Spontaneous regression of cerebral arteriovenous malformations: clinical and angiographic analysis with review of the literature

Spontaneous regression of cerebral arteriovenous malformation (AVM) is rare and poorly understood. We reviewed the clinical and angiographic findings in patients who had spontaneous regression of cerebral AVMs to determine whether common features were present. The clinical and angiographic findings of four cases from our series and 29 cases from the literature were retrospectively reviewed. The clinical and angiographic features analyzed were: age at diagnosis, initial presentation, venous drainage pattern, number of draining veins, location of the AVM, number of arterial feeders, clinical events during the interval period to thrombosis, and interval period to spontaneous thrombosis. Common clinical and angiographic features of spontaneous regression of cerebral AVMs are: intracranial hemorrhage as an initial presentation, small AVMs, and a single draining vein. Spontaneous regression of cerebral AVMs can not be predicted by clinical or angiographic features, therefore it should not be considered as an option in cerebral AVM management, despite its proven occurrence.     

多层螺旋CT血管造影在急性自发性颅内出血中的应用价值

目的探讨多层螺旋CT血管造影(MSCTA)在急性自发性颅内出血中的应用价值。方法CT诊断急性自发性颅内出血41例,其中蛛网膜下腔出血29例、脑内血肿12例,采用容积重建(VR)和最大密度投影(MIP)方法进行MSCTA检查,并对7例颅内动脉瘤钛夹夹闭术病例和2例脑动静脉畸形、1例脑动静脉畸形伴巢内动脉瘤手术切除病例进行术后MSCTA评价。结果41例急性自发性颅内出血中,MSCTA检查出颅内动脉瘤11例、脑动静脉畸形4例、脑动静脉畸形伴巢内动脉瘤1例;MSCTA对动脉瘤的瘤体大小、瘤颈、载瘤动脉和脑动静脉畸形的部位、大小、瘤巢的形态、供血动脉和引流静脉的显示均较清楚。7例动脉瘤行钛夹夹闭术和2例脑动静脉畸形、1例脑动静脉畸形伴巢内动脉瘤行手术切除,手术所见与术前MSCTA表现相符;术后行MSCTA复查,显示夹闭动脉瘤之钛夹位置正常,载瘤动脉、颅内大血管通畅,脑动静脉畸形之瘤巢已切除。结论MSCTA是急性自发性颅内出血病因诊断的一种无创伤、快捷有效的影像学方法,并且在颅内动脉瘤、脑动静脉畸形术后评价方面也具有临床应用价值。     

Revisiting normal perfusion pressure breakthrough in light of hemorrhage-induced vasospasm

Cerebral arteriovenous malformations (AVMs) have abnormally enlarged arteries and veins prone to spontaneous hemorrhage. Immediately following surgical excision of a cerebral AVM, even normal brain tissue surrounding the lesion is subject to hemorrhage, a phenomenon termed normal perfusion pressure breakthrough (NPPB) syndrome. According to this theory, arteries supplying cerebral AVMs become dilated and lose their capacity to dilate or constrict to autoregulate pressure. Acutely after removal of a cerebral AVM, excessive blood pressure in these arterial feeders can cause normal brain tissue to bleed. However, this theory remains controversial. We present a patient with a cerebral AVM that demonstrated cerebrovascular reactivity and argues against an assumption underlying the theory of NPPB syndrome.     

出血性脑血管病全脑血管造影结果分析

目的评价DSA在出血性脑血管病中的应用及价值。资料与方法回顾性分析216例出血性脑血管病患者的全脑血管造影结果。结果112例蛛网膜下腔出血(SAH)患者中发现颅内动脉瘤45例(40．2％),动静脉畸形(AVM)4例(3．57％),未见异常者63例(56．2％)。自发性脑出血104例,发现AVM50例(48．1％),动静脉瘘2例(1．92％),动脉瘤3例(2．88％),烟雾病2例(1．92％),未见异常者47例(45．2％)。结论脑血管造影在出血性脑血管病的病因诊断中是一项必不可少的检查,对明确诊断,制定合理的治疗方案有明确的指导意义。     

