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Stanishevskiy A, Babichev K, Svistov D, Savello A, Abramyan A, Zelenskiy B. Coexistence of moyamoya syndrome with arteriovenous malformation. Systematic review and illustrative case report. J Clin Neurosci 2024; 121:34-41. [PMID: 38354649 DOI: 10.1016/j.jocn.2024.02.004] [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: 10/30/2023] [Revised: 01/19/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
The coexistence of Moyamoya Syndrome with Arteriovenous Malformation is exceedingly rare. Here, we present the case of a 37-year-old female patient diagnosed with AVM in the right parietal lobe, accompanied by severe stenosis of the right middle cerebral artery and right anterior cerebral artery, along with moyamoya collateral induction. Our objective was to investigate the frequency and mutual influence of these conditions, and to determine a preferable treatment strategy by conducting a comprehensive review of previous case reports. We conducted a thorough search of PubMed, Scopus, and Web of Science databases, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our review encompassed 36 publications, reporting a total of 64 cases of AVM coexisting with Moyamoya Syndrome. Notably, bilateral stenosis was observed in half of the cases. Among patients with unilateral stenosis, AVM was localized in the opposite hemisphere only in 2 cases. Treatment approaches varied, with 18 cases undergoing active treatment for both stenosis and AVM, 11 cases treating stenosis prior to AVM, 5 cases addressing AVM first, and 3 cases treating both AVM and stenosis simultaneously. Embolization, either standalone or supplemented by stereotactic radiosurgery, was employed in six cases. Stereotactic radiosurgery alone was utilized in 12 cases, while 15 patients underwent surgical removal of the AVM. Our findings provide valuable insights for neurosurgeons managing patients with concurrent AVM and Moyamoya Syndrome. The variety of treatment approaches observed in the literature underscores the complexity of these cases, emphasizing the need for individualized strategies. This information may guide future systematic reviews and meta-analyses, contributing to a better understanding of the optimal management of these rare coexisting vascular pathologies.
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Affiliation(s)
- Artem Stanishevskiy
- Department of Neurosurgery, Military Medical Academy named after S.M. Kirov, Saint-Petersburg, Russia.
| | - Konstantin Babichev
- Department of Neurosurgery, Military Medical Academy named after S.M. Kirov, Saint-Petersburg, Russia.
| | - Dmitriy Svistov
- Department of Neurosurgery, Military Medical Academy named after S.M. Kirov, Saint-Petersburg, Russia.
| | - Alexander Savello
- Department of Neurosurgery, Military Medical Academy named after S.M. Kirov, Saint-Petersburg, Russia
| | | | - Bogdan Zelenskiy
- Department of Neurosurgery, Military Medical Academy named after S.M. Kirov, Saint-Petersburg, Russia.
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2
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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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Hou K, Zhao Y, Chen X, Xu K, Yu J. Moyamoya disease concurrent with dural arteriovenous fistula: A case report and literature review. Exp Ther Med 2020; 20:161. [PMID: 33093899 PMCID: PMC7571339 DOI: 10.3892/etm.2020.9290] [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: 01/17/2020] [Accepted: 09/11/2020] [Indexed: 11/06/2022] Open
Abstract
Moyamoya disease (MMD) and dural arteriovenous fistula (DAVF) are two distinct types of intracranial lesion that share different pathogenic mechanisms. Under rare circumstances, patients with MMD have been reported to have concurrent DAVF. The present case study reports on a 47-year-old male admitted due to sudden headache. Head CT revealed hemorrhage of the right thalamus with ventricular extension. On CT angiography, the normal vasculature in the anterior and posterior circulation disappeared and was replaced by moyamoya-like vessels. The patient received conservative management and was discharged 3 days later. After three months, the patient was readmitted for acute cerebellar hemisphere infarction. Angiogram indicated that the DAVF (Cognard classification Ⅰ) was supplied by the left middle meningeal artery, occipital artery and posterior meningeal artery and drained into the transverse-sigmoid sinus and occipital sinus. Conservative management of the DAVF was adopted. The patient was stable and lived independently during a 4-year follow-up. A literature review of the reported cases was also performed to further characterize this rare entity. The management of DAVF concurrent with MMD depends on its clinical presentation and invasiveness. For patients with symptoms or cortical venous drainage, endovascular intervention should be performed. For asymptomatic DAVFs or those without cerebral venous drainage, close follow-up is a reasonable option.
