Cerebral arteriovenous malformations. Part 2: physiology.

OBJECT The scientific understanding of the nature of arteriovenous malformations (AVMs) in the brain is evolving. It is clear from current work that AVMs can undergo a variety of phenomena, including growth, remodeling, and/or regression-and the responsible processes are both molecular and physiological. A review of these complex processes is critical to directing future therapeutic approaches. The authors performed a comprehensive review of the literature to evaluate current information regarding the genetics, pathophysiology, and behavior of AVMs. METHODS A comprehensive literature review was conducted using PubMed to reveal the angioarchitecture and cerebral hemodynamics of AVMS as they relate to lesion development. RESULTS Feeding artery pressures, brain AVM compartmentalization, venous drainage, flow phenomena, and vascular steal are discussed. CONCLUSIONS The dynamic nature of brain AVMs is at least in part attributable to hemodynamic and flow-related phenomena. These forces acting on an evolving structure are critical to understanding the challenges in endovascular and surgical therapy. As knowledge in this field continues to progress, the natural history and predicted behavior of these AVMs will become more clearly elucidated.

[1]  S. Chuang,et al.  Aneurysms of the vein of Galen. Experience at The Hospital for Sick Children, Toronto. , 1982, Journal of neurosurgery.

[2]  E. Lo.  A haemodynamic analysis of intracranial arteriovenous malformations. , 1993, Neurological research.

[3]  P. Lasjaunias.  A Revised Concept of the Congenital Nature of Cerebral Arteriovenous Malformations , 1997, Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences.

[4]  J. Bederson,et al.  Genesis of a dural arteriovenous malformation in a rat model. , 1995, Journal of neurosurgery.

[5]  T. Valiante,et al.  A simple relationship between radiological arteriovenous malformation hemodynamics and clinical presentation: a prospective, blinded analysis of 31 cases. , 1999, Journal of neurosurgery.

[6]  Wilson Cb.  Cryptic vascular malformations. , 1992 .

[7]  W. Young,et al.  Lack of flow regulation may explain the development of arteriovenous malformations , 2001, Neurological research.

[8]  J. Torner,et al.  Bleeding from cerebral arteriovenous malformations as part of their natural history. , 1983, Journal of neurosurgery.

[9]  R. Grossman,et al.  Xenon-enhanced CT CBF measurements in cerebral AVM's before and after excision. Contribution to pathogenesis and treatment. , 1983, Journal of neurosurgery.

[10]  W. Young,et al.  Anesthesia-related considerations for cerebral arteriovenous malformations. , 2001, Neurosurgical focus.

[11]  J. Kuratsu,et al.  Natural course of unoperated intracranial arteriovenous malformations: study of 50 cases. , 1989, Journal of neurosurgery.

[12]  D. Deshpande,et al.  Histology of the persistent embryonic veins in arteriovenous malformations of brain , 2005, Acta Neurochirurgica.

[13]  E. G. Ventureyra,et al.  Spontaneous intracranial hemorrhage of structural origin during the first year of life , 1997, Child's Nervous System.

[14]  G. Forbes,et al.  Unruptured intracranial aneurysms and arteriovenous malformations: frequency of intracranial hemorrhage and relationship of lesions. , 1990, Journal of neurosurgery.

[15]  C. Comstock,et al.  Arteriovenous Malformations , 2016 .

[16]  C. Truwit,et al.  The pathogenesis of arteriovenous malformations: insights provided by a case of multiple arteriovenous malformations developing in relation to a developmental venous anomaly. , 1998, Neurosurgery.

[17]  J. Kuratsu,et al.  Intracerebral venous angioma with arterial blood supply: a mixed angioma. , 1986, Surgical neurology.

[18]  J. Schramm,et al.  Association of venous and true arteriovenous malformation: a rare entity among mixed vascular malformations of the brain. Case report. , 1995, Journal of neurosurgery.

[19]  A. Pries,et al.  Structural adaptation and stability of microvascular networks: theory and simulations. , 1998, The American journal of physiology.

[20]  S. Mullan.  Reflections upon the nature and management of intracranial and intraspinal vascular malformations and fistulae. , 1994, Journal of neurosurgery.

