of lesions. Although these 2 facts have delayed research on this topic, knowledge about the pathophysiology, diagnosis, and treatment of bAVMs has evolved in recent years. We conducted a review of the literature to update the knowledge about diagnosis, molecular biology, genetic, pathology, and treatment by searching for the following terms: "Epidemiology AND Natural History," "risk of hemorrhage," "intracranial hemorrhage," "diagnosis," "angiogenesis," "molecular genetics," "VEGF," "KRAS," "radiosurgery," "endovascular," "microsurgery," or "surgical resection." Our understanding of bAVMs has significantly evolved in recent years. The latest investigations have helped in defining some molecular pathways involved in the pathology of bAVM. Although there is still more to learn and discover, describing these pathways will allow the creation of targeted treatments that could improve the prognosis of patients with bAVMs.
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Affiliation(s)
- Rebeca Pérez-Alfayate
- Department of Neurosurgery, Neuroscience Institute, Hospital Clínico San Carlos, Madrid, Spain.
| | - Giovanni Grasso
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
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Florian IA, Beni L, Moisoiu V, Timis TL, Florian IS, Balașa A, Berindan-Neagoe I. 'De Novo' Brain AVMs-Hypotheses for Development and a Systematic Review of Reported Cases. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:201. [PMID: 33652628 PMCID: PMC7996785 DOI: 10.3390/medicina57030201] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 12/11/2022]
Abstract
Background and Objectives: Brain arteriovenous malformations AVMs have been consistently regarded as congenital malformations of the cerebral vasculature. However, recent case reports describing "de novo AVMs" have sparked a growing debate on the nature of these lesions. Materials and Methods: We have performed a systematic review of the literature concerning de novo AVMs utilizing the PubMed and Google Academic databases. Termes used in the search were "AVM," "arteriovenous," "de novo," and "acquired," in all possible combinations. Results: 53 articles including a total of 58 patients harboring allegedly acquired AVMs were identified by researching the literature. Of these, 32 were male (55.17%), and 25 were female (43.10%). Mean age at de novo AVM diagnosis was 27.833 years (standard deviation (SD) of 21.215 years and a 95% confidence interval (CI) of 22.3 to 33.3). Most de novo AVMs were managed via microsurgical resection (20 out of 58, 34.48%), followed by radiosurgery and conservative treatment for 11 patients (18.97%) each, endovascular embolization combined with resection for five patients (8.62%), and embolization alone for three (5.17%), the remaining eight cases (13.79%) having an unspecified therapy. Conclusions: Increasing evidence suggests that some of the AVMs discovered develop some time after birth. We are still a long way from finally elucidating their true nature, though there is reason to believe that they can also appear after birth. Thus, we reason that the de novo AVMs are the result of a 'second hit' of a variable type, such as a previous intracranial hemorrhage or vascular pathology. The congenital or acquired characteristic of AVMs may have a tremendous impact on prognosis, risk of hemorrhage, and short and long-term management.
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Affiliation(s)
- Ioan Alexandru Florian
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, 400012 Cluj-Napoca, Romania; (L.B.); (V.M.); (I.S.F.)
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Lehel Beni
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, 400012 Cluj-Napoca, Romania; (L.B.); (V.M.); (I.S.F.)
| | - Vlad Moisoiu
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, 400012 Cluj-Napoca, Romania; (L.B.); (V.M.); (I.S.F.)
| | - Teodora Larisa Timis
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Ioan Stefan Florian
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, 400012 Cluj-Napoca, Romania; (L.B.); (V.M.); (I.S.F.)
