Article
Transdural blood supply in cerebral arteriovenous malformations – a systematic evaluation of angio-architecture
Cerebrale arteriovenöse Malformationen mit transduraler Blutversorgung – eine systematische Erhebung der Angio-Architektur
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Published: | May 8, 2019 |
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Objective: Arterial transdural blood supply (TDBS) is a rare angiographic phenomenon in cerebral AVMs. This study aims to evaluate angiographic TDBS characteristics and to describe the clinical peculiarities of these lesions.
Methods: A prospective AVM database of 535 patients, enrolled from 1990-2016 was analyzed retrospectively. Clinical information was reviewed through patients’ medical charts and radiologic studies. Patients with previous AVM treatment were excluded (n=28).
Results: Patients with (n=32, male/female n=10/22, mean age 46±15a, range 13–75a) and without TDBS (n=475, male/female n=260/215, mean age 40±18a, range 2–87a) did not show significant differences in clinical presentation (age, hemorrhage, seizures, chronic headache). Predominant nidus size in patients with TDBS was ≥30mm, with significantly more patients carrying large AVMs (>60mm, p=0.001). To describe TDBS, three grades were used, based on angiographic TDBS proportion and intensity of AVM nidus perfusion (°I-°III). 57% of patients with chronic headache exhibited a strong and substantial transdural nidus perfusion (°III), as well as a high flow TDBS.
Conclusion: Cerebral AVMs with TDBS represent a rare and heterogeneous subgroup. Lesions can be graded by quantifying TDBS of the nidus and by capturing hemodynamic characteristics. The broad spread of angiographic features and comparable clinical patterns of patients either with or without TDBS rises questions towards the relevance of TDBS on AVM natural history risk and the intention for treatment.