[21]  S. Mayer,et al.  Transcranial Doppler ultrasonography in cerebral arteriovenous malformations. Diagnostic sensitivity and association of flow velocity with spontaneous hemorrhage and focal neurological deficit. , 1995, Stroke.

[22]  C. Huang,et al.  Dystrophic intracranial calcification: CT evidence of ‘cerebral steal’ from arteriovenous malformation , 2004, Neuroradiology.

[23]  D. Chadwick,et al.  Arteriovenous malformations of the brain: natural history in unoperated patients. , 1986, Journal of neurology, neurosurgery, and psychiatry.

[24]  I. Awad,et al.  Mixed vascular malformations of the brain: clinical and pathogenetic considerations. , 1993, Neurosurgery.

[25]  R. Lonser,et al.  Concept of arteriovenous malformation compartments and surgical management , 2004, Neurological research.

[26]  M. Marks,et al.  Vascular characteristics of intracerebral arteriovenous malformations in patients with clinical steal. , 1991, AJNR. American journal of neuroradiology.

[27]  J. Toole,et al.  Precapillary arteriovenous anastomoses. "Thoroughfare channels" in the brain. , 1967, Archives of neurology.

[28]  A. Kurata,et al.  Draining vein pressure increases and hemorrhage in patients with arteriovenous malformation. , 1994, Stroke.

[29]  M. Brock,et al.  Animal Model for Cerebral Arteriovenous Malformation , 2000, Acta Neurochirurgica.

[30]  J Pile-Spellman,et al.  'Steal' is an unestablished mechanism for the clinical presentation of cerebral arteriovenous malformations. , 1995, Stroke.

[31]  P. Hoffer,et al.  Cerebral Arteriovenous Shunts Re‐examined , 1972, Stroke.

[32]  Jen-Chuen Hsieh,et al.  Toward normal perfusion after radiosurgery: perfusion MR Imaging with independent component analysis of brain arteriovenous malformations. , 2004, AJNR. American journal of neuroradiology.

[33]  G. Streeter.  The development of the venous sinuses of the dura mater in the human embryo , 1915 .

[34]  R. Ratcheson,et al.  Functional evaluation of arteriovenous malformations. , 2001, Neurosurgical focus.

[35]  John R. Robinson,et al.  Mixed vascular malformations of the brain: clinical and pathogenetic considerations. , 1993, Neurosurgery.

[36]  D. Nichols,et al.  Occlusive hyperemia: a theory for the hemodynamic complications following resection of intracerebral arteriovenous malformations. , 1993, Journal of neurosurgery.

[37]  M. Lawton,et al.  Redefined role of angiogenesis in the pathogenesis of dural arteriovenous malformations. , 1997, Journal of neurosurgery.

[38]  L Pellettieri,et al.  Hidden compartments in AVMs — A new concept , 1997, Acta radiologica.

[39]  J. Detre,et al.  Arteriovenous Shunt Visualization in Arteriovenous Malformations with Arterial Spin-Labeling MR Imaging , 2008, American Journal of Neuroradiology.

[40]  R. Macdonald,et al.  Embryological basis of some aspects of cerebral vascular fistulas and malformations. , 1996, Journal of neurosurgery.

[41]  M. Brock,et al.  Factors associated with intracranial hemorrhage in cases of cerebral arteriovenous malformation. , 2000, Neurosurgery.

[42]  J. Ransohoff,et al.  Vein of Galen malformation , 2012, BMJ Case Reports.

[43]  H. Henkes,et al.  Pressure measurements in arterial feeders of brain arteriovenous malformations before and after endovascular embolization , 2004, Neuroradiology.

[44]  Walter Montanera,et al.  Angioarchitectural Factors Present in Brain Arteriovenous Malformations Associated With Hemorrhagic Presentation , 2002, Stroke.

[45]  P. Weinstein,et al.  Normal perfusion pressure breakthrough theory. , 1978, Clinical neurosurgery.

[46]  R. Homan,et al.  Quantification of intracerebral steal in patients with arteriovenous malformation. , 1986, Archives of neurology.

[47]  W. Henderson,et al.  Natural history of cerebral angiomas. , 1967, British medical journal.