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Affiliation(s)
- Kun Hou
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yuhao Zhao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Xuan Chen
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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4
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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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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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7
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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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8
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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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9
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Shidoh S, Kobayashi M, Akaji K, Kano T, Tanizaki Y, Mihara B. De Novo Arteriovenous Malformation after Aneurysm Clipping. NMC Case Rep J 2017; 4:89-92. [PMID: 28840086 PMCID: PMC5566691 DOI: 10.2176/nmccrj.cr.2016-0272] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/24/2017] [Indexed: 11/20/2022] Open
Abstract
We report a 73-year-old woman with de novo arteriovenous malformations (AVMs) that developed in the ipsilateral parietal lobe after craniotomy and aneurysm clipping. While intracerebral AVMs are considered to be congenital lesions, there have been several reported cases of acquired AVM arising after ischemic or traumatic episodes. We summarize previously reported cases of such acquired 'de novo' AVMs with a discussion of some pathophysiological responses or factors suggested to promote their development.
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Affiliation(s)
- Satoka Shidoh
- Department of Neurosurgery, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Gunma, Japan
| | - Masahito Kobayashi
- Department of Neurosurgery, Saitama Medical University, Iruma-gun, Saitama, Japan
| | - Kazunori Akaji
- Department of Neurosurgery, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Gunma, Japan
| | - Tadashige Kano
- Department of Neurosurgery, Gunma University, Gunma, Japan
| | - Yoshio Tanizaki
- Department of Neurosurgery, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Gunma, Japan
| | - Ban Mihara
- Department of Neurology, Institute of Brain and Blood Vessels, Mihara Memorial Hospital, Isesaki, Gunma, Japan
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10
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Shah A, Patni N, Ramdasi R, Goel A. Progression in size of an arterio-venous malformation. Asian J Neurosurg 2017; 12:207-210. [PMID: 28484532 PMCID: PMC5409368 DOI: 10.4103/1793-5482.145150] [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] [Indexed: 11/08/2022] Open
Abstract
We report a case of a young girl who was admitted with history of sudden onset left hemiplegia, when she was 5 years old. Investigations revealed no vascular malformation or abnormality. On conservative treatment, she progressively improved and had residual hemiparesis. She continued to have intermittent episodes of generalized and focal convulsions. For persistent convulsions, she was investigated again with MRI and angiography after 5 years of first presentation. Investigations at this time revealed a large arteriovenous malformation in the left posterior frontal region. The arteriovenous malformation was resected by surgery. Following surgery, the episodes of convulsions reduced. Arteriovenous malformations are generally considered to be congenital lesions and their size and physical architecture generally remains constant. The presented case clearly demonstrated de novo appearance or growth of the size of the arteriovenous malformation. Such a pattern of development and growth of a arteriovenous malformation is rare and only infrequently reported.
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Affiliation(s)
- Abhidha Shah
- Department of Neurosurgery, Seth G. S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India
| | - Neeraj Patni
- Department of Neurosurgery, Seth G. S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India
| | - Raghvendra Ramdasi
- Department of Neurosurgery, Seth G. S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India
| | - Atul Goel
- Department of Neurosurgery, Seth G. S. Medical College and K.E.M Hospital, Parel, Mumbai, Maharashtra, India
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Shi S, Gupta R, Moore JM, Griessenauer CJ, Adeeb N, Motiei-Langroudi R, Thomas AJ, Ogilvy CS. De novo AVM formation following venous sinus thrombosis and prior AVM resection in adults: report of 2 cases. J Neurosurg 2017; 128:506-510. [PMID: 28186446 DOI: 10.3171/2016.9.jns161710] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Brain arteriovenous malformations (AVMs) are traditionally considered congenital lesions, arising from aberrant vascular development during the intrauterine period. Rarely, however, AVMs develop in the postnatal period. Individual case reports of de novo AVM formation in both pediatric and adult patients have challenged the traditional dogma of a congenital origin. Instead, for these cases, a dynamic picture is emerging of AVM growth and development, initially triggered by ischemic and/or traumatic events, coupled with genetic predispositions. A number of pathophysiological descriptions involving aberrant angiogenic responses following trauma, hemorrhage, or inflammation have been proposed, although the exact etiology of these lesions remains to be elucidated. Here, the authors present 2 cases of de novo AVM formation in adult patients. The first case involves the development of an AVM following a venous sinus thrombosis and to the authors' knowledge is the first of its kind to be reported in the literature. They also present a case in which an elderly patient with a previously ruptured AVM developed a second AVM in the contralateral hemisphere 11 years later. In addition to presenting these cases, the authors propose a possible mechanism for de novo AVM development in adult patients following ischemic injury.
