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Pediatric brain arteriovenous malformations are a major cause of morbidity and mortality, with the harmful effects of this disease compounded by the additional disability-years experienced by children with ruptured or other symptomatic arteriovenous malformations. In addition to the risks shared with their adult counterparts, pediatric patients frequently experience recurrence following radiographic cure, which presents an additional source of morbidity and mortality. Therefore, there is a need to synthesize potential mechanisms contributing to the elevated recurrence risk in the pediatric population and discuss how these translate to practical considerations for managing these patients. [ABSTRACT FROM AUTHOR]

Brain arteriovenous malformations (AVMs) are dynamic lesions. Unlike the recruitment of additional vessels and the growth of the nidus over time, which are well reported in the literature, spontaneous regression is much less frequent. Only a handful of cases reporting recanalization of spontaneously regressed AVMs have been published. AVMs that undergo spontaneous regression typically share structural and historical features, including previous hemorrhage, a small nidus, superficial venous drainage, and a single draining vein. Structural features and hemodynamic changes may predispose brain AVMs to spontaneous regression, and angiogenic processes are hypothesized to contribute to recanalization and hemorrhage. We present the case of a 37-year-old female who had been diagnosed 12 years ago with an unruptured Spetzler-Martin grade 3 AVM in the left medial occipital lobe after a history of progressively worsening migraines. The AVM was monitored for 1 year, but the patient was lost to follow-up until 11 years later, when the AVM nidus was found to be significantly smaller in size. One month later, the patient presented with acute intraparenchymal hemorrhage due to rupture of the AVM, which was then surgically resected. Our case is the second reported case of rupture of a spontaneously regressed AVM and the first reported case of this outcome with no history of previous hemorrhage. Close monitoring of brain AVMs may be warranted for longer periods of time than previously recommended. [ABSTRACT FROM AUTHOR]

Intracerebral hemorrhage, seizures, neurologic deficits, and cognitive impairments due to brain AVM in childhood are incriminating for brain and executive function with sequelae for further social life. Long-term follow-up data on brain AVM in young patients are rare, making it difficult to compare and evaluate treatment risks and outcomes. We studied young patients with brain AVM who were referred to our institution between 2005 and 2012 and for whom follow-up data were available. We stratified the patients into those with ruptured AVM (rAVM) and unruptured AVM (uAVM) and compared treated and nontreated patients. Differences in outcome and social participation were assessed. A total of 29 young patients with brain AVM, median age 16 years, were included in our study with complete follow-up data of over 5 years (mean, 6 years). In 18 (62.1%) patients rAVM and in 11 (37.9%) patients uAVM were found. Twenty (69%) patients received treatment (rAVM 70% vs. uAVM 30%). Among treatment methods, microsurgery was most frequently used (rAVM 33.3% vs. uAVM 36.4%). In rAVM, 16 of 18 (88.9%) patients returned to work or school, and in uAVM, 11 (100%) patients did so. Concerning cognitive problems, no statistically significant difference was found in the 2 groups comparing treated and nontreated patients (P > 0.05). A favorable outcome was achieved in 13 (72.2%) patients with rAVM and in 11 (100%) patients with uAVM. Favorable outcome was achieved in the majority of patients. The rate of neurologic improvement and participation in social life was very high in the 2 groups. [ABSTRACT FROM AUTHOR]

Background Angiolipomas are mesenchymal tumors composed of mature adipocytes with abnormal vascular elements. They are most commonly found in subcutaneous tissues of the trunk and are rarely seen at craniospinal axes. Case Description We present an untypical case of frontal lobe angiolipoma manifested with seizures and initially described as an arteriovenous malformation. Conclusion MRI with fat-suppression sequence plays key role in angiolipomas diagnostics. [ABSTRACT FROM AUTHOR]

Rationale and Objectives: For the evaluation of patients scheduled for the treatment of brain arteriovenous malformations (AVMs), accurate anatomical information is essential. The purpose of this study was to assess the usefulness of three-dimensional (3D) digital subtraction angiography (DSA)-magnetic resonance (MR) fusion imaging for the pretreatment evaluation of AVMs. Materials and Methods: The study population consisted of 11 consecutive patients (7 males, 4 females; age 10–72 years; mean 45 years) with brain AVMs. All prospectively underwent pretreatment MR imaging (MRI), MR angiography (MRA), and two-dimensional (2D) and 3D DSA. The 3D DSA and MR images were semiautomatically fused with fusion software on a workstation. In the delineation of AVM nidus, feeder, drainer, and relationship between AVM and the adjacent brain structures, two radiologists independently evaluated MRA and MRI, three-dimensional (3D) DSA, and MRI, and 3D DSA-MR fusion images using a 4-point scoring system. The referring neurosurgeons were asked whether the information provided by 3D DSA-MR fusion images was helpful for treatment decisions. Results: For all four items, the delineation was significantly better with the 3D DSA/MRI or 3D DSA-MR fusion images than the MRA/MRI images. Although the delineation for the nidus, feeder, and drainer were not significantly different between the 3D DSA/MRI and 3D DSA-MR fusion images, 3D DSA-MR fusion imaging were significantly better for the relationship between AVM and the adjacent brain structures than 3D DSA/MR imaging (P = .0047). The information provided by 3D DSA-MR fusion images was helpful for treatment decisions in all cases. Conclusion: 3D DSA-MR fusion images are useful for the pretreatment evaluation of brain AVMs. [ABSTRACT FROM AUTHOR]

A 71-year-old man, with a pial micro-arteriovenous malformation (pAVM) draining into the confluence of the vein of Trolard and the vein of Labbé was surgically removed, sparing these cortical veins. 4-months MR and angiographic controls showed a de novo dural arteriovenous fistula (dAVF) draining into the previously spared cortical veins. It was removed using intraoperative motor evoked potentials (MEP). This is the first case of iatrogenic dAVF developing on the same draining vein of a previously treated pAVM. De novo dAVFs are generally iatrogenic. This case suggests that the unresected venous drainage of an AVM might be the substratum for neo-angiogenetic processes; moreover inflammation related to surgery might be the trigger factor for the development of the dAVF. [ABSTRACT FROM AUTHOR]