Division of Neuroradiology, JDMI, University Health Network, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Division of Neuroradiology, ETZ Elisabeth Hospital, Tilburg, Noord-Brabant, the Netherlands.
Division of Neuroradiology, JDMI, University Health Network, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
World Neurosurg. 2021 Aug;152:e467-e475. doi: 10.1016/j.wneu.2021.05.116. Epub 2021 Jun 2.
Focal brain edema in unruptured brain arteriovenous malformations (AVMs) is rare and associated with venous outflow abnormalities and aneurysm growth. These patients have an increased rate of progressive neurologic symptoms, as well as a potentially increased risk of hemorrhage. In this study, we aim to assess in further detail the relationship between perifocal edema and enhancement of the vessel wall in symptomatic patients with an unruptured brain AVM.
A single-center retrospective cohort study of all patients presenting with an unruptured AVM at Toronto Western Hospital from 2009 to 2019 was performed. Patients were included for review if they had focal edema surrounding an AVM on magnetic resonance imaging (MRI) and a contrast-enhanced MRI scan. Associated digital subtraction angiography studies were reviewed.
A total of 122 patients presented with an unruptured AVM. Twelve symptomatic patients presented with focal edema surrounding the AVM. Six patients had focal edema and contrast-enhanced MRI performed. All 6 demonstrated luminal thrombosis at the level of the brain edema on MRI. Moreover, the vessel wall demonstrated enhancement at the level of the luminal thrombus in all.
Vessel wall enhancement, perifocal edema, and luminal thrombosis demonstrated in all patients with unruptured AVM points towards a common mechanism. We suspect an interplay between vascular hypoxia, the innate immune system, and thrombosis formation. Current research in the field of immunothrombosis supports this theory. Unravelling the mechanisms involved is important because it might guide therapy for patients with an unruptured AVM towards noninvasive options.
未破裂脑动静脉畸形（AVM）中的局灶性脑水肿罕见，与静脉流出异常和动脉瘤生长有关。这些患者有进展性神经症状的发生率增加，以及潜在的出血风险增加。在这项研究中，我们旨在更详细地评估有症状的未破裂脑 AVM 患者的周围水肿与血管壁强化之间的关系。
对 2009 年至 2019 年在多伦多西部医院就诊的所有未破裂 AVM 患者进行了单中心回顾性队列研究。如果患者的磁共振成像（MRI）上有 AVM 周围的局灶性水肿和增强 MRI 扫描，则对其进行回顾性分析。回顾了相关的数字减影血管造影研究。
共有 122 例患者出现未破裂 AVM。12 例症状性患者出现 AVM 周围局灶性水肿。6 例患者进行了局灶性水肿和增强 MRI 检查。所有 6 例患者均在 MRI 上显示出脑水肿水平的管腔血栓形成。此外，所有患者的血管壁在管腔血栓形成水平均显示出增强。
所有未破裂 AVM 患者均表现出血管壁增强、周围水肿和管腔血栓形成，这表明存在共同的机制。我们怀疑血管缺氧、固有免疫系统和血栓形成之间存在相互作用。该领域的当前研究支持这一理论。揭示所涉及的机制很重要，因为它可能指导未破裂 AVM 患者的治疗方法采用非侵入性选择。
