The relationship of cortical folding and brain arteriovenous malformations

Abstract

Background The pathogenesis of human intracranial arteriovenous malformations (AVMs) is not well understood; this study aims to quantitatively assess cortical folding in patients with these lesions. Methods Seven adult participants, 4 male and 3 female, with unruptured, surgically unresectable intracranial AVMs were prospectively enrolled in the study, with a mean age of 42.1 years and Spetzler-Martin grade range of II–IV. High-resolution brain MRI T1 and T2 sequences were obtained. After standard preprocessing, segmentation and registration techniques, three measures of cortical folding, the depth difference index (DDI), coordinate distance index (CDI) and gyrification index (GI)), were calculated for the affected and unaffected hemispheres of each subject as well as a healthy control subject set. Results Of the three metrics, CDI, DDI and GI, used for cortical folding assessment, none demonstrated significant differences between the participants and previously studied healthy adults. There was a significant negative correlation between the DDI ratio between affected and unaffected hemispheres and AVM volume (correlation coefficient r = −0.74, p = 0.04). Conclusion This study is the first to quantitatively assess human brain cortical folding in the presence of intracranial AVMs and no significant differences between AVM-affected versus unaffected hemispheres were found in a small dataset. We suggest longitudinal, larger human MRI-based cortical folding studies to assess whether AVMs are congenital lesions of vascular development or de novo, dynamic lesions.

Microenvironment changes in arteriovenous malformations after stereotactic radiation

“…The pathogenesis and biological development of brain AVMs remains poorly understood, but recent evidence suggests that aberrant angiogenesis may be embroiled in the expansion, development, and rupture of AVMs (Berman et al, 2000 ; Leblanc et al, 2009 ; Chen et al, 2014 ; Rangel-Castilla et al, 2014 ). Vasculogenesis precedes embryologic cortical folding and studies have found no difference in the cortical folding patterns in normal vs. AVM brains (Shah et al, 2016 ). Digressive expression of angiogenic factors in central nervous system is a main contributor to vascular malformations including brain AVMs (Mouchtouris et al, 2015 ).…”

Thermal and Magnetic Dual-Responsive Catheter-Assisted Shape Memory Microrobots for Multistage Vascular Embolization

“…It also prolongs the procedure and increases the utilization of contrast agents, thereby escalating the procedural risks [ 5 – 9 ]. These challenges lie in accessing the distal cortical arteries, which are crucial for treating various lesions and diseases in that region, including aneurysms [ 10 – 12 ], arteriovenous malformations [ 13 , 14 ], liver tumors [ 15 , 16 ], vascular tumors [ 17 ], and bleeding control [ 18 – 20 ]. Please refer to Table S1 for current limitations for these diseases.…”

Adaptive wireless millirobotic locomotion into distal vasculature

“…As a typical example, the distally cortical arteries are limited to safely and effectively access by catheters to treat various lesions and diseases around this region, such as acute ischemic stroke (AIS) 3 , 7 , 8 , aneurysm 9 , 10 , cerebral arteriovenous malformation (CAVM) 11 , 12 , dural arteriovenous fistulas (dAVFs) 13 , 14 , and brain tumors 15 , 16 . Particularly, most malignant primary brain tumors occur in the cerebral cortex, with the highest percentage of 26% developing in the frontal lobe 15 , and dAVFs and 86% of the CAVM occur in the cortical region 12 . Although occurrence rates of cortical aneurysms and AIS were reported to be 1% and lower than 15%, respectively, it has also been raised that actual rates were underestimated due to the sensitivity of medical imaging 3 , 10 .…”