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Iampreechakul P, Wangtanaphat K, Wattanasen Y, Hangsapruek S, Lertbutsayanukul P, Siriwimonmas S. Long-term surveillance in an infant with spontaneous obliteration of pial arteriovenous malformation and large intranidal aneurysm: A unique case observation. Surg Neurol Int 2024; 15:206. [PMID: 38974548 PMCID: PMC11225396 DOI: 10.25259/sni_45_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/23/2024] [Indexed: 07/09/2024] Open
Abstract
Background Spontaneous obliteration of untreated cerebral arteriovenous malformations (AVMs) is rare, occurring in <1% of cases, and is even less common in pediatric populations. The mechanisms driving spontaneous regression of brain AVMs remain poorly understood, and long-term surveillance in pediatric patients is infrequently documented. Case Description The authors reported a remarkably rare instance of spontaneous thrombosis in a pial AVM accompanied by a large intranidal aneurysm in a 10-month-old infant, initially presenting with a nocturnal seizure. Diagnostic imaging revealed a ruptured intranidal aneurysm causing acute hemorrhage in the left anterior interhemispheric subdural space, extending into adjacent areas. Further, magnetic resonance imaging (MRI) and magnetic resonance angiography delineated the AVM in the left superior frontal gyrus, associated with a thrombosed aneurysm and surrounding edema. Cerebral angiography confirmed the AVM's origin from the left anterior cerebral artery, displaying early venous drainage and small, indirect feeders not amenable to endovascular treatment. Over time, serial imaging showed the aneurysm's transition from partial to complete thrombosis. Subsequent MRIs and angiographic assessments up to age 10 confirmed complete resolution of the AVM and aneurysm, with focal hyperemia persisted until age 16, when recurrent AVM was identified. Conclusion We document a rare spontaneous regression of a pial AVM with an intranidal aneurysm influenced by specific vascular factors. Despite this, spontaneous thrombosis should not replace vigilant long-term monitoring in pediatric neurovascular care.
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Affiliation(s)
| | | | - Yodkhwan Wattanasen
- Department of Neuroradiology, Neurological Institute of Thailand, Bangkok, Thailand
| | - Sunisa Hangsapruek
- Department of Neuroradiology, Neurological Institute of Thailand, Bangkok, Thailand
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Milazzo N, Pizzuto S, Gratieux J, Sgreccia A, Di Maria F, Coskun O, Condette-Auliac S, Boulin A, Rodesch G, Consoli A. A case of spontaneous brain arteriovenous malformation occlusion: Imaging analysis and clinical debate. Interv Neuroradiol 2024:15910199231226142. [PMID: 38418386 DOI: 10.1177/15910199231226142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
The spontaneous occlusion of brain arteriovenous malformations (bAVMs) is a rare event, particularly for unruptured ones. Associated factors include single-venous drainage and small nidus size. Most of the previously reported cases were ruptured bAVMs. We report the case of a middle-aged male patient with an unruptured, rolandic, left-sided bAVM associated with a 30-year history of refractory epilepsy. We documented the spontaneous thrombosis of the venous drainage of the AVM without any sign of bleeding. Finally, we underline the difference between ruptured-induced occlusion and truly spontaneous thrombosis of the bAVMs.