[48]  R. Macdonald,et al.  Cerebral venous malformation-arteriovenous malformation transition forms. , 1996, Journal of neurosurgery.

[49]  I. Feigin,et al.  ARTERIOVENOUS COMMUNICATIONS IN THE HUMAN BRAIN , 1972, Journal of neuropathology and experimental neurology.

[50]  M. Matsumoto,et al.  Perinidal Dilated Capillary Networks in Cerebral Arteriovenous Malformations , 2004, Neurosurgery.

[51]  J. Hernesniemi.  Arteriovenous malformations of the vein of Galen: report of three microsurgically treated cases. , 1991, Surgical neurology.

[52]  E. Zager,et al.  Hypertension, small size, and deep venous drainage are associated with risk of hemorrhagic presentation of cerebral arteriovenous malformations. , 1998, Neurosurgery.

[53]  W. Young,et al.  The effects of intracranial arteriovenous malformations on cerebral hemodynamics. , 1996, Neurosurgery clinics of North America.

[54]  J F Toole,et al.  Anastomoses in the vascular bed of the human cerebrum. , 1968, Journal of neuropathology and experimental neurology.

[55]  B. Guidetti,et al.  Intracranial arteriovenous malformations. Conservative and surgical treatment. , 1980, Journal of neurosurgery.

[56]  W. Mckissock,et al.  A clinical survey of intracranial angiomas with special reference to their mode of progression and surgical treatment: a report of 110 cases. , 1956, Brain : a journal of neurology.

[57]  O. Waltimo.  The relationship of size, density and localization of intracranial arteriovenous malformations to the type of initial symptom. , 1973, Journal of the neurological sciences.

[58]  O. Houser,et al.  Arteriovenous malformations of the parenchyma of the brain. Angiographic aspects. , 1973, Radiology.

[59]  K. Nozaki,et al.  Do cerebral arteriovenous malformations recur after angiographically confirmed total extirpation? , 1999, Critical reviews in neurosurgery : CR.

[60]  O. Wiestler,et al.  Intracranial venous hypertension and the effects of venous outflow obstruction in a rat model of arteriovenous fistula. , 1991, Neurosurgery.

[61]  W. Young,et al.  Evidence for adaptive autoregulatory displacement in hypotensive cortical territories adjacent to arteriovenous malformations. Columbia University AVM Study Project. , 1994, Neurosurgery.

[62]  C. Schaller,et al.  Physiological steal around AVMs of the brain is not equivalent to cortical ischemia. , 1998, Neurological research.

[63]  C. Schaller,et al.  Distributions of local oxygen saturation and its response to changes of mean arterial blood pressure in the cerebral cortex adjacent to arteriovenous malformations. , 1999, Stroke.

[64]  C. Schaller,et al.  Patterns of Cortical Oxygen Saturation Changes During CO2 Reactivity Testing in the Vicinity of Cerebral Arteriovenous Malformations , 2003, Stroke.

[65]  K. Sano,et al.  Subarachnoid hemorrhage in children. , 1978, Child's brain.

[66]  R. Higashida,et al.  Acquired pial arteriovenous fistula following cerebral vein thrombosis. , 1999, Stroke.

[67]  H. Yonas,et al.  Use of acetazolamide-challenge xenon CT in the assessment of cerebral blood flow dynamics in patients with arteriovenous malformations. , 1990, AJNR. American journal of neuroradiology.

[68]  R F Spetzler,et al.  Relationship of perfusion pressure and size to risk of hemorrhage from arteriovenous malformations. , 1992, Journal of neurosurgery.

[69]  D. Parkinson,et al.  Arteriovenous malformations. Summary of 100 consecutive supratentorial cases. , 1980, Journal of Neurosurgery.

[70]  W. Young,et al.  Abnormal Pattern of Tie-2 and Vascular Endothelial Growth Factor Receptor Expression in Human Cerebral Arteriovenous Malformations , 2000, Neurosurgery.

[71]  J. Chodkiewicz,et al.  Angioarchitecture associated with haemorrhage in cerebral arteriovenous malformations: a prognostic statistical model , 1997, Neuroradiology.

[72]  M. Marks,et al.  Hemorrhage in intracerebral arteriovenous malformations: angiographic determinants. , 1990, Radiology.