DSA对脑动静脉畸形出血的预测分析

目的:探讨脑动静脉畸形(AVM)血管造影形态与出血关系,预测脑动静脉畸形(AVM)出血的危险性。方法:回顾性分析104例数字减影脑血管畸形资料。结果:穿支动脉供血、单支引流和深部引流、小病灶及位于基底节和后颅窝者易出血。结论:通过观察脑动静脉畸形(AVM)供血动脉(类型)、大小、位置、引流静脉数目及通畅情况,可以对脑动静脉畸形(AVM)的出血情况进行预测。     

Size determination of supratentorial arteriovenous malformations by MR,CT and angio

Summary Twenty patients with high-flow supratentorial arteriovenous malformations (AVMs) were studied by magnetic resonance imaging (MR), computed tomography (CT), and selective cerebral angiography. The size of the malformation measured on MR was found, in general, to be smaller than the size determined from angiographic films. This discrepancy increased as the size of the AVM increased. AVM size on CT and angiography was found to be essentially equivalent. The reason for these differences between MR and CT or angiography was the ability to separate out the draining veins by MR, whereas this was difficult on projection films and contrast enhanced CT. Calcification was more easily detected by CT than by MR. MR better detected hemorrhage, which could be mistaken for old infarction on CT. Foci of cystic change within the nidus of the AVM were equally evident on MR and CT. Due to its sensitivity in discriminating between AVM nidus and adjacent draining veins and MR's ability to show the AVM in three planes, MR appeared to be more accurate in defining the AVM nidus than either CT or cerebral angiography. Such accurate delineation is crucial in patients prior to stereotactic radiosurgery.     

64层MSCTA对蛛网膜下腔出血病因的诊断

目的：探讨64层螺旋CT血管成像（MSCTA）在自发性蛛网膜下腔出血的临床应用价值。方法：搜集临床拟诊为蛛网膜下腔出血患者76例,行64层螺旋CT血管成像检查,并将结果与DSA结果、手术结果相对照。结果：本组76例患者中CTA诊断动脉瘤28例,DSA发现29例,手术证实29例;诊断为动静脉畸形3倒,DSA发现3例,手术证实3例。有45例CTA检查未见异常发现,其中1例动脉瘤CTA漏诊。结论：64层螺旋CT血管成像可作为自发性蛛网膜下腔出血病因诊断方法之一。     

蛛网膜下腔出血的CT与临床（附94例分析）

本文分析７４例经腰穿证实的自发性蛛网膜下腔出血（ＳＡＨ）及２０例经ＣＴ检查为外伤性ＳＡＨ的ＣＴ和临床表现。着重探讨了自发性ＳＡＨ的病因诊断，笔者认为常见原因是颅内动脉瘤、脑动静脉畸形（ＡＶＭ）、高血压动脉硬化。而动脉瘤、ＡＶＭ最常见，占查出原因的７４％，ＣＴ像上有ＳＡＨ表现的又以动脉瘤最常见，根据ＣＴ像上ＳＡＨ的分布及附近并发的脑内血肿可推断动脉瘤破裂的位置。本文还概括了ＳＡＨ典型的临床表现和常见     

Transcranial colour Doppler sonography in emergency management of intracerebral haemorrhage caused by an arteriovenous malformation: case report

We present a case which demonstrates the use of transcranial colour Doppler (TCCD) sonography in screening for an underlying arteriovenous malformation (AVM) in a middle-aged hypertensive patient with a spontaneous thalamic haematoma. The AVM was not detected on emergency CT but its presence, site and shape were demonstrated by TCCD, in the presence of a massive cerebral haemorrhage and acute intracranial hypertension. Received: 1 March 2000/Accepted: 17 April 2000     

脑动静脉畸形的破裂出血与其动脉供血系统的关系

本文对经过脑血管造影及手术证实的１１０例脑ＡＶＭ进行回顾性分析，探讨了脑ＡＶＭ破裂出血与其动脉供血系统的关系。本文结果显示：供血动脉轻度扩张（Ｐ＜０．０１）、供血动脉主干较短（Ｐ＜０．００１）及动脉供血系统合并动脉瘤的（Ｐ＜０．０１）脑ＡＶＭ出血率高。我们认为在制定脑ＡＶＭ治疗方案时，要考虑其供血动脉的特点。     

Intranidal aneurysms in cerebral arteriovenous malformations: evaluation and endovascular treatment.