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Affiliation(s)
- Nicola Milazzo
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
- Neuroradiology Unit, Department of Biomedical Sciences and Morphological and Functional Images, Azienda Ospedaliera Universitaria Policlinico G Martino, Messina, Italy
| | - Silvia Pizzuto
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
| | - Julie Gratieux
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
| | - Alessandro Sgreccia
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
| | - Federico Di Maria
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
| | - Oghuzan Coskun
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
| | | | - Anne Boulin
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
| | - Georges Rodesch
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
| | - Arturo Consoli
- Department of Therapeutic and Interventional Neuroradiology, Hospital Foch, Suresnes, France
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Yindeedej V, Duangprasert G, Noiphithak R, Nimmannitya P, Punyarat P, Tantongtip D, Thamwongskul C. Bleeding pediatric AVM with negative pre-operative angiography: the first case report. Childs Nerv Syst 2023; 39:3327-3331. [PMID: 37380926 DOI: 10.1007/s00381-023-06055-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 06/22/2023] [Indexed: 06/30/2023]
Abstract
INTRODUCTION Pediatric arteriovenous malformation (pAVM) is one of the most common vascular entities in non-traumatic intracerebral hemorrhage (ICH) in children. To diagnose arteriovenous malformation (AVM), digital subtraction angiography (DSA) is the gold standard investigation because it can provide sufficient dynamic information about the AVM. In extremely rare occasions, angiography is unable to detect an AVM because the AVM is spontaneously occluded. All reported cases found by authors in the literature had already been diagnosed with AVM by angiography or other vascular studies before the AVM occlusion. CASE PRESENTATION We present a case of a 4-year-old girl who presented with left occipital ICH with atypical calcification. Based on history and investigation, pAVM was the most likely diagnosis. However, preoperative angiography was negative for pAVM and for shunting. Bleeding tumor was then suspected instead. After resection, pathological diagnosis confirmed pAVM. CONCLUSION Our case demonstrates that DSA, despite being considered the gold standard, cannot always diagnose pAVM. The mechanism of spontaneous AVM occlusion remains unknown.
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Affiliation(s)
- Vich Yindeedej
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
| | - Gahn Duangprasert
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Raywat Noiphithak
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Pree Nimmannitya
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Prachya Punyarat
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Dilok Tantongtip
- Division of Neurosurgery, Department of Surgery, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Chatchai Thamwongskul
- Department of Pathology, Thammasat University Hospital, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
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Asymptomatic partial regression of cerebral arteriovenous malformation without treatment: Case report and literature review. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Liew JA, Yang W, Mashouf LA, Li S, Caplan JM, Tamargo RJ, Huang J. Incidence of Spontaneous Obliteration in Untreated Brain Arteriovenous Malformations. Neurosurgery 2019; 86:139-149. [DOI: 10.1093/neuros/nyz047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 01/31/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Spontaneous obliteration (SpO) of untreated arteriovenous malformations (AVMs) is rare with fewer than 100 cases reported. The incidence and predisposing factors of SpO remain unclear, impeding our understanding of lesion progression in untreated patients.
OBJECTIVE
To determine the incidence rate and predisposing factors of SpO in a North American cohort.
METHODS
AVMs were retrospectively evaluated at our institution for over 25 yr. Untreated AVMs were divided into 2 groups: SpO-AVMs and non-SpO-AVMs. All statistical results were based on univariate analyses. Incidence was generated from counts of SpO over the untreated interval in patient years from birth until obliteration, treatment, or last follow-up.
RESULTS
One hundred fifty-four patients had untreated AVMs; SpO was observed in 4. Average ages were 49.0 ± 23.6 and 48.7 ± 20.4 yr in the SpO-AVM and non-SpO-AVM group, respectively (P = .98). Average AVM sizes were 2.0 ± 1.8 cm (SpO-AVMs) and 3.7 ± 2.6 cm (non-SpO-AVMs, P = .25). All SpO-AVMs and 40 (27.0%) non-SpO-AVMs had a ruptured presentation (P = .006). A single draining vein was observed in all SpO-AVMs and 39 (32.8%) non-SpO-AVMs (P = .01). Deep venous drainage was not observed in any SpO-AVMs, but in 81 (57.9%) non-SpO-AVMs (P = .04). Mean follow-up time was 37.0 ± 42.6 and 75.6 ± 161.7 mo in SpO-AVM and non-SpO-AVMs patients, respectively. Of the 2 SpO-AVM patients with postobliteration follow-up, 1 experienced recanalization. From a 672-patient cohort, the incidence of SpO over 28 961 patient years was 0.014%.
CONCLUSION
SpO-AVMs have an annual incidence rate of approximately 0.014% and tend to present with rupture, a single draining vein, and superficial venous drainage. Expectation of SpO for untreated AVMs is not justified, and patients should anticipate life-long hemorrhagic risk for untreated AVMs.