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12
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Koch MJ, Agarwalla PK, Stapleton CJ, Ogilvy CS, Loeffler JS. De novo development of a cerebral arteriovenous malformation following radiation therapy: Case report and an update to classical arteriovenous malformation nomenclature. J Clin Neurosci 2016; 28:162-7. [DOI: 10.1016/j.jocn.2015.11.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 11/29/2015] [Indexed: 12/27/2022]
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13
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Shimoda Y, Osanai T, Nakayama N, Ushikoshi S, Hokari M, Shichinohe H, Abumiya T, Kazumata K, Houkin K. De novo arteriovenous malformation in a patient with hereditary hemorrhagic telangiectasia. J Neurosurg Pediatr 2016; 17:330-5. [PMID: 26613274 DOI: 10.3171/2015.7.peds15245] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant systemic disorder characterized by the enlargement of capillaries, recurrent nosebleeds, and multiple arteriovenous malformations (AVMs). Although cerebral AVMs are traditionally considered to be congenital lesions, some reports have described de novo AVMs, which suggests that the authors believed them to be dynamic conditions. In this article, the authors describe the case of a 5-year-old boy with HHT in whom a de novo cerebral AVM was detected after a negative MRI result at 5 months. To the authors' knowledge, this is the first report of a de novo AVM in a patient with HHT. In patients with a family history of HHT, de novo AVMs are possible, even when no lesions are detected at the first screening. Therefore, regular screenings need to be performed, and the family should be informed that AVMs could still develop despite normal MRI results.
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Affiliation(s)
- Yusuke Shimoda
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine; and
| | - Toshiya Osanai
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine; and
| | - Naoki Nakayama
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine; and
| | - Satoshi Ushikoshi
- Department of Neurosurgery, Hokkaido Medical Center, Sapporo, Hokkaido, Japan
| | - Masaaki Hokari
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine; and
| | - Hideo Shichinohe
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine; and
| | - Takeo Abumiya
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine; and
| | - Ken Kazumata
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine; and
| | - Kiyohiro Houkin
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine; and
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Crimmins M, Gobin YP, Patsalides A, Knopman J. Therapeutic management of cerebral arteriovenous malformations: a review. Expert Rev Neurother 2015; 15:1433-44. [PMID: 26567441 DOI: 10.1586/14737175.2015.1079129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The therapeutic management of cerebral arteriovenous malformations has undergone significant change over the past 40 years. Embolization, radiosurgery, advanced imaging modalities, neuropsychological testing and advances in surgical technique has both significantly improved our ability to treat patients, as well as confounding the landscape as to what constitutes best medical practice. Variability in natural history provides additional challenges in that it is challenging to determine an accurate estimate of the risk of hemorrhage, morbidity and mortality. It is clear that the complexity of the treatment of these lesions demands a multidisciplinary approach. The need for a team of neurosurgeons, interventional and diagnostic neuroradiologists, neurologists, radiation oncologists and neuropsychologists will improve outcomes and aid in determining best therapy for patients.
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Affiliation(s)
- Michael Crimmins
- a Weill Cornell Medical Center - Neurosurgery , 525 East 68th Street Starr Pavilion, 10065 , NY , USA
| | - Y Pierre Gobin
- a Weill Cornell Medical Center - Neurosurgery , 525 East 68th Street Starr Pavilion, 10065 , NY , USA
| | - Athos Patsalides
- a Weill Cornell Medical Center - Neurosurgery , 525 East 68th Street Starr Pavilion, 10065 , NY , USA
| | - Jared Knopman
- a Weill Cornell Medical Center - Neurosurgery , 525 East 68th Street Starr Pavilion, 10065 , NY , USA
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15
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Lo Presti A, Weil AG, Fallah A, Peterson EC, Niazi TN, Bhatia S. Treatment of a cerebral pial arteriovenous fistula in a patient with sickle cell disease-related moyamoya syndrome: case report. J Neurosurg Pediatr 2015; 16:207-11. [PMID: 26053963 DOI: 10.3171/2014.12.peds14486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Sickle cell disease (SCD) is an autosomal recessive hematological disorder, characterized by sickling of the red blood cells in response to a hypoxic stress and vaso-occlusive crises. It is associated with moyamoya-like changes on cerebral angiographic imaging in 43% of patients. Cerebral aneurysms, arteriovenous malformations, and dural arteriovenous fistulas (AVFs) have been described in association with SCD and moyamoya disease. However, the description of a pial AVF (pAVF) in a patient with SCD and/or moyamoya formation has not yet been reported. The authors present the case of a 15-year-old boy with SCD-associated moyamoya disease harboring a pAVF who developed a de novo venous aneurysm 8 months after undergoing indirect superficial temporal artery-middle cerebral artery (MCA) bypass that was complicated by bilateral ischemia of the MCA territory. The pAVF was successfully treated with transarterial embolization using Onyx. The authors describe the possible pathophysiological mechanisms and management strategies for this rare occurrence.