Patients with cerebral arteriovenous malformations (AVMs) have an increased risk of hemorrhage if an intranidal aneurysm is present. Angiograms from 125 patients with cerebral AVMs were evaluated, and 15 (12%) had intranidal aneurysms. All 15 patients had a history of bleeding. Five patients underwent particulate or liquid embolization before surgical excision of or radiation therapy for the AVM. All aneurysms were thrombosed at the time of embolization. Ten patients underwent radio-surgery alone. Eight of the 10 underwent angiographic follow-up (mean, 33 months); seven patients showed complete obliteration of the AVM without residual aneurysm. Histologic evaluation showed intranidal aneurysms to be thin-walled vascular structures, and they are the likely site for AVM hemorrhage. Embolization is an effective method for achieving thrombosis of the intranidal aneurysm and may be beneficial in patients undergoing radiation therapy because of a long latency period between treatment and thrombosis of the AVM.     

Spontaneous regression of cerebral arteriovenous malformation in hereditary hemorrhagic telangiectasia

Cerebral arteriovenous malformations (AVMs) are associated with hereditary hemorrhagic telangiectasia (HHT). I report a case of a patient with HHT with four cerebral AVMs in whom one AVM spontaneously regressed during a 5-year period. The spontaneous regression of this AVM in this patient with HHT supports the theory that AVMs associated with this syndrome have a different natural history than that of typical sporadic AVMs.     

Pseudoaneurysm formation secondary to spontaneous thrombosis of a massive cerebral arteriovenous malformation

Summary A case of a large cerebral arteriovenous malformation (AVM) with spontaneous partial thrombosis and intracerebral hematoma is reported. The unusual and unique features of the radionuclide brain scan and cerebral angiogram are described. The characteristic angiographic features of residual tortuosity and dilatation or pseudoaneurysm formation at the bifurcations of the feeding arteries in a partially thrombosed cerebral AVM have not been described previously in the literature.     

动脉数字减影血管造影对脑动静脉畸形出血的预测分析

报告８３例经ＤＳＡ和手术证实的脑动静脉畸形。其中ＣＴ示出血者５８例，占６９．９％。笔者探讨脑动静脉畸形血管造影形态与出血的关系，结果表明下列因素与出血有关：（１）小的脑动静脉畸形；（２）仅有１支引流静脉的；（３）向深部静脉引流的及引流静脉狭窄和并发动脉瘤者。而供血动脉的数目和有颈外动脉参与供血者未见明显关系，笔者还分析了脑动静脉畸形的ＣＴ表现，认为ＣＴ与脑血管造影并用，可为临床提供更详细的资料。     

Vascular malformations in newborn infants, infants and children

Vascular malformations are the cause of nearly all non-traumatic intracranial hemorrhage in children beyond the neonatal stage. Therefore, any child presenting with spontaneous intracranial hemorrhage should be evaluated for child abuse and for vascular malformations. Intracerebral malformations of the cerebral vasculature include vein of Galen malformations, arteriovenous malformation (AVM), cavernomas, dural arteriovenous fistulas, venous anomalies (DVA), and capillary teleangiectasies. Although a few familial vascular malformation have been reported, the majority are sporadic. Clinical symptoms, diagnostic and therapeutic options are discussed.     

The changing angiographic appearance of an arteriovenous malformation after subarachnoid hemorrhage

Summary The changing angiographic appearance of a cerebral arteriovenous malformation (AVM) illustrated hemodynamic changes that can occur following subarachnoid hemorrhage and antifibrinolytic therapy. Decreased size of this lesion suggested thrombosis of the AVM. This appearance actually represented a transient, vasospastic phenomenon which reversed with time. Although the AVM underwent significant changes acutely, little changed in the long term.     

