Cavernous Malformations of the Pineal Region: Overview, Management, and Controversies

Bertalanffy, Helmut; Florian, Ioan Alexandru

doi:10.1007/978-3-030-50913-2_22

Cited by 3 publications

(5 citation statements)

References 48 publications

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“…Brain endothelial cells (BECs) of BAVMs are considered strikingly active, proliferate and migrate faster than normal endothelial cells, and exhibit atypical functions aside from modified expression levels of growth factors modulating angiogenesis [9,22,52]. Increased levels of thrombospondin-1 (TSP-1), an antagonist of Vascular Endothelial Growth Factor A (VEGF-A) have been discerned within BAVM BECs, as a result of the high levels of "inhibitor of DNA-binding protein A" (Id-1), which represses the transcription of TSP-1 [19,20,53].…”

Section: Mir-18amentioning

confidence: 99%

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An Insight into the microRNAs Associated with Arteriovenous and Cavernous Malformations of the Brain

Florian

Buruiană

Şuşman

et al. 2021

Cells

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Background: Brain arteriovenous malformations (BAVMs) and cerebral cavernous malformations (CCMs) are rare developmental anomalies of the intracranial vasculature, with an irregular tendency to rupture, and as of yet incompletely deciphered pathophysiology. Because of their variety in location, morphology, and size, as well as unpredictable natural history, they represent a management challenge. MicroRNAs (miRNAs) are strands of non-coding RNA of around 20 nucleotides that are able to modulate the expression of target genes by binding completely or partially to their respective complementary sequences. Recent breakthroughs have been made on elucidating their contribution to BAVM and CCM occurrence, growth, and evolution; however, there are still countless gaps in our understanding of the mechanisms involved. Methods: We have searched the Medline (PubMed; PubMed Central) database for pertinent articles on miRNAs and their putative implications in BAVMs and CCMs. To this purpose, we employed various permutations of the terms and idioms: ‘arteriovenous malformation’, ‘AVM’, and ‘BAVM’, or ‘cavernous malformation’, ‘cavernoma’, and ‘cavernous angioma’ on the one hand; and ‘microRNA’, ‘miRNA’, and ‘miR’ on the other. Using cross-reference search; we then investigated additional articles concerning the individual miRNAs identified in other cerebral diseases. Results: Seven miRNAs were discovered to play a role in BAVMs, three of which were downregulated (miR-18a, miR-137, and miR-195*) and four upregulated (miR-7-5p, miR-199a-5p, miR-200b-3p, and let-7b-3p). Similarly, eight miRNAs were identified in CCM in humans and experimental animal models, two being upregulated (miR-27a and mmu-miR-3472a), and six downregulated (miR-125a, miR-361-5p, miR-370-3p, miR-181a-2-3p, miR-95-3p, and let-7b-3p). Conclusions: The following literature review endeavored to address the recent discoveries related to the various implications of miRNAs in the formation and growth of BAVMs and CCMs. Additionally, by presenting other cerebral pathologies correlated with these miRNAs, it aimed to emphasize the potential directions of upcoming research and biological therapies.

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Section: Mir-18amentioning

confidence: 99%

“…Cerebral cavernous malformations (CCMs), or cavernomas, are vascular lesions that, unlike BAVMs, are generally small and well delineated, with a low blood flow within them [9][10][11][12][13]. Aside from the majority of them being congenital, they have also been observed to appear in patients subjected to radiosurgery [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

An Insight into the microRNAs Associated with Arteriovenous and Cavernous Malformations of the Brain

Florian

Buruiană

Şuşman

et al. 2021

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“…In spite of this comprehensible reasoning, we have evacuated microsurgically during the past 2 decades a substantial number of cavernous malformations of the midbrain, pons, and medulla that were not readily visible on the surface of the brainstem, and we still have achieved most satisfactory results in these cases [4,18,29]. Based on these observations, we gradually learned that limited splitting of the healthy brainstem parenchyma and gentle microsurgical manipulation within the brainstem were tolerated well and, with few exceptions, did not cause additional or at least no permanent neurological longterm sequelae.…”