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Affiliation(s)
- Anna Lo Presti
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Miami Children's Hospital, University of Miami/Miller School of Medicine
| | - Alexander G Weil
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Miami Children's Hospital, University of Miami/Miller School of Medicine
| | - Aria Fallah
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Miami Children's Hospital, University of Miami/Miller School of Medicine
| | - Eric C Peterson
- Division of Neuroendovascular Surgery, Department of Neurosurgery, University of Miami/Miller School of Medicine, Miami, Florida
| | - Toba N Niazi
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Miami Children's Hospital, University of Miami/Miller School of Medicine
| | - Sanjiv Bhatia
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Miami Children's Hospital, University of Miami/Miller School of Medicine
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16
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Neil JA, Li D, Stiefel MF, Hu YC. Symptomatic de novo arteriovenous malformation in an adult: Case report and review of the literature. Surg Neurol Int 2014; 5:148. [PMID: 25371848 PMCID: PMC4209707 DOI: 10.4103/2152-7806.142796] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 07/02/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Cerebral arteriovenous malformations (AVMs) have been long thought to be a congenital anomaly of vasculogenesis in which arteries and veins form direct connections forming a vascular nidus without an intervening capillary bed or neural tissue. Scattered case reports have described that AVMs may form de novo suggesting they can become an acquired lesion. CASE DESCRIPTION The current case report describes a patient who presented with new-onset seizures with an initial negative magnetic resonance imaging (MRI) of the brain and subsequently developed an AVM on a MRI 9 years later. CONCLUSION This case joins a small, but growing body of literature that challenges the notion that all AVMs are congenital.
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Affiliation(s)
- Jayson A Neil
- Department of Neurological Surgery, New York Medical College, Valhalla, New York, USA
| | - Daphne Li
- Department of Neurological Surgery, New York Medical College, Valhalla, New York, USA
| | - Michael F Stiefel
- Department of Neurological Surgery, New York Medical College, Valhalla, New York, USA
| | - Yin C Hu
- Department of Neurological Surgery, New York Medical College, Valhalla, New York, USA
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17
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Miller BA, Bass DI, Chern JJ. Development of a de novo arteriovenous malformation after severe traumatic brain injury. J Neurosurg Pediatr 2014; 14:418-20. [PMID: 25084086 DOI: 10.3171/2014.7.peds1431] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Arteriovenous malformations (AVMs) are typically considered congenital lesions, although there is growing evidence for de novo formation of these lesions as well. The authors present the case of an AVM in the same cerebral cortex that had been affected by a severe traumatic brain injury (TBI) more than 6 years earlier. To the best of the authors' knowledge, this is the first report attributing the formation of an AVM directly to TBI.
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Morales-Valero SF, Bortolotti C, Sturiale C, Lanzino G. Are parenchymal AVMs congenital lesions? Neurosurg Focus 2014; 37:E2. [DOI: 10.3171/2014.6.focus14234] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A long-held dogma in neurosurgery is that parenchymal arteriovenous malformations (AVMs) are congenital. However, there is no strong evidence supporting this theory. An increasing number of documented cases of de novo formation of parenchymal AVMs cast doubt on their congenital nature and suggest that indeed the majority of these lesions may form after birth. Further evidence suggesting the postnatal development of parenchymal AVMs comes from the exceedingly rare diagnosis of these lesions in utero despite the widespread availability of high-resolution imaging modalities such as ultrasound and fetal MRI. The exact mechanism of AVM formation has yet to be elucidated, but most likely involves genetic susceptibility and environmental triggering factors. In this review, the authors report 2 cases of de novo AVM formation and analyze the evidence suggesting that they represent an acquired condition.
