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Management of multiple cerebral arteriovenous malformations in a non-pediatric population

  • Clinical Article - Vascular
  • Published:
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Abstract

Background

The occurrence of concomitant multiple cerebral arteriovenous malformations (mAVMs) is often associated with hereditary hemorrhagic telangiectasia (HHT) or craniofacial arteriovenous metameric syndrome (CAMS) and frequently occurs in the pediatric population.

Methods

Between 1995 and 2013, demographic, clinical, and angiographic data of cerebral AVMs have been prospectively collected. We retrospectively analyzed data of patients presenting multiple cerebral AVMs.

Results

Six patients (mean age, 44 years, male-to-female ratio, 5) presented an angiographic diagnosis of cerebral mAVMs. Only one of them was known to have a HHT. Five patients presented two cerebral AVMs and one patient had three. Three AVMs (23.1 %) presented bleeding at admission. Three patients had supratentorial mAVMs only and the three others had supra and infratentorial AVMs. Only one patient suffered from bleeding of more than one of his mAVMs with an interval of 23 years.

Conclusions

For asymptomatic AVMs discovered incidentally without angiographic bleeding risk, we propose a therapeutic abstention. In case of AVM rupture and bleeding, the other “associated” AVMs (discovered through a complete angiographic assessment) should also be treated if they are not located in an eloquent area and if the treatment does not present technical difficulties. AVMs with a history of bleeding or associated to angiographic risks have to be treated more aggressively.

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Authors and Affiliations

  1. Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019, Paris, France

    Thomas Robert, Raphaël Blanc, Daniele Botta, Gabriele Ciccio, Stanislas Smajda, Hocine Redjem, Robert Fahed & Michel Piotin

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  1. Thomas Robert
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  2. Raphaël Blanc
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  3. Daniele Botta
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  4. Gabriele Ciccio
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  5. Stanislas Smajda
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  6. Hocine Redjem
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  7. Robert Fahed
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  8. Michel Piotin
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Corresponding author

Correspondence to Thomas Robert.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Informed consent was obtained from all individual participants included in the study.

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Robert, T., Blanc, R., Botta, D. et al. Management of multiple cerebral arteriovenous malformations in a non-pediatric population. Acta Neurochir 158, 1019–1025 (2016). https://doi.org/10.1007/s00701-016-2785-5

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  • DOI: https://doi.org/10.1007/s00701-016-2785-5

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