脑动静脉畸形破裂出血的急诊手术治疗

目的探讨急诊外科手术治疗脑动静脉畸形（AVM）破裂出血的效果。方法对12例破裂出血并脑内血肿的脑AVM患者实施急诊显微手术治疗,清除血肿,同时切除畸形。结果手术完全切除病灶9例,占75％;次全切除1例,占8％,部分切除2例,占17％。按GOS评分,患者恢复良好10例,轻残1例,重残1例。结论急诊外科手术能够提高脑AVM破裂出血的治愈率,降低死残率,急诊的血管造影可提供一定的信息以降低手术风险,提高治愈率。     

脑动静脉畸形栓塞治疗术并发颅内出血的原因及处理

目的探讨栓塞治疗脑动静脉畸形(AVM)及并发颅内出血的原因和处理方法。方法2006年至2011年收治45例脑AVM患者,其中35例为首发症状,表现为颅内血肿21例,蛛网膜下腔出血14例。6例患者反复出血2～4次不等。畸形血管团直径3～15 cm,平均(6.84±2.52)cm;体积50～200cm~3,平均(133.83±43.32)cm~3。对所有患者均采用Onyx液体栓塞剂进行栓塞治疗,并进行随访,观察有无并发症发生。结果45例中,37例随防时间3个月～3年,平均15个月;优31例(83.7%),良5例(13.5%),差1例(2.7%),无重残及死亡。栓塞术后出现颅内出血7例,均不同程度存在正常灌注压突破,2例行开颅血肿清除,其余均为小型血肿自行吸收。7例出血者中,2例痊愈,4例神经功能障碍,1例偏瘫。结论脑AVM栓塞治疗术并发颅内出血的机制较为复杂,掌握其发生机制可以更好地控制诱发因素,减少并发症的发生。     

64层螺旋CT分别减影脑动脉混合脑动静脉和脑静脉血管成像在颅内自发性出血术前评估的价值

目的：探讨64层螺旋CT分别减影脑动脉、混合脑动静脉、脑静脉血管成像在自发性颅内出血术前评估价值。方法回顾分析同时行CT血管造影（CTA）和数字减影血管造影（DSA）检查的自发性颅内出血患者共215例。 CTA检查全部行64层螺旋CT平扫、增强动脉早期和静脉早期扫描,将动、静脉早期数据减去平扫数据分别重建动脉及混合动静脉,静脉早期数据减去动脉早期数据重建静脉。结果减影脑动脉、脑静脉血管图像去除了颅骨并且动脉、静脉无相互干扰,分别清晰显示动脉或静脉病变,混合脑动静脉则去除颅骨干扰且同时显示脑动静脉病变。215例颅内出血患者中14例CTA和DSA检查颅内均未见畸形血管,2例动脉瘤DSA发现而CTA未显示,3例动脉瘤CTA发现而DSA未显示。 CTA和DSA共同显示畸形血管196例,敏感性为99．9％,特异性为82．4％,其中动脉瘤179例,动静脉畸形9例,静脉瘤3例,烟雾病5例。结论64层螺旋CT分别减影脑动脉、混合脑动静脉、脑静脉血管成像在颅内出血检查,病变及周围结构显示清楚,对临床术前评估有较大意义,值得推广应用。     

DSA全脑血管造影431例分析

目的:分析431例全脑血管造影,探讨颅内血管病变用DSA全脑血管造影的价值。材料和方法:92年至96年行DSA全脑血管造影431例。采用Seldinger技术,经股动脉穿刺置管行选择性或/和超选择性全脑血管造影。前交通及后交通动脉瘤经显微神经外科证实。结果:动脉瘤155例,血管畸形76例,占位性病变48例。颅内动脉瘤发生在大脑前动脉系统为42.58％,而前交通动脉瘤为大脑前动脉系统的74.24％。颅内动脉瘤为全脑血管造影阳性发现的首位,其次为血管畸形,颅内占位。本组阴性率为25.75％。结论:CT、MR发现颅内出血或血管畸形时,不一定全脑血管造影有阳性改变。