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Affiliation(s)
- Saul F. Morales-Valero
- 1Department of Neurologic Surgery, Mayo Clinic, Mayo Medical School, Rochester, Minnesota; and
| | - Carlo Bortolotti
- 2Department of Neurosurgery, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Carmelo Sturiale
- 2Department of Neurosurgery, IRCCS Institute of Neurological Sciences, Bellaria Hospital, Bologna, Italy
| | - Giuseppe Lanzino
- 1Department of Neurologic Surgery, Mayo Clinic, Mayo Medical School, Rochester, Minnesota; and
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19
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Case report of a de novo brainstem arteriovenous malformation in an 18-year-old male and review of the literature. Neurosurg Rev 2014; 37:685-91. [DOI: 10.1007/s10143-014-0557-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 03/29/2014] [Accepted: 04/13/2014] [Indexed: 10/25/2022]
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20
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De novo cerebral arteriovenous malformations: is epileptic seizure a potential trigger? Childs Nerv Syst 2014; 30:1277-81. [PMID: 24714803 DOI: 10.1007/s00381-014-2413-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
Abstract
MATERIAL AND METHODS The pathogenesis of cerebral arteriovenous malformations (cAVMs) is still not well understood. Generally, cAVMs are thought to be congenital lesions originating prenatally. We report a 7-year-old boy diagnosed with a de novo cAVM after 3 years of recurrent epileptic seizures. RESULTS MR imaging at 4 years of age was normal. Follow-up MR imaging 3 years later demonstrated a de novo 2-cm cAVM in the right occipital lobe, confirmed by conventional angiography. We reviewed five previously reported cases of de novo cAVMs who did not have a previous neurovascular abnormality. Including our case, recurrent epileptic seizures are the major presentation (83.3 %) before de novo cAVM occurrence. CONCLUSION We suggest that epileptic seizure is a potential trigger of de novo cAVMs.
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Fujimura M, Kimura N, Ezura M, Niizuma K, Uenohara H, Tominaga T. Development of a de novo arteriovenous malformation after bilateral revascularization surgery in a child with moyamoya disease. J Neurosurg Pediatr 2014; 13:647-9. [PMID: 24745340 DOI: 10.3171/2014.3.peds13610] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The development of a de novo arteriovenous malformation (AVM) in patients with moyamoya disease is extremely rare. A 14-year-old girl developed an AVM in the right occipital lobe during the 4-year postoperative period following successful bilateral revascularization surgeries. She suffered a transient ischemic attack with hemodynamic compromise of the bilateral hemispheres at the age of 10 years. Results of an initial examination by 1.5-T MRI and MR angiography satisfied the diagnostic criteria of moyamoya disease but failed to detect any vascular malformation. Bilateral direct and indirect revascularization surgeries in the anterior circulation relieved her symptoms, and she underwent MRI and MR angiography follow-up every year after surgery. Serial T2-weighted MRI revealed the gradual appearance of flow voids in the right occipital lobe during the follow-up period. Magnetic resonance angiography ultimately indicated the development of an AVM 4 years after these surgeries when catheter angiography confirmed the diagnosis of an AVM in the right occipital lobe. The AVM remained asymptomatic, and the patient remained free of cerebrovascular events during the time she was observed by the authors. Acquired AVM in moyamoya disease is extremely rare, with only 3 pediatric cases including the present case being reported in the literature. The development of a de novo AVM in a postoperative patient with moyamoya disease appears to be unique, and this case may provide insight into the dynamic pathology of AVMs.
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Affiliation(s)
- Miki Fujimura
- Department of Neurosurgery, Tohoku University Graduate School of Medicine; and
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22
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Alvarez H, Perry V, Solle M, Castillo M. De novo cerebral arteriovenous malformation in a child with previous cavernous malformation and developmental venous anomaly. J Neurosurg Pediatr 2012; 9:327-30. [PMID: 22380963 DOI: 10.3171/2011.12.peds11312] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although cerebral vascular malformations are traditionally considered to be congenital lesions, they often become clinically evident in the 3rd to 4th decades of life, leading to the assumption of a long silent clinical period. Unlike vein of Galen malformations, antenatal diagnosis of cerebral arteriovenous malformations (AVMs) is highly uncommon. Postnatal development of an AVM is an emergent concept supported by more clinical observations. Genetic and biological studies demonstrate that an environmental trigger ("second hit") in addition to genetic predisposition may be a key in understanding the pathophysiology of AVMs and other cerebral vascular lesions such as cavernous malformations (CMs). The authors describe a 6-year-old boy in whom a giant CM was diagnosed and a de novo AVM was detected 25 months after initial resection of the CM. This case seems to support the second-hit hypothesis.
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Affiliation(s)
- Hortensia Alvarez
- Division of Interventional Neuroradiology, University of North Carolina at Chapel Hill, NC, USA.
