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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 23:945-952, June-July 2002
© 2002 American Society of Neuroradiology

INTERVENTIONAL

Cerebral Microarteriovenous Malformations: Diagnostic and Therpeutic Features in a Series of Patients

Martino Cellerini^a, Salvatore Mangiafico^a, Gabriella Villa^a, Marco Nistri^a, Cesare Pandolfo^a, Hahman Noubari^b, Franco Ammannati^b, Pasquale Mennonna^b, Antonio Scollato^c, Paulo Perrini^c, Nicola Di Lorenzo^c and Gian Paolo Giordano^a

^a Neuroradiology Unit, University of Florence, Italy
^b Neurosurgery Department, Careggi Hospital, University of Florence, Italy
^c Neurosurgical Clinic, University of Florence, Italy

Address reprint requests to Martino Cellerini, MD, U.O. Neuroradiologia, Centro Traumatologico Ortopedico, Azienda Ospedaliera Careggi, Largo Palagi,1-50134, Firenze, Italy

BACKGROUND AND PURPOSE: Few collected series of cerebral microarteriovenous malformations (micro-AVMs) have been reported. Our propose was to assess the unique diagnostic and therapeutic challenges posed by these lesions and their influence on outcomes.

METHODS: The clinical presentation, diagnostic features, principles of endovascular or surgical treatment, and outcomes for a consecutive series of 10 patients (five male, five female; mean age, 48.8 years; age range, 31–65 years) with angiographically demonstrated cerebral micro-AVMs were retrospectively analyzed.

RESULTS: All patients presented with a cerebral hematoma (supratentorial in eight, infratentorial in two, intraventricular in one, subarachnoid in one; mean volume, 11.6 cm³), which was superficially situated in nine patients. Neurologic deficits were observed in nine patients, and three patients had seizures. The mean delay between the onset of symptoms and diagnosis was 129.8 days (range, 6 days to 1 year). Superselective angiography was performed in seven patients and followed by successful acrylic embolization of the lesion in five. Five patients underwent surgical intervention, which led to definitive resection. Although long-term neurologic problems were present in eight patients, they were able to return to their previous activities and employment.

CONCLUSION: The diagnosis of cerebral micro-AVMs requires a high index of suspicion, especially in young adults with atypical hemorrhaging. Single-shot embolization of micro-AVMs may be a safe alternative to the established surgical therapy in select cases. Outcomes depend mostly on the clinical conditions at admission.