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Adrian Balașa
- Clinic of Neurosurgery, Tîrgu Mureș County Clinical Emergency Hospital, 540136 Tîrgu Mureș, Romania;
- Department of Neurosurgery, Tîrgu Mureș University of Medicine, Pharmacy, Science and Technology, 540139 Tîrgu Mureș, Romania
| | - Ioana Berindan-Neagoe
- Research Center for Functional Genomics, Biomedicine, and Translational Medicine, Institute of Doctoral Studies, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
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Healy V, O'Halloran PJ, Husien MB, Bolger C, Farrell M. Intermixed arteriovenous malformation and hemangioblastoma: case report and literature review. CNS Oncol 2020; 9:CNS66. [PMID: 33244995 PMCID: PMC7737198 DOI: 10.2217/cns-2020-0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 10/27/2020] [Indexed: 12/14/2022] Open
Abstract
We report the third presentation of an intermixed arteriovenous malformation and hemangioblastoma. The rare occurrence of the diagnostic histologic features of both a neoplasm and vascular malformation in a single lesion is more common in gliomas, as angioglioma, and is termed an 'intermixed' lesion. We review the literature concerning the developmental biology of each lesion, and potential interplay in the formation of an intermixed vascular neoplasm and vascular malformation. The roles of cellular origin, genetic susceptibility, favourable microenvironment, altered local gene expression and key regulatory pathways are reviewed. Our review supports angiography and genetic profiling in intermixed lesions to inform management strategies. Consideration should be given to multimodality therapeutic interventions as required, including microsurgical resection, stereotactic radiosurgery and further research to exploit emerging molecular targets.
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Affiliation(s)
- Vincent Healy
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
- Department of Neuroscience, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Philip J O'Halloran
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
- Department of Neuroscience, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Ciaran Bolger
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
- Department of Neuroscience, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Michael Farrell
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland
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9
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Nagai Y, Anan M, Fujiki M. Cerebral Arteriovenous Malformations as Acquired Lesions: Case Reports and Review of the Literature. J Stroke Cerebrovasc Dis 2020; 29:105157. [PMID: 32912502 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/12/2020] [Indexed: 12/18/2022] Open
Abstract
Cerebral arteriovenous malformations (AVMs) are generally attributed to congenital lesions that arise from aberrant vasculogenesis between the fourth and eighth weeks of embryonic life. However, this dogma has been challenged by several recent observations, one of which is de novo formation of AVMs. Forty cases of de novo AVMs were published between 2000 and 2019, all of which involved a history of intracranial insult, such as vascular abnormalities or nonvascular conditions, prior to AVM diagnosis. We hereby present two unique operative cases of ruptured de novo AVMs in older adult patients. Case 1 is novel in the sense that the patient did not experience any kind of environmental trigger ("second hit") such as a previous intracranial insult, while Case 2 serves as the second report of a de novo AVM patient with a medical history of Bell's palsy. Although the exact mechanisms of AVM formation remain to be elucidated, it is likely to be a multifactorial process related to environmental and hemodynamic factors.
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Affiliation(s)
- Yasuyuki Nagai
- Department of Neurosurgery, National Hospital Organization Beppu Medical Center, 1473 Uchikamado, Beppu, Oita 8740011, Japan.
| | - Mitsuhiro Anan
- Department of Neurosurgery, National Hospital Organization Beppu Medical Center, 1473 Uchikamado, Beppu, Oita 8740011, Japan
| | - Minoru Fujiki
- Department of Neurosurgery, Oita University Faculty of Medicine, 1-1 Idaigaoka Hasama-machi, Yufu, Oita 8795593, Japan
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10
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Yamada E, Ito Y, Nakai Y, Uemura K, Ishikawa E, Matsumura A. Infant Fistula-Type Arteriovenous Malformation with Cerebellar Hemorrhage Developed into Nidus-Type in Adolescence. World Neurosurg 2020; 136:205-207. [DOI: 10.1016/j.wneu.2020.01.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 01/12/2020] [Indexed: 11/28/2022]
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11
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Tasiou A, Tzerefos C, Alleyne CH, Boccardi E, Karlsson B, Kitchen N, Spetzler RF, Tolias CM, Fountas KN. Arteriovenous Malformations: Congenital or Acquired Lesions? World Neurosurg 2019; 134:e799-e807. [PMID: 31715403 DOI: 10.1016/j.wneu.2019.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/31/2019] [Accepted: 11/01/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Arteriovenous malformations (AVMs) were believed to be congenital. However, an increasing number of de novo AVM cases have questioned this doctrine. METHODS A consensus meeting of international experts attempted to establish a consensus on the nature of these relatively rare but challenging vascular lesions. In addition, an extensive search of the subject was performed using the PubMed medical database. RESULTS All participants agreed that genetic factors may play a role in the pathogenesis of AVMs. All but 1 participant believed that an underlying genetic predisposition may be detected later on in a patient's life, whereas genetic variations may contribute to sporadic AVM formation. The presence of genetic variations alone may not be enough for an AVM formation. A second hit is probably required. This consensus opinion is also supported by our literature search. CONCLUSIONS We discuss the literature on the genetics of AVMs and compare it with the consensus meeting outcomes. The congenital or noncongenital character of intracranial AVMs has an impact on the understanding their biological behavior, as well as their efficient short-term and long-term management.