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23
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Yashar P, Amar AP, Giannotta SL, Yu C, Pagnini PG, Liu CY, Apuzzo MLJ. Cerebral arteriovenous malformations: issues of the interplay between stereotactic radiosurgery and endovascular surgical therapy. World Neurosurg 2011; 75:638-47. [PMID: 21704930 DOI: 10.1016/j.wneu.2011.01.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 01/25/2011] [Accepted: 01/28/2011] [Indexed: 11/25/2022]
Abstract
Intracranial arteriovenous malformations (AVMs) are congenital lesions frequently diagnosed as a result of hemorrhage or other neurological symptoms. Prevention of such devastating neurological injury has promoted a variety of treatment strategies. The rich history of multimodal therapy in the treatment of AVMs includes microsurgery, endovascular embolization, and stereotactic radiosurgery (SRS). This article reviews the biology and natural history of AVMs, as well as their treatment with both SRS and endovascular neurosurgery. It considers various paradigms and goals of endovascular treatment, along with relevant issues such as the features of an AVM to be targeted. Issues of the interplay between SRS and endovascular neurosurgery include the compartments of an embolized AVM to contain within the radiosurgery plan, the radioprotective and radiosensitizing effects of the embolic agent, the durability of embolization, and the sequencing of embolization with respect to the radiosurgical treatment. Published literature on these topics is sparse, and the flimsiness of the data offers limited guidance.
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Affiliation(s)
- Parham Yashar
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
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24
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O'Lynnger TM, Al-Holou WN, Gemmete JJ, Pandey AS, Thompson BG, Garton HJL, Maher CO. The effect of age on arteriovenous malformations in children and young adults undergoing magnetic resonance imaging. Childs Nerv Syst 2011; 27:1273-9. [PMID: 21442267 DOI: 10.1007/s00381-011-1434-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 03/08/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Arteriovenous malformations (AVMs) are the most frequently encountered structural cause of spontaneous intracerebral hemorrhage in childhood, excluding hemorrhages of prematurity. The goal of our study was to examine the relationship between age and AVM prevalence on imaging in children, which to date has not been well described. METHODS We queried the electronic and radiographic records of 14,936 consecutive patients aged 25 years or less who had undergone brain magnetic resonance imaging (MRI) at a single institution over an 11-year period to identify those with a cerebral AVM. We collected age, gender, and other demographic characteristics for all patients. For all patients with a cerebral AVM, we recorded the location, size, drainage pattern, Spetzler-Martin grade, medical history, and presence of neurological symptoms. RESULTS Cerebral AVMs were identified in 55 patients (0.37%). The prevalence of AVMs detected on MRI significantly increased with age (p = 0.001). AVMs were found in 0.34% of boys (25 of 7,447) and 0.40% of girls (30 of 7,489). AVMs were most commonly identified in the frontal lobes (36%), followed by parietal (20%) and temporal lobes (13%). Sixty percent (n = 33) of AVMs were less than 3 cm in size, 35% (n = 19) were 3-6 cm in size, and 5.5% (n = 3) were greater than 6 cm in size. As for Spetzler-Martin grade of the AVMs, 25.5% were grade I, 18.2% were grade II, 36.4% were grade III, 16.4% were grade IV, and 3.6% were grade V. CONCLUSIONS AVMs are seen more frequently on MRI with advancing age in children and young adults.
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Affiliation(s)
- Thomas M O'Lynnger
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, 48109-5338, USA
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25
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Silent cerebral infarcts occur despite regular blood transfusion therapy after first strokes in children with sickle cell disease. Blood 2010; 117:772-9. [PMID: 20940417 DOI: 10.1182/blood-2010-01-261123] [Citation(s) in RCA: 185] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Children with sickle cell disease (SCD) and strokes receive blood transfusion therapy for secondary stroke prevention; despite this, approximately 20% experience second overt strokes. Given this rate of second overt strokes and the clinical significance of silent cerebral infarcts, we tested the hypothesis that silent cerebral infarcts occur among children with SCD being transfused for secondary stroke prevention. A prospective cohort enrolled children with SCD and overt strokes at 7 academic centers. Magnetic resonance imaging and magnetic resonance angiography of the brain were scheduled approximately every 1 to 2 years; studies were reviewed by a panel of neuroradiologists. Eligibility criteria included regularly scheduled blood transfusion therapy. Forty children were included; mean pretransfusion hemoglobin S concentration was 29%. Progressive cerebral infarcts occurred in 45% (18 of 40 children) while receiving chronic blood transfusion therapy; 7 had second overt strokes and 11 had new silent cerebral infarcts. Worsening cerebral vasculopathy was associated with new cerebral infarction (overt or silent; relative risk = 12.7; 95% confidence interval, 2.65-60.5, P = .001). Children with SCD and overt strokes receiving regular blood transfusion therapy experience silent cerebral infarcts at a higher rate than previously recognized. Additional therapies are needed for secondary stroke prevention in children with SCD.
