Jeffree Rosalind L, Stoodley Marcus A
Australian School of Advanced Medicine, Macquarie University, and Institute of Neurological Sciences, Prince of Wales Hospital, Sydney, NSW, Australia.
Pediatr Neurosurg. 2009;45(4):296-304. doi: 10.1159/000235604. Epub 2009 Aug 19.
Arteriovenous malformations (AVMs) are commonly thought to be congenital malformations; however, patients usually present in adolescence or adulthood. This study was carried out to better understand the development of AVMs between birth and presentation.
A retrospective review was performed of the medical records of all patients under 25 presenting to a single institution with an AVM or spontaneous intracerebral hemorrhage from 2000 to 2007.
Out of a total of 34 cases, 3 children were identified with delayed de novo appearance of an AVM after an intracerebral hemorrhage and normal initial angiography. The clinical and angiographic features are presented for these 3 patients and for an additional patient with AVM recurrence after complete surgical excision.
In the light of these cases and a review of the literature, we suggest a hypothesis that AVMs develop postnatally, undergoing a period of growth in childhood or early adulthood, and that they may become symptomatic from the time of their earliest development. The trigger to growth may be shear stress stimulating growth factor expression by endothelial cells lining an arteriovenous fistula. Alternative stimuli, such as venous hypertension, cannot be ruled out.
动静脉畸形（AVM）通常被认为是先天性畸形；然而，患者通常在青春期或成年期出现症状。本研究旨在更好地了解AVM在出生至出现症状期间的发展情况。
对2000年至2007年期间在单一机构就诊的所有25岁以下患有AVM或自发性脑出血患者的病历进行回顾性分析。
在总共34例病例中，3例患儿在脑出血后出现AVM延迟性新生，初始血管造影正常。本文介绍了这3例患者以及1例完全手术切除后AVM复发患者的临床和血管造影特征。
鉴于这些病例及文献回顾，我们提出一个假设，即AVM在出生后发展，在儿童期或成年早期经历一个生长阶段，并且可能从最早发展时就出现症状。生长的触发因素可能是剪切应力刺激动静脉瘘内衬内皮细胞表达生长因子。也不能排除其他刺激因素，如静脉高压。