Section: Background and Aim Of This Studymentioning

confidence: 99%

“…As other neurosurgeons, we tended to expose the MCMs in the area where we expected the lesion to be closest to the midbrain surface or where it seemed to abut the pial surface [4,13,14,21]. The choice of the exact entry point into the brainstem (see Fig.…”

Section: Surgical Access and Entry Points Into The Midbrainmentioning

confidence: 99%

Microsurgical management of midbrain cavernous malformations: does lesion depth influence the outcome?

et al. 2021

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Background The purpose of this study was to clarify whether the intrinsic depth of midbrain cavernous malformations (MCMs) influenced the surgical outcome. Methods The authors conducted a retrospective study of 76 consecutive patients who underwent microsurgical resection of a MCM. The vascular lesions were categorized into 4 distinct groups based on how these lesions had altered the brainstem surface. Additionally, it was verified whether the actual aspect of the brainstem surface could be predicted only by evaluating the pertinent preoperative MRI slices. Clinical outcome was assessed by determining the modified Rankin Scale Score (mRS) before and after surgery. Results Twenty-three MCMs (30.3%) were located deeply within the midbrain. The overlying midbrain surface appeared to be normal (group nl). In 33 patients (43.4%), the midbrain surface showed only a yellowish discoloration (group yw). In another 14 individuals (18.4%), the midbrain surface was distorted by the underlying MCM and bulging out while the vascular lesion still remained covered by a thin parenchymal layer (group bg). In the smallest group comprising 6 patients (7.9%), the exophytic MCM had disrupted the midbrain surface and was clearly visible at microsurgical exposure (group ex). The mean mRS decreased in the group nl from 1.43 preoperatively to 0.61 at follow-up. Conclusion This study demonstrates in a large patient population that a deep intrinsic MCM location is not necessarily associated with an unfavorable clinical outcome after microsurgical lesionectomy. Predicting the aspect of the midbrain surface by evaluating preoperative MR images alone was not sufficiently reliable.

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“…Because they are comprised of serpiginous and entangled vessels shunting oxygenated blood directly into the venous stream, bAVMs represent a therapeutic challenge from all perspectives, surgical, endovascular or radiosurgical [ 3 , 11 , 12 , 13 ]. CCMs, on the other hand, are theoretically much easier to resect since they possess extremely thin vascular feeders, yet this means that endovascular procedures are not an option [ 3 , 14 , 15 ]. Many breakthroughs have been made in understanding these two distinct pathologies, yet their pathophysiology and etiology still largely remain a mystery.…”

Section: Introductionmentioning

confidence: 99%

Involvement of Microglia in the Pathophysiology of Intracranial Aneurysms and Vascular Malformations—A Short Overview

Florian

Şuşman

2021

IJMS

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Aneurysms and vascular malformations of the brain represent an important source of intracranial hemorrhage and subsequent mortality and morbidity. We are only beginning to discern the involvement of microglia, the resident immune cell of the central nervous system, in these pathologies and their outcomes. Recent evidence suggests that activated proinflammatory microglia are implicated in the expansion of brain injury following subarachnoid hemorrhage (SAH) in both the acute and chronic phases, being also a main actor in vasospasm, considerably the most severe complication of SAH. On the other hand, anti-inflammatory microglia may be involved in the resolution of cerebral injury and hemorrhage. These immune cells have also been observed in high numbers in brain arteriovenous malformations (bAVM) and cerebral cavernomas (CCM), although their roles in these lesions are currently incompletely ascertained. The following review aims to shed a light on the most significant findings related to microglia and their roles in intracranial aneurysms and vascular malformations, as well as possibly establish the course for future research.

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Cavernous Malformations of the Pineal Region: Overview, Management, and Controversies

Cited by 3 publications

References 48 publications

An Insight into the microRNAs Associated with Arteriovenous and Cavernous Malformations of the Brain

An Insight into the microRNAs Associated with Arteriovenous and Cavernous Malformations of the Brain

Microsurgical management of midbrain cavernous malformations: does lesion depth influence the outcome?

Involvement of Microglia in the Pathophysiology of Intracranial Aneurysms and Vascular Malformations—A Short Overview

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