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26
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Ahn SH, Choo IS, Kim JH, Kim HW. Arteriovenous Malformation with an Occlusive Feeding Artery Coexisting with Unilateral Moyamoya Disease. J Clin Neurol 2010; 6:216-20. [PMID: 21264203 PMCID: PMC3024527 DOI: 10.3988/jcn.2010.6.4.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 09/23/2009] [Accepted: 09/23/2009] [Indexed: 11/21/2022] Open
Abstract
Background Arteriovenous malformations (AVMs) with vascular abnormalities, including aneurysms, have been reported frequently. However, the coexistence of AVM and unilateral moyamoya disease is rare. We report herein an AVM patient who presented with acute ischemic stroke with unilateral moyamoya disease and occlusion of the feeding artery. Case Report A-41-year old man was admitted with sudden dysarthria and facial palsy. Brain computed tomography and magnetic resonance imaging revealed an acute infarction adjacent to a large AVM in the right frontal lobe. Cerebral angiography revealed occlusions of the proximal right middle cerebral and proximal anterior cerebral arteries, which were the main feeders of the AVM. Innumerable telangiectatic moyamoya-type vessels between branches of the anterior cerebral artery and dilated lenticulostriate arteries on the occluded middle cerebral artery were detected. However, a nidus of the AVM was still opacified through the distal right callosomarginal artery, which was supplied by the remaining anterior cerebral artery and leptomeningeal collaterals from the posterior cerebral artery. Conclusions While AVM accompanied by unilateral moyamoya disease is rare, our case suggests an association between these two dissimilar vascular diseases.
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Affiliation(s)
- Seong Hwan Ahn
- Department of Neurology, Chosun University School of Medicine, Gwangju, Korea
| | - In Seong Choo
- Department of Neurology, Chosun University School of Medicine, Gwangju, Korea
| | - Jin Ho Kim
- Department of Neurology, Chosun University School of Medicine, Gwangju, Korea
| | - Hoo Won Kim
- Department of Neurology, Chosun University School of Medicine, Gwangju, Korea
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27
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De novo arteriovenous malformations: case report and review of the literature. Neurosurg Rev 2009; 33:115-9. [PMID: 19787381 DOI: 10.1007/s10143-009-0227-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 08/04/2009] [Accepted: 08/17/2009] [Indexed: 10/20/2022]
Abstract
Intracerebral arteriovenous malformations (AVMs) are traditionally recognized as congenital lesions. However, with the advent of frequent, noninvasive imaging of the brain, that notion has been challenged. We describe another patient with a de novo cerebral arteriovenous malformation and evaluate the reported literature for trends in the development of these lesions. Cases were selected from the English literature using the PUBMED database using the search term "acquired or de novo cerebrovascular arteriovenous malformations". A total of seven patients (including the one reported in this study) with de novo arteriovenous malformations are reported. Majority of patients were female, and mostly diagnosed as children. Their mean age at diagnosis was 18 years (6-32), and the mean time from the initial intracranial study to the diagnosis of an AVM was 8 years (3-17). De novo formation of AVMs is being increasingly reported, especially in young females. We present only the seventh such case reported in the literature and challenge the traditional view that all arteriovenous malformations are congenital in nature.
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28
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Abstract
OBJECT The authors reviewed the experience of a single surgeon in the surgical treatment of arteriovenous malformations (AVMs) in children, with specific attention to the angioarchitectural appearance of these lesions. Methods The authors performed a retrospective review of pediatric cases of AVM treated at a single institution over a 15-year period. Inclusion criteria consisted of pediatric age at time of treatment and resection of a pial AVM. The AVMs were considered linear-based if they had a single, centrally located, dominant vein with a linear configuration rather than the typical central nidus. RESULTS Sixty-seven patients, ranging in age from 6 months to 17 years, underwent surgical treatment of an AVM between January 1, 1990, and December 30, 2005. In these patients, 31 AVMs (46%) had a distinct linear configuration that was centered on a dominant draining vein ("vein-based"). These AVMs presented with hemorrhage (61%), incidental findings on imaging (16%), or seizures (13%). In 4 cases, AVM recurrence was noted on angiographic follow-up after postoperative angiography showed no residual lesion. Recurrence was seen at 1 year in 2 cases, and at 3 and 11 years in 1 case each. CONCLUSIONS A linear vein-based morphological pattern is common in pediatric AVMs and may recapitulate the embryological origins of the cerebral circulation. Surgical treatment in these cases can also be vein-based, through a narrow surgical corridor, which leads to minimal cortical disruption.