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Affiliation(s)
- Anastasia Tasiou
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece.
| | - Christos Tzerefos
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
| | | | - Edoardo Boccardi
- Department of Diagnostic and Interventional Neuroradiology, Niguarda Hospital, Milan, Italy
| | - Bengt Karlsson
- Department of Surgery, Division of Neurosurgery, National University Hospital, Singapore
| | - Neil Kitchen
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Robert F Spetzler
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Christos M Tolias
- Department of Neurovascular Surgery, Kings College Hospital, London, United Kingdom
| | - Kostas N Fountas
- Department of Neurosurgery, University Hospital of Larissa, School of Medicine, University of Thessaly, Larissa, Greece
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12
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Gondar R, El Rahal A, Kulcsár Z, Schaller K, Momjian S. Spontaneous appearance of de novo intracranial arteriovenous malformation in hepatic cirrhosis. Neurochirurgie 2019; 65:393-396. [PMID: 31605684 DOI: 10.1016/j.neuchi.2019.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 08/23/2019] [Accepted: 09/22/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Intracranial arteriovenous malformations (AVMs) are rare lesions that can be congenital or acquired in early childhood, with fatal outcome in approximately 30% of cases. De novo formation during adulthood without established predisposing vascular pathology or previous brain insult is even less frequent. CASE DESCRIPTION We present a case of de novo brain AVM in an alcoholic Child-B cirrhosis setting. Thirty previously reported cases presented de novo AVM in patients of all ages that had another previous brain pathology or insult, such as AVM resection. Seventeen of those cases occurred in adult patients, with only 2 showing no significant predisposing factor. The present pathophysiological review covers and completes Mullan's hemodynamic "two-hit" model, associating probable thrombotic predisposition to AVM with brain insult triggering a later stage based on angiogenic stimuli. CONCLUSIONS This case report and literature review renews previously discussed hemodynamic theories and contributes to a fuller understanding of the pathogenesis and progression of AVM. We postulate a causal link between hepatopathy and de novo AVM, which should be strengthened and interpreted based on recent genetic data and future prospective studies.
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Affiliation(s)
- R Gondar
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland; Department of Spine Surgery and Neurosurgery, University of Fribourg, Hôpital Fribourgeois, Chemin des Pensionnats 2-6, 1700 Fribourg, Switzerland.
