Abstract
The authors present a series of 13 multiple arteriovenous malformations (MAVMs) in the pediatric population (16.9% of their overall series of brain AVMs in this group). Two types of MAVMs can be distinguished: congenital and acquired. Congenital MAVMs may be of the nidus or fistula type. They may be uni- or bilateral, placed in one or several cerebral lobes, separated or close one to another, or even systematized (Wiburn-Mason syndrome). The symptoms created by these MAVMs are the same as those encountered in the presence of other AVMs, with hemorrhage as revealing symptom in 31% of patients. The responsibility of one particular nidus in the onset of clinical signs is often difficult to determine. From an angioarchitectural point of view, it seems that venous drainage changes are mainly responsible for the symptomatology. The natural history of these MAVMs is difficult to assess; spontaneous regression has been noted in 15% of cases. Acquired cerebral MAVMs can be due to angiogenesis (“sprouting” or “non-sprouting”) around a true AVM because of previous hemorrhage or ischemia, or to pial shunts associated with dural arteriovenous malformations. The treatment of MAVMs is difficult. Embolization seems to the authors the best therapeutic modality available, as surgery or radiosurgery are often unable to treat these multifocal lesions. Anatomical cure is rarely obtained; the therapeutic strategy has to be targeted on the symptomatic lesions.
Similar content being viewed by others
References
Berenstein A, Lasjaunias P (1992) Endovascular treatment of brain lesions. (Surgical neurangiography, vol 4) Springer, Berlin Heidelberg New York, pp 10–20
Celli P, Ferrante L, Palma C, Cavedon G (1984) Cerebral arteriovenous malformations in children. Clinical features and outcome of treatment in children and in adults. Surg Neurol 22:43–49
Folkman J (1986) How is blood vessel growth regulated in normal and neoplastic tissue? Cancer Res 46:467–473
Fournier D, Rodesch G, Terbrugge K, Flodmark O, Lasjaunias P (1991) Acquired dural arterio-venous shunts of the vein of Galen. Neuroradiology 33:52–55
Garcia-Monaco R, Rodesch G, Terbrugge K, Burrows P, Lasjaunias P (1991) Multifocal dural arteriovenous shunts in children. Child's Nerv Syst 7:425–431
Hanieh A, Blumbergs PC, Carney PG (1981) Arteriovenous malformations associated with soft-tissue vascular malformations: a case report. J Neurosurg 54:670–672
Hash CJ, Grossman CB, Shenkin HA (1975) Concurrent intracranial and spinal cord arteriovenous malformations: a case report. J Neurosurg 43:104–107
Hoffman JH, Mohn G, Kusunaki T (1976) Multiple arteriovenous malformations of spinal cord and brain in a child: case report. Child's Brain 2:317–324
Lasjaunias P, Rodesch G, Hannedouche A, Comoy J, Landrieu P (1990) Approche endovasculaire des malformations artérioveineuses cranio-cérébrales de l'enfant. Pédiatrie 45S:239s-244s
Parkinson D, West M (1977) Spontaneous subarachnoid hemorrhage first from an intracranial and then from a spinal arteriovenous malformation: case report. J Neurosurg 47:965–968
Reddy K, West M, Mc Clarty B (1987) Multiple intracerebral arteriovenous malformations: a case report and a literature review. Surg Neurol 27:495–499
Rodesch G, Lasjaunias P, Terbrugge K, Burrows P (1988) Lésions vasculaires artérioveineuses intracrâniennes de l'enfant. Place des techniques endovasculaires. A propos de 44 cas. Neurochirurgie 34:293–303
Schlacter LB, Fleisher AS, Faria MA, Tindall GT (1980) Multifocal intracranial arteriovenous malformations. Neurosurgery 7:440–444
Smith ME, Barth PG, Valk SJ (1981) Congenital multiple angiomatosis with brain involvement. Child's Brain 8:461–467
Stone JL, Crowell RM, Lisner BM, Nasseen M, Oldershaw JB (1983) Bilateral parietal arteriovenous malformations: report of a case. Neurosurgery 5:587–592
Tada T, Sugita K, Kobayashi S, Watanabe N (1986) Supra- and infratentorial arteriovenous malformations with an aneurysmal dilation: a case report. Neurosurgery 5:831–834
Tamaki N, Fujita K, Yamashito H (1971) Multiple arteriovenous malformations involving the scalp, dura, retina, cerebrum and posterior fossa: case report. J Neurosurg 34:95–98
Theron J, Newton TH, Hoyt WF (1974) Unilateral retinocephalic vascular malformation. Neuroradiology 7:185–196
Wiburn-Mason R (1943) Arteriovenous aneurysm of mid brain and retina, facial naevi and mental changes. Brain 66:162–203
Willinsky R, Lasjaunias P, Terbrugge K, Burrows P (1990) Multiple cerebral arteriovenous malformations (MAVMs). Review of our experience of 203 patients with cerebral vascular lesions. Neuroradiology 32:207–210
Zellam RT, Buchheit WA (1985) Multiple intracranial arteriovenous malformations: case report. Neurosurgery 17:88–93
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Iizuka, Y., Rodesch, G., Garcia-Monaco, R. et al. Multiple cerebral arteriovenous shunts in children: report of 13 cases. Child's Nerv Syst 8, 437–444 (1992). https://doi.org/10.1007/BF00274404
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00274404