Cerebral arteriovenous malformations (C. AVM) and associated arterial aneurysms (AA)

Abstract

We report a series of 101 patients with cerebral arteriovenous malformations (CAVM), in which 23 cases presented with one or several arterial aneurysm(s) (AA). Each AA could be classified into distal intra-lesional, proximal or remote. Patients with CAVM + AA tend to be older and more frequently present with epilepsy, haemorrhage events and neurological deficits. Of these 23 patients, 16 had their AVM treated partially or totally by embolization. In our series, the endovascular treatment of the arteriovenous shunt with a proximal AA on the same vessel has resulted in at least a regression, and sometimes a disappearance of the arterial ectasia. Although partial treatment of the AVM does no erase the risk of haemorrhage from the malformation itself, it may diminish the chance of developing a flow-related AA or any other expression of the high-flow angiopathy.

Does treatment with N-butyl cyanoacrylate embolization protect against hemorrhage in cerebral arteriovenous malformations?

“…Luessenhop 16 observed that partial embolization may reduce the risk of hemorrhage by reducing intranidal pressure. However, the reports found in the literature so far are inconclusive concerning the protective role of partial embolization 7,12,16,18,23 , since any residue of malformed vessels has the potential to cause future bleeding, no matter what percentage of the lesion was obliterated 15,18,22,23 . Partial embolization has also been thought to increase the risk of cAVM rupture, even in patients without a previous hemorrhagic event 8,10 .…”

“…Associated aneurysms, especially intranidal, are also considered a factor of increased risk for hemorrhage in untreated cAVMs 2,12,27,28 . The occlusion of aneurysms has been thought to confer relative protection 2,12,29 .…”

“…The occlusion of aneurysms has been thought to confer relative protection 2,12,29 . but this was not what we observed in the present study, in which patients presented hemorrhage even after aneurysm occlusion.…”

“…The factors that are known to predispose to the occurrence of hemorrhage are smallsized lesions, deep or posterior fossa location, deep venous drainage, venous stenosis, elevated per-fusion pressure, and presence of aneurysms 2,3,[10][11][12][13] . Some investigators claim that presentation with seizures may be a protective factor against hemorrhage in untreated cAVMs.…”

“…Several studies have also reported that embolization in cAVM may be useful in the management of patients presenting hard-to-control seizures, progressive neurological deficit, and headaches, and to improve cerebral perfusion 8,9,16 . In addition, embolization has been thought to be useful in the elimination of aneurysms, which are independent risk factors for hemorrhage 8,12,[16][17][18][19] . However, there are no conclusive data concerning the benefits of this procedure.…”