| | - A El Rahal
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland
| | - Z Kulcsár
- Interventional Neuroradiology Division, Department of Radiology and Medical Informatics, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland; Department of Neuroradiology, University Hospital of Zurich, Frauenklinikstraße 10, 8091 Zürich, Switzerland
| | - K Schaller
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland
| | - S Momjian
- Neurosurgery Division, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Medical Center, Geneva, Switzerland
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Karlsson B, Johansson AV, Yang HC, Jokura H, Yamamoto M, Martínez-Álvarez R, Kawagishi J, Guo WY, Beute G, Pan DHC, Chung WY, Söderman M, Aiyama H, Yeo TT. A novel method to determine the natural course of unruptured brain arteriovenous malformations without the need for follow-up information. J Neurosurg 2019; 129:10-16. [PMID: 30544301 DOI: 10.3171/2018.7.gks181278] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/11/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEThere is a strong clinical need to accurately determine the average annual hemorrhage risk in unruptured brain arteriovenous malformations (AVMs). This need motivated the present initiative to use data from a uniquely large patient population and design a novel methodology to achieve a risk determination with unprecedented accuracy. The authors also aimed to determine the impact of sex, pregnancy, AVM volume, and location on the risk for AVM rupture.METHODSThe present study does not consider any specific management of the AVMs, but only uses the age distribution for the first hemorrhage, the shape of which becomes universal for a sufficiently large set of patients. For this purpose, the authors collected observations, including age at first hemorrhage and AVM size and location, in 3425 patients. The average annual risk for hemorrhage could then be determined from the simple relation that the number of patients with their first hemorrhage at a specific age equals the risk for hemorrhage times the number of patients at risk at that age. For a subset of the patients, the information regarding occurrence of AVM hemorrhage after treatment of the first hemorrhage was used for further analysis of the influence on risk from AVM location and pregnancy.RESULTSThe age distribution for the first AVM hemorrhage was used to determine the average annual risk for hemorrhage in unruptured AVMs at adult ages (25-60 years). It was concluded to be 3.1% ± 0.2% and unrelated to AVM volume but influenced by its location, with the highest risk for centrally located AVMs. The hemorrhage risk was found to be significantly higher for females in their fertile years.CONCLUSIONSThe present methodology allowed the authors to determine the average annual risk for the first AVM hemorrhage at 3.1% ± 0.2% without the need for individual patient follow-up. This methodology has potential also for other similar types of investigations. The conclusion that centrally located AVMs carry a higher risk was confirmed by follow-up information. Follow-up information was also used to conclude that pregnancy causes a substantially greater AVM hemorrhage risk. The age distribution for AVM hemorrhage is incompatible with AVMs present at birth having the same hemorrhage risk as AVMs in adults. Plausibly, they instead develop in the early years of life, possibly with a lower hemorrhage risk during that time period.
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Affiliation(s)
- Bengt Karlsson
- 1Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
| | - Arne V Johansson
- 2Department of Mechanics, KTH Royal Institute of Technology, Stockholm, Sweden
| | | | - Hidefumi Jokura
- 4Jiro Suzuki Memorial Gamma House, Furukawa Seiryo Hospital, Osaki, Japan
| | | | | | - Jun Kawagishi
- 4Jiro Suzuki Memorial Gamma House, Furukawa Seiryo Hospital, Osaki, Japan
| | - Wan-Yuo Guo
- 9Radiology, Veterans General Hospital, Taipei, Taiwan
| | - Guus Beute
- 7ETZ Elizabeth, Tilburg, The Netherlands; and
| | | | | | | | | | - Tseng Tsai Yeo
- 1Division of Neurosurgery, Department of Surgery, National University Hospital, Singapore
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De Novo Formation of Direct Arteriovenous Fistula Involving Anterior Communicating Artery Aneurysm in Remote Site from Prior Ruptured Arteriovenous Malformation in Pediatric Patient: Case Report and Review of Literature. World Neurosurg 2019; 126:252-256. [PMID: 30878757 DOI: 10.1016/j.wneu.2019.02.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND De novo formation of arteriovenous malformations (AVMs) and arteriovenous fistulas (AVFs) is increasingly being reported in the neurosurgical literature, challenging the notion that AVMs are congenital in origin. Most of this literature centers around the pediatric population. After treatment of an AVM or AVF, recurrence, if any, appears to occur locally to the original insult. We present, to the best of our knowledge, the first case of a de novo direct AVF involving an anterior communicating artery aneurysm in a remote site from a prior ruptured AVM in a pediatric patient. CASE DESCRIPTION We present a case of a 14-year-old female who presented 2 years prior with an intraparenchymal hemorrhage secondary to a left parietal arteriovenous malformation. That AVM was successfully microsurgically resected and revealed complete angiographic obliteration on postoperative and surveillance angiograms. This patient now presents with a spontaneous intraventricular hemorrhage secondary to a ruptured anterior communicating artery complex aneurysm with a fistulous connection from this aneurysm to the inferior petrosal sinus. The aneurysm and direct AVF were not identified on prior surveillance imaging, indicating de novo formation in a remote site from her prior AVM. CONCLUSIONS This case highlights the importance of long-term imaging surveillance in patients with AVMs. Further prospective studies are indicated to evaluate the long-term imaging surveillance necessary to detect early recurrence, thereby allowing doctors to institute earlier definitive treatment. The exact pathophysiology behind these lesions is not fully understood; however, this case lends support to an acquired etiology to vascular malformations.
