CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2017; 36(03): 153-159
DOI: 10.1055/s-0037-1604344
Review Article | Artigo de Revisão
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

The Natural History of Brain Arteriovenous Malformations

História natural das malformações arteriovenosas encefálicas
Carlos Michel Albuquerque Peres
1   Department of Neurosurgery, Hospital Santa Julia, Manaus, AM, Brazil
,
Vitor Nagai Yamaki
2   Division of Neurosurgery, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
,
Eberval Gadelha Figueiredo
2   Division of Neurosurgery, School of Medicine, Universidade de São Paulo, São Paulo, SP, Brazil
› Institutsangaben
Weitere Informationen

Publikationsverlauf

18. Mai 2017

05. Juni 2017

Publikationsdatum:
19. Juli 2017 (online)

Abstract

Brain arteriovenous malformations (AVMs) are relatively rare lesions with irreversible consequences in the context of hemorrhage. They are characterized by direct connections between arteries and veins without an intervening capillary network. The natural history of brain AVMs is controversial in the literature, with low evidence level gathered in the papers published, and with large divergence of results among them. A detailed understanding of the natural history is critical for treatment decision. The risk of development of deleterious outcomes such as hemorrhage or brain infarction should always be considered when submitting a patient to the risks of treatment. Several factors related to the patient and to the AVMs are determinants in the natural history of this disease. The topography, size, morphology and angioarchitecture of AVMs determine the risk of rupture. Large AVMs, those located in the posterior fossa and with deep venous drainage, have higher risk of rupture. Due to divergence in the literature regarding the natural history of AVMs, the choice of treatment should also consider experiences acquired over the years from reference centers with a high number of AVMs treated per year. We determined 7 variables that should be considered during the decision to treat an AVM: 1) previous hemorrhage; 2) aneurysm associated to the AVM; 3) direct arteriovenous fistula; 4) factors related to the nidus; 5) age and habits (smoking, sedentary lifestyle, diet quality); 6) the functional performance of the patient; 7) psychological factors.

Resumo

Malformações arteriovenosas (MAVs) são lesões caracterizadas por conexões diretas entre artérias e veias sem rede capilar. São relativamente raras e com consequências muitas vezes irreversíveis no contexto de hemorragia. A história natural das MAVs é controversa na literatura, com pouca evidência extraída dos artigos publicados, além de alta divergência entre resultados. Um entendimento detalhado da história natural da doença é determinante para a decisão do tratamento. O risco de desenvolver consequências deletérias como hemorragia ou isquemia deve ser sempre considerado antes de submeter pacientes ao tratamento. Vários fatores relacionados ao paciente e às MAVs são determinantes na história natural da doença. A localização, tamanho, morfologia e angioarquitetura das MAVs estimam o risco de ruptura. As MAVs grandes, de fossa posterior, com drenagem venosa profunda, têm maior risco de ruptura. A decisão de tratar deve também levar em conta a experiência do serviço, adquirida após anos de tratamento de MAVs. Nós determinamos 7 fatores que devem ser avaliados diante da decisão de tratamento das MAVs: 1) hemorragia prévia; 2) aneurismas associados à MAV; 3) fístula arteriovenosa; 4) fatores relacionados ao nidus; 5) idade e hábitos de vida; 6) performance funcional do paciente; 7) fatores psicológicos.

 
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