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Thrombosed arteriovenous malformations: a type of occult vascular malformation. Magnetic resonance imaging and
J D Ebeling1, B I Tranmer, K A Davis
1Department of Neurosurgery, University of Missouri, Columbia.
Abstract:
Thrombosed arteriovenous malformations (AVMs) are the predominant type of occult vascular malformation and do not seem to differ significantly in clinical or radiographic presentation from other types of occult vascular malformations. Thrombosed AVMs and occult vascular malformations occasionally present with symptoms secondary to subacute or occult hemorrhage that requires operation. The histopathology of thrombosed AVMs and occult vascular malformations does not seem to have prognostic significance. Five patients with histologically verified thrombosed AVMs are reported. Two patients had previous incomplete resection of histologically proven thrombosed AVMs and presented with recurrence and bleeding. Two patients presented with seizures and headaches, and one patient presented with hemiparesis and headache. All histology specimens had evidence of hemorrhage. The pathological findings of these lesions seem variable; two specimens contained a mixture of cavernous angioma and AVM. Two previously resected lesions had been defined histologically as thrombosed AVMs. Successful excision of the lesions was accomplished in four patients, and one patient had stereotactic biopsy. The magnetic resonance imaging characteristics of lesions seem to add a degree of specificity over computed tomography and angiography. We have found that the literature poorly describes the natural history and histology of these lesions. Conservative management for seizures and headaches due to thrombosed AVMs may not be warranted because of a propensity for hemorrhage and recurrence.
Insights
Thrombosed arteriovenous malformations (AVMs) are common occult vascular malformations. Conservative management may not be suitable due to risks of hemorrhage and recurrence.
Area of Science:
- Neurology
- Vascular Surgery
- Pathology
Background:
- Thrombosed arteriovenous malformations (AVMs) are the most common occult vascular malformations.
- Their presentation and histopathology do not significantly differ from other occult vascular malformations.
- Hemorrhage and recurrence are potential complications requiring surgical intervention.
Observation:
- Five patients with histologically confirmed thrombosed AVMs were analyzed.
- Presentations included recurrence after incomplete resection, seizures, headaches, and hemiparesis.
- All specimens showed evidence of hemorrhage, with some containing mixed cavernous angioma and AVM components.
Findings:
- Magnetic resonance imaging (MRI) offers greater specificity than computed tomography (CT) and angiography for diagnosing these lesions.
- Histopathology did not appear to have prognostic significance.
- The natural history and histology of thrombosed AVMs are poorly documented in existing literature.
Implications:
- Conservative management for symptoms like seizures and headaches may be inappropriate due to the risk of bleeding and reoccurrence.
- Surgical excision is a viable treatment option, with successful outcomes in four of five reported cases.
- Further research into the natural history and optimal management of thrombosed AVMs is warranted.