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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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Zeleňák K, Šalát D, Kolarovszki B, Kurča E, Zeleňáková J, Koçer N. Embolization of Ruptured Infratentorial Pial AVM in Pregnancy. Life (Basel) 2023; 13:life13040896. [PMID: 37109425 PMCID: PMC10144631 DOI: 10.3390/life13040896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/12/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
A primigravida 22-year-old woman, at a gestation of 23 weeks, experienced bleeding from a pial arteriovenous malformation (AVM) located in the right cerebellum. After interdisciplinary consensus and with the informed consent of the patient and her family, AVM embolization was performed. Complete occlusion of the AVM was achieved by embolization with PHIL (precipitating hydrophobic injectable liquid). The calculated dose in the uterus was less than 1 µSv, which represents a negligible risk of harmful effects on the fetus. She delivered a baby at 37 weeks of gestation by cesarean section without complications. No congenital disorders were diagnosed by standard screening methods until the age of the newborn was two years. The angiography protocol must be optimized to minimize the radiation dose. Adequate shielding protection of the uterus is important. Premature termination of pregnancy is not necessary. Multidisciplinary care of neurologists, neurosurgeons, interventional radiologists, anesthesiologists, neonatologists, and obstetricians is necessary.
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Park H, Koh EJ, Lee EJ, Cheon JE, Kim SK. An acquired cerebral arteriovenous malformation after brain abscess treatment: case report and a review of the literature. Childs Nerv Syst 2021; 37:2923-2926. [PMID: 33502542 DOI: 10.1007/s00381-021-05050-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
A cerebral arteriovenous malformation (AVM) is a congenital and static disease. However, there are increasing reports of acquired AVMs. The pathophysiology of an acquired AVM has not been fully elucidated but the suggested pathophysiology is a combination of genetic abnormalities and inflammatory cytokines caused by previous brain insults. We report a patient who developed an acquired AVM after the treatment for a brain abscess. She underwent Gamma Knife surgery to treat the acquired AVM. It is necessary to understand the characteristics of acquired AVMs and to further research acquired AVMs.
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Affiliation(s)
- Hangeul Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Eun Jung Koh
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.,Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Eun Jung Lee
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jung-Eun Cheon
- Division of Pediatric Radiology, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, South Korea
| | - Seung-Ki Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.
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Park H, Lee EJ, Cheon JE, Kim JE, Kang HS, Kim SK. Clinical Features and Treatment Outcomes of Cerebral Arteriovenous Malformation Associated With Moyamoya Disease. World Neurosurg 2021; 154:e633-e640. [PMID: 34329751 DOI: 10.1016/j.wneu.2021.07.100] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cerebral arteriovenous malformation (AVM) can rarely occur in conjunction with moyamoya disease (MMD). There is still no consensus on how to treat AVM when accompanied by MMD. In this study, we assessed the clinical features and suggested appropriate management when AVM was combined with MMD. METHODS From August 1994 to December 2020, 7 out of 4004 patients with MMD were found to have AVM. The Karnofsky Performance Scale (KPS) was used to evaluate the clinical outcomes of AVM and MMD. KPS greater than 80 was classified as a good outcome. In addition, the radiologic outcomes of the patients were evaluated. RESULTS The incidence of AVM with MMD was 1.7 per 1000 persons. Five patients underwent bypass surgery for MMD, and 5 patients underwent Gamma Knife surgery (GKS) for concurrent AVM. Postoperative perfusion magnetic resonance imaging and brain single photon emission computerized tomography showed improved cerebral hemodynamics in 4 out of 7 territories. Postoperative cerebral angiography showed good revascularization in 4 out of 8 territories. After GKS, 4 patients showed complete obliteration, and 1 patient showed a significantly decreased AVM size. Six patients showed favorable clinical outcomes (KPS 80-100), and 1 patient with delayed GKS for AVM had a poor outcome (KPS 20) due to AVM rupture. CONCLUSIONS In this study, AVM tended to occur where the angiographic stage of MMD was higher. When AVM is combined with MMD, MMD bypass surgery is recommended based on symptoms and cerebral perfusion status. For AVM, less invasive but effective treatments, such as GKS, should be implemented as soon as possible.
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Affiliation(s)
- Hangeul Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun Jung Lee
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Eun Cheon
- Division of Pediatric Radiology, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Jeong Eun Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyun-Seung Kang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Ki Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Division of Pediatric Neurosurgery, Seoul National University Children's Hospital, Seoul, Republic of Korea.
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Guest W, Krings T. Brain Arteriovenous Malformations: The Role of Imaging in Treatment Planning and Monitoring Response. Neuroimaging Clin N Am 2021; 31:205-222. [PMID: 33902875 DOI: 10.1016/j.nic.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Brain arteriovenous malformations (AVMs) are characterized by shunting between pial arteries and cortical or deep veins, with the presence of an intervening nidus of tortuous blood vessels. These lesions present a therapeutic challenge, because their natural history entails a risk of intracranial hemorrhage, but treatment may cause significant morbidity. In this article, imaging features of AVMs on MR imaging and catheter angiography are reviewed to stratify the risk of hemorrhage and guide appropriate management. The angioarchitecture of AVMs may evolve over time, spontaneously or in response to treatment, necessitating ongoing imaging surveillance.
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Affiliation(s)
- Will Guest
- Department of Neuroradiology, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Timo Krings
- Department of Neuroradiology, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada.
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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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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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Lopez-Rivera V, Sheriff FG, Sandberg DI, Blackburn S, Dannenbaum M, Sheth SA, Day AL, Chen PR. De novo thalamic arteriovenous malformation in a boy with a brainstem cavernous malformation. J Clin Neurosci 2020; 76:226-228. [PMID: 32331948 DOI: 10.1016/j.jocn.2020.04.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/14/2020] [Indexed: 11/16/2022]
Abstract
Brain arteriovenous malformations (bAVMs) have long been considered to be congenital, developing between the third and eighth weeks of embryogenesis. However, cases reporting their de novo formation suggest that these lesions can develop after birth and have challenged this concept. We present a case of a 6-year-old boy with a history of a brainstem cavernous malformation diagnosed after birth who later developed a de novo bAVM. The de novo occurrence of this bAVM distant to the site of the cavernous malformation and a prior negative catheter angiography contributes to the uncertainty of the dynamics and pathophysiology of bAVMs.
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Affiliation(s)
- Victor Lopez-Rivera
- Departments of Neurology, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Faheem G Sheriff
- Departments of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - David I Sandberg
- Departments of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, United States; Departments of Division of Pediatric Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Spiros Blackburn
- Departments of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Mark Dannenbaum
- Departments of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Sunil A Sheth
- Departments of Neurology, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Arthur L Day
- Departments of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Peng Roc Chen
- Departments of Neurosurgery, University of Texas Health Science Center at Houston, Houston, TX, United States.
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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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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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