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Affiliation(s)
- Jason A Liew
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wuyang Yang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Leila A Mashouf
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Justin M Caplan
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Cuoco JA, Hoehmann CL, Hitscherich K, Zakhary SM, Leheste JR, Torres G. Linking Brain Arteriovenous Malformations With Anorectal Hemorrhoids: A Clinical and Anatomical Review. Anat Rec (Hoboken) 2017; 300:1973-1980. [PMID: 28696502 PMCID: PMC5655777 DOI: 10.1002/ar.23643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 02/24/2017] [Accepted: 03/03/2017] [Indexed: 12/29/2022]
Abstract
Patients who harbor brain arteriovenous malformations are at risk for intracranial hemorrhage. These malformations are often seen in inherited vascular diseases such as hereditary hemorrhagic telangiectasia. However, malformations within the brain also sporadically occur without a hereditary-coding component. Here, we review recent insights into the pathophysiology of arteriovenous malformations, in particular, certain signaling pathways that might underlie endothelial cell pathology. To better interpret the origins, determinants and consequences of brain arteriovenous malformations, we present a clinical case to illustrate the phenotypic landscape of the disease. We also propose that brain arteriovenous malformations might share certain signaling dimensions with those of anorectal hemorrhoids. This working hypothesis provides casual anchors from which to understand vascular diseases characterized by arteriovenous lesions with a hemorrhagic- or bleeding-risk component. Anat Rec, 2017. © The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association of Anatomists. Anat Rec, 300:1973-1980, 2017. © 2017 The Authors. The Anatomical Record published by Wiley Periodicals, Inc. on behalf of American Association of Anatomists.
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Affiliation(s)
- Joshua A. Cuoco
- Department of Biomedical SciencesNew York Institute of Technology College of Osteopathic MedicineOld WestburyNew York
| | - Christopher L. Hoehmann
- Department of AnatomyNew York Institute of Technology College of Osteopathic MedicineOld WestburyNew York
| | - Kyle Hitscherich
- Department of Biomedical SciencesNew York Institute of Technology College of Osteopathic MedicineOld WestburyNew York
| | - Sherry M. Zakhary
- Department of RadiologyBrookhaven Memorial Hospital Medical CenterPatchogueNew York
| | - Joerg R. Leheste
- Department of Biomedical SciencesNew York Institute of Technology College of Osteopathic MedicineOld WestburyNew York
| | - German Torres
- Department of Biomedical SciencesNew York Institute of Technology College of Osteopathic MedicineOld WestburyNew York
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Cai J, Lin H, Li S, Zou Z, Zhang Y, Liu S, Chen X, Bai X. Dormant micro arteriovenous malformations lead to recurrent cerebral haemorrhage. SPRINGERPLUS 2016; 5:1054. [PMID: 27462502 PMCID: PMC4940323 DOI: 10.1186/s40064-016-2615-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/17/2016] [Indexed: 12/02/2022]
Abstract
Introduction Some micro arteriovenous malformations (AVMs) located in deep brain are undetectable. How to choose a proper timing to detect these AVMs remains unclear. Case description A 21-year-old male patient was admitted to our center for intraventricular haematoma. Digital subtraction angiographies (DSAs) were performed one week and one month respectively after his haemorrhage, but no positive results were obtained. The patient was hospitalized for re-haemorrhage six years later. A micro AVM with two diffused niduses was detected and embolised three months after his re-haemorrhage. The patient recovered without any neurological deficit. Discussion and evaluation Compressive effects of haematoma and spontaneous obliteration of AVMs might play pivotal roles in negative DSA results. Conclusions Strategic and timely use of DSA could identify some dormant re-haemorrhagic AVMs. Electronic supplementary material The online version of this article (doi:10.1186/s40064-016-2615-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jun Cai
- Department of Neurosurgery, Hospital of Guangzhou University Mega Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510006 China
| | - Hao Lin
- Department of Neurosurgery, Hospital of Guangzhou University Mega Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510006 China
| | - Shaoxue Li
- Department of Neurosurgery, Hospital of Guangzhou University Mega Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510006 China
| | - Zhimin Zou
- Department of Neurosurgery, Hospital of Guangzhou University Mega Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510006 China
| | - Yanting Zhang
- Department of Neurosurgery, Hospital of Guangzhou University Mega Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510006 China
| | - Shiwan Liu
- Department of Neurosurgery, Hospital of Guangzhou University Mega Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510006 China
| | - Xin Chen
- Department of Radiology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510120 China
| | - Xiaoxin Bai
- Department of Neurosurgery, Hospital of Guangzhou University Mega Center, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, 510006 China
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