Tanaka Michihiro
Department of Neurosurgery and Neuroendovascular Surgery, Kameda Medical Center, Kamogawa, Chiba, Japan.
J Neuroendovasc Ther. 2025;19(1). doi: 10.5797/jnet.ra.2024-0037. Epub 2024 Aug 6.
Brain arteriovenous malformations (AVMs) are intricate networks of blood vessels in which arteries connect directly to veins, bypassing the capillary system. This aberration can lead to serious neurological manifestations, including seizures, headaches, and hemorrhagic strokes. The embryonic development of AVMs implicates possible disruptions in arteriovenous differentiation during angiogenesis, improper regression of the primary capillary plexus, or the retention of fetal vasculature as contributing factors. Additionally, genetic mutations and environmental influences during pregnancy may facilitate AVM formation, with identified mutations in genes such as endoglin, activin receptor-like kinase 1, SMAD family member 4, and RAS p21 protein activator 1 disrupting vascular development. Such mutations are associated with conditions like hereditary hemorrhagic telangiectasia and capillary malformation-arteriovenous malformation syndrome, thus highlighting the essential role of genetic counseling in AVM management. This review underscores the importance of a deep comprehension of the embryological and genetic foundations of AVMs to refine diagnostic, therapeutic, and prognostic approaches. The paper advocates for advanced research on intervention strategies and emphasizes the significance of a genetics-focused approach in the clinical management of AVMs.
脑动静脉畸形(AVM)是错综复杂的血管网络,其中动脉直接与静脉相连,绕过了毛细血管系统。这种异常可导致严重的神经学表现,包括癫痫发作、头痛和出血性中风。AVM的胚胎发育涉及血管生成过程中动静脉分化的可能中断、初级毛细血管丛的不当消退或胎儿血管系统的保留等促成因素。此外,孕期的基因突变和环境影响可能促进AVM的形成,已确定诸如内皮糖蛋白、激活素受体样激酶1、SMAD家族成员4和RAS p21蛋白激活剂1等基因的突变会破坏血管发育。此类突变与遗传性出血性毛细血管扩张症和毛细血管畸形 - 动静脉畸形综合征等病症相关,从而凸显了遗传咨询在AVM管理中的重要作用。本综述强调了深入理解AVM的胚胎学和遗传学基础对于完善诊断、治疗和预后方法的重要性。本文提倡对干预策略进行深入研究,并强调在AVM临床管理中以遗传学为重点的方法的重要性。