Multiple Arteriovenous Malformations with Hemorrhage

Utsuki, Satoshi; Kurata, Akira; Miyasaka, Yoshio; Takano, Makoto; Ootaka, H.; Fujii, Kiyotaka

doi:10.1007/s701-002-8279-0

Cited by 15 publications

(6 citation statements)

References 27 publications

(42 reference statements)

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“…Multiple AVMs are rare, except in the Rendu-Osler-Weber and Wyburn-Mason syndromes, with an incidence in major series ranging from only 0.3 to 4%. 2,4,10,13,14,16 Iizuka, et al, 4 divided multiple AVMs into two groups: congenital or acquired. According to their classification, the multiple AVMs presented here should be classified as acquired lesions.…”

Section: Discussionmentioning

confidence: 99%

Development of multiple cerebral arteriovenous malformations documented in an adult by serial angiography

Miyasaka¹,

Nakahara²,

Hagiwara³

2003

Journal of Neurosurgery

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A 50-year-old woman with a parietal intracerebral hematoma was initially treated by hematoma evacuation. Initial preoperative and follow-up angiograms obtained 6 months later demonstrated no pial arteriovenous malformations (AVMs). She suffered a subarachnoid hemorrhage 8 years later. Results of follow-up cerebral angiography revealed the development of previously undetected multiple cerebral AVMs. This appears to be the first reported case of the development of multiple cerebral AVMs in an adult, demonstrated on serial angiography.

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Section: Discussionmentioning

confidence: 99%

Development of multiple cerebral arteriovenous malformations documented in an adult by serial angiography

Miyasaka¹,

Nakahara²,

Hagiwara³

2003

Journal of Neurosurgery

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“…This structural instability in nidi and other vulnerable areas of the cerebral vasculature may result from hemodynamic changes following partial obliteration of nidi, which has been frequently hypothesized throughout the literature [6,19,26,30,31,32,33,34]. It has been observed that obliteration of a nidus may be associated with subsequent alterations in blood pressure and flow [35,36].…”

Section: Discussionmentioning

confidence: 99%

Hemorrhage Risk in Pediatric Patients with Multiple Intracranial Arteriovenous Malformations

et al. 2016

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Background/Aims: This study aims to characterize the clinical features, treatment strategies, and annual hemorrhage incidence rate of pediatric patients with multiple arteriovenous malformations (MAVM). Methods: The PubMed and EMBASE databases and the arteriovenous malformations (AVM) database at the Johns Hopkins Hospital were searched for reports of pediatric patients (under 21 years of age) with MAVM. Data related to demographics, clinical features, management, and treatment outcomes were analyzed using descriptive statistics. Twenty-four pediatric patients met the inclusion criteria. Results: The annual hemorrhage incidence rate was 2.1%. The most common presenting features were neurological deficit (38%) and hemorrhage (21%). Treatment with embolization has become the most frequently used modality. In patients undergoing staged treatment of MAVM, hemorrhage of an untreated nidus (n = 1), visualization of a new nidus (n = 2), or disappearance of a draining vein (n = 1) occurred. Conclusion: The annual hemorrhage incidence rate for pediatric patients with MAVM approaches the upper range of previously reported hemorrhage rates for solitary AVM. A staged approach to treating MAVM requires close follow-up as changes to the remaining nidi may occur during the latency period. Limitations of this study include its small sample size and reporting bias.

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“…In the context of multiple AVM surgery, secondary hemorrhage has occasionally been noted after the first operation, and hemodynamic changes during the different treatment stages have demonstrated previously undiagnosed vascular malformations. 2,4,7,8) Utsuki et al and Tada et al emphasized such a event, 6,7) and Salcman et al and de Sousa et al recommend total resection of all lesions; first ruptured AVM, and then the remaining lesions. 1,5) In the present case, angiography demonstrated a small tectal AVM after resection of an AVM in the occipital lobe, so the angiographical appearance of the lesion might have been affected by thrombosis of the shunt just after hemorrhage, by absorption of the hematoma, and by hemodynamic changes after resection of the larger AVM.…”

Section: Discussionmentioning

confidence: 99%

“…5) Multiple AVMs differ somewhat from common solitary AVMs in terms of clinical course and surgical strategy, because of the influence of hemodynamic changes during resection of multiple lesions. 6,7) We present a case of multiple AVMs in which initial angiography revealed only solitary AVM; however, after removal of the first AVM, repeat angiography disclosed another AVM that was the true cause of hemorrhage. To the best of our knowledge, this is the first such case to be reported, and this situation would appear extremely rare.…”

Section: Introductionmentioning

confidence: 95%

Ruptured Tectal Arteriovenous Malformation Demonstrated Angiographically After Removal of an Unruptured Occipital Lobe Arteriovenous Malformation -Case Report-

Komatsu

Sakamoto

Takemura

et al. 2009

Neurol. Med. Chir.(Tokyo)

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We report a case of ruptured tectal arteriovenous malformation (AVM) that was demonstrated angiographically only after removal of an unruptured occipital AVM. A 57-year-old man presented with sudden onset of diplopia and tinnitus. Computed tomography revealed a small hemorrhage in the right tectum mesencephali with intraventricular hemorrhage. Magnetic resonance imaging and angiography disclosed AVM in the right occipital lobe which was separate from the hemorrhagic lesion. Angiography demonstrated that the right occipital AVM was fed by the parieto-occipital artery and drained into the superior sagittal sinus and vein of Galen. However, no abnormal vascular lesion was detected near the tectum mesencephali. As venous hypertension was considered the reason for hemorrhage, the occipital AVM was completely resected. Postoperative angiography demonstrated disappearance of the occipital AVM, but it also disclosed a small tectal AVM fed by branches from the superior cerebellar artery, which had not been detected on preoperative angiography. This was considered the true cause of hemorrhage, and gamma knife surgery was accordingly performed. Even if an AVM is demonstrated, if the lesion does not correspond to the hemorrhage we recommend serial angiographical evaluation so that a small AVM is not missed.

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Multiple Arteriovenous Malformations with Hemorrhage

Cited by 15 publications

References 27 publications

Development of multiple cerebral arteriovenous malformations documented in an adult by serial angiography

Development of multiple cerebral arteriovenous malformations documented in an adult by serial angiography

Hemorrhage Risk in Pediatric Patients with Multiple Intracranial Arteriovenous Malformations

Ruptured Tectal Arteriovenous Malformation Demonstrated Angiographically After Removal of an Unruptured Occipital Lobe Arteriovenous Malformation -Case Report-

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