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Affiliation(s)
- Cormac O Maher
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan48109-5338, USA.
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29
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Killory BD, Gonzalez LF, Wait SD, Ponce FA, Albuquerque FC, Spetzler RF. SIMULTANEOUS UNILATERAL MOYAMOYA DISEASE AND IPSILATERAL DURAL ARTERIOVENOUS FISTULA. Neurosurgery 2008. [DOI: 10.1227/01.neu.0000317274.57687.0e] [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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30
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Killory BD, Gonzalez LF, Wait SD, Ponce FA, Albuquerque FC, Spetzler RF. SIMULTANEOUS UNILATERAL MOYAMOYA DISEASE AND IPSILATERAL DURAL ARTERIOVENOUS FISTULA. Neurosurgery 2008; 62:E1375-6; discussion E1376. [DOI: 10.1227/01.neu.0000333311.87554.9c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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31
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Hankinson TC, Bohman LE, Heyer G, Licursi M, Ghatan S, Feldstein NA, Anderson RCE. Surgical treatment of moyamoya syndrome in patients with sickle cell anemia: outcome following encephaloduroarteriosynangiosis. J Neurosurg Pediatr 2008; 1:211-6. [PMID: 18352765 DOI: 10.3171/ped/2008/1/3/211] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Children with sickle cell anemia (SCA) and moyamoya syndrome carry a significant risk of ischemic stroke. Given the success of encephaloduroarteriosynangiosis (EDAS) or pial synangiosis in the treatment of moyamoya disease, the purpose of this study was to examine whether it reliably and durably protected children with SCA and moyamoya syndrome against cerebrovascular complications. METHODS The authors retrospectively reviewed a series of 12 patients with SCA who developed clinical and/or radiological evidence of moyamoya syndrome and underwent EDAS. RESULTS Eleven patients (92%) presented following a cerebrovascular accident (CVA), transient ischemic attack (TIA), or seizure. Magnetic resonance (MR) imaging or angiography suggested moyamoya vascular changes, and cerebral angiography confirmed the diagnosis in all 12 patients. At the time of surgery, the median age was 12.3 years (range 6.8-19.4 years). Ten (83%) of 12 patients had a history of CVA, and 4 of these patients were compliant with a transfusion protocol at the time of their CVA. Bilateral (7 patients) or unilateral (5 patients) EDAS was performed without complications. The mean follow-up period was 46.8 months (range 8.1-106 months). During the follow-up period, 2 patients (16.7%) suffered cerebrovascular events. One patient, who was stroke-free preoperatively, suffered a CVA 3 weeks after the procedure. The other patient suffered a single left lower-extremity TIA 18 months following right-sided EDAS. She returned to her neurological baseline condition and remains stable 53 months postoperatively. Seven patients underwent follow-up angiography or MR angiography, and evidence of revascularization was noted in all cases. At this time, no patient has developed progressive disease requiring a contralateral procedure after unilateral EDAS. CONCLUSIONS The EDAS procedure is a safe and effective treatment option in patients with SCA who develop moyamoya syndrome.
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Affiliation(s)
- Todd C Hankinson
- Department of Neurosurgery, Division of Hematology and Bone Marrow Transplantation, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA.
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32
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Song JK, Niimi Y, Kupersmith MJ, Berenstein A. Postnatal growth and development of a cerebral arteriovenous malformation on serial magnetic resonance imaging in a child with hemangiomatosis. Case report. J Neurosurg 2007; 106:384-7. [PMID: 17566206 DOI: 10.3171/ped.2007.106.5.384] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors report the case of a 3-week-old girl with two enhancing extraaxial masses in the posterior fossa, one in the left cerebellopontine angle (CPA) and the other to the right of the vein of Galen. Serial magnetic resonance images obtained in this patient at 3 months and then at 2.5 years of age documented regression of the enhancing mass in the left CPA and development of a cerebellar brain arteriovenous malformation (AVM) in the same CPA location. Also documented were regression of the pineal region mass and formation of the major draining vein of the AVM. The findings in this case support the theory that cerebral AVMs have early postnatal growth potential.
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Affiliation(s)
- Joon K Song
- Center for Endovascular Surgery, Beth Israel Hyman-Newman Institute for Neurology and Neurosurgery, Roosevelt Hospital, New York, New York 10019, USA.
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