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De novo brain arteriovenous malformation after tumor resection: case report and literature review. Acta Neurochir (Wien) 2018; 160:2191-2197. [PMID: 30206686 DOI: 10.1007/s00701-018-3668-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/31/2018] [Indexed: 02/03/2023]
Abstract
The congenital origin of brain arteriovenous malformations (bAVMs) has been increasingly challenged by reports of de novo bAVMs in patients previously confirmed to have no vascular malformation. We describe the oldest patient reported in the English language literature harboring a de novo bAVM. An uneventful frontal convexity meningioma resection was performed for a 60-year-old woman, and at 67 years of age, a bAVM was detected by MRI and confirmed by digital subtraction angiography at the site of the previous meningioma resection. This case adds to the growing literature that the etiology of bAVMs is most likely multifactorial.
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Dalton A, Dobson G, Prasad M, Mukerji N. De novo intracerebral arteriovenous malformations and a review of the theories of their formation. Br J Neurosurg 2018; 32:305-311. [DOI: 10.1080/02688697.2018.1478060] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- A. Dalton
- James Cook University Hospital, Middlesbrough, UK
| | - G. Dobson
- James Cook University Hospital, Middlesbrough, UK
| | - M. Prasad
- James Cook University Hospital, Middlesbrough, UK
| | - N. Mukerji
- James Cook University Hospital, Middlesbrough, UK
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Lv X, Wang G. Review of de novo cerebral arteriovenous malformation: haemorrhage risk, treatment approaches and outcomes. Neuroradiol J 2018; 31:224-229. [PMID: 29469668 PMCID: PMC5958505 DOI: 10.1177/1971400918759811] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective A small number of patients has been reported to develop a completely new or de novo arteriovenous malformation (AVM) after brain surgery, haemorrhage, head trauma or ischaemic stroke. The natural history of these lesions is unknown. In this review, both ruptured and unruptured de novo AVMs and their treatments were reviewed. Methods Published literature in the PubMed database citing 'de novo cerebral arteriovenous malformation' was reviewed. Additional studies were identified through reference searches in each reviewed article. A review was performed using all published cases, the treatment approaches and outcomes. Results A total of 38 patients, including 37 de novo AVMs reported from 1988 to 17 November 2017 and our one patient, was collected. The age at AVM diagnosis was 5-73 years (mean ± SD, 27.6 ± 20.5 years). The duration time, from negative examination to AVM diagnosis, was 2 months to 25 years (mean ± SD, 6.6 ± 4.9 years). The presentation of de novo AVM was headaches in three (7.9%) patients, bleedings in 12 (31.6%), incidental in 14 (36.8%) and seizure in nine (23.7%). The estimated risk of haemorrhage was 4.8% per year. Seventeen (44.7%) patients were treated with surgical resection, 10 (26.3%) were conservatively observed, nine (23.7%) were treated with radiosurgery and two (5.3%) were endovascularly embolised. The morbidity and mortality were reported as 5.3% and 7.9%, respectively. Conclusion Post-natal de novo AVMs have been reported. Their annual haemorrhage risk is 4.8%. Most of them are treated by surgical resection and are associated with morbidity and mortality.
