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Cerebral micro arteriovenous malformations (mAVMs). Review of 13 cases
R Willinsky1, P Lasjaunias, J Comoy
1Unité de Neuroradiologie Diagnostique et Therapeutique, Hôpital Bicêtre, France.
Abstract:
In a personal series of 152 cerebral vascular malformation, 13 patients had small (less than 1 cm) parenchymal arteriovenous malformations (mAVMs) with small nidus or fistula and a single normal-sized feeding artery and draining vein. All 13 patients presented with intracerebral haematomas (ICHs). The average age in this group was 31 years with no sex dominance; 8 patients had no antecedent symptoms. In 11 patients the small AMV could be demonstrated angiographically, with the remaining 2 malformations evident at surgery. In addition, all these mAVMs, being superficial (95% cortical), were surgically removable with no perioperative morbidity. They were not accessible by endovascular approach. This population group narrows the concept of occult vascular lesions if high quality angiographic studies are performed. mAVMs are by nature CT and MRI occult.
Insights
Small arteriovenous malformations (mAVMs) often present as intracerebral hemorrhages. These superficial mAVMs are surgically accessible, unlike CT/MRI-occult lesions, offering a distinct diagnostic challenge.
Area of Science:
- Neurology
- Neurosurgery
- Radiology
Background:
- Cerebral vascular malformations present a diagnostic challenge.
- Small parenchymal arteriovenous malformations (mAVMs) are often occult on advanced imaging.
- Intracerebral hemorrhages (ICHs) can be the presenting symptom of mAVMs.
Purpose of the Study:
- To characterize small parenchymal arteriovenous malformations (mAVMs) presenting with ICH.
- To evaluate the diagnostic modalities and treatment accessibility of these specific mAVMs.
Main Methods:
- Retrospective review of 152 cerebral vascular malformations.
- Analysis of 13 patients with small (less than 1 cm) mAVMs.
- Correlation of clinical presentation, imaging findings (angiography, CT, MRI), and surgical outcomes.
Main Results:
- All 13 patients presented with intracerebral hematomas (ICHs).
- The mAVMs were small, superficial (95% cortical), with a single feeding artery and draining vein.
- These mAVMs were surgically removable with no perioperative morbidity but not endovascularly accessible.
- Angiography demonstrated 11 mAVMs; 2 were found during surgery.
- mAVMs are inherently occult on CT and MRI.
Conclusions:
- Small, superficial mAVMs presenting as ICH represent a distinct subgroup of vascular lesions.
- High-quality angiography is crucial for diagnosing these otherwise occult malformations.
- Surgical resection is the primary treatment modality for these accessible mAVMs.