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Affiliation(s)
| | - Guihuai Wang
- Guihuai Wang, Neurosurgery Department, Beijing Tsinghua Changgung Hospital, Tsinghua University, Changping, Litanglu 168, Beijing 102218, China.
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Radiosurgery reduces plasma levels of angiogenic factors in brain arteriovenous malformation patients. Brain Res Bull 2018; 140:220-225. [PMID: 29752992 DOI: 10.1016/j.brainresbull.2018.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/19/2018] [Accepted: 05/07/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE Aberrant expression of angiogenic factors has been anecdotally documented in brain arteriovenous malformation (AVM) nidus vessels; however, no data is available on the effect of radiosurgery on the levels of angiogenic factors in AVM patients. We sought to determine the plasma contents of VEGF, TGF-β, Ang-2 and bFGF in 28 brain AVM patients at baseline and post radiosurgery and further analyzed the relationship between plasma contents of these angiogenic factors with clinicopathologic variables of these patients. METHODS We enrolled brain AVM patients who underwent Cyberknife radiosurgery at our hospital between January 2014 and December 2015. Brain AVM was confirmed by cerebral angiography and radiosurgery was performed with Cyberknife irradiation. Plasma contents of VEGF, TGF-β, Ang-2 and bFGF were analyzed using commercially available enzyme-linked immunoassay (ELISA) kits. RESULTS The baseline plasma VEGF content was 222.63 pg/mL (range 43.25-431.25 pg/mL). At three months post surgery, there was a significant -34.29% decline in plasma VEGF content versus baseline (P = 0.000). Furthermore, the median baseline plasma VEGF levels were higher in brain AVM with a nidus volume ≥ 10 cm3) than those with a nidus volume < 10 cm3 [median(IQR) 293.5 (186.5,359.25) vs. 202 (59.75, 270.75) pg/mL, P = 0.057]. The baseline plasma TGF-β content was 556.17 pg/mL (range 44.44-1486.11 pg/mL) and there was a significant -27.47% decline in plasma TGF-β content at 3 months post radiosurgery versus baseline (P = 0.015). Moreover, the baseline plasma ANG-2 content was 214.27 pg/mL (range 77.14-453.76 pg/mL). There was an immediate and significant -12.47% decline in plasma ANG-2 content post surgery versus baseline (P = 0.002). At three months post surgery, the plasma ANG-2 content still remained significantly depressed versus baseline (P = 0.002). In addition, the baseline plasma bFGF content was 9.17 pg/mL (range 3.67-36.78 pg/mL). No significant difference in plasma bFGF content was observed immediately post surgery and 3 months post surgery versus baseline (P = 0.05). CONCLUSIONS Radiosurgery for brain AVM patients significantly reduced the plasma levels of angiogenic factors. The plasma angiogenic factors may be candidate markers for aberrant agniogenesis of brain AVM and patient response to radiosurgery.
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Santos R, Aguilar-Salinas P, Entwistle JJ, Aldana PR, Beier AD, Hanel RA. De Novo Arteriovenous Malformation in a Pediatric Patient: Case Report and Review of the Literature. World Neurosurg 2018; 111:341-345. [DOI: 10.1016/j.wneu.2017.12.145] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 12/17/2022]
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Derdeyn CP, Zipfel GJ, Albuquerque FC, Cooke DL, Feldmann E, Sheehan JP, Torner JC. Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2017. [DOI: 10.1161/str.0000000000000134] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bongetta D, Zoia C, Lafe E, Gaetani P. Could Thalidomide Be a Treatment Option for Arteriovenous Malformations? World Neurosurg 2017; 99:802. [DOI: 10.1016/j.wneu.2016.10.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 10/12/2016] [Indexed: 10/19/2022]
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