Diagnostic and therapeutic dilemmas of asymptomatic intracranial AVMs: A case report and evidence-based review

First described by Virchow in the 19th century, intracranial arteriovenous malformations (AVMs) are complex, tangle-shaped vascular lesions with a number of associated neuroparenchymal, hemodynamic, and angio-architectural changes. However, the clinical description of extracranial AVMs dates back to...

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Bibliographic Details
Published in:	Radiology case reports Vol. 19; no. 12; pp. 6452 - 6459
Main Authors:	Mansour, Moustafa A., Malaeb, Reem W., Mostafa, Hamdi Nabawi, Kamal, Mohamed Ibrahem, Ayoub, Basim
Format:	Journal Article
Language:	English
Published:	Netherlands Elsevier Inc 01-12-2024 Elsevier
Subjects:	Arteriovenous malformations complications Arteriovenous malformations diagnostic imaging Arteriovenous malformations therapy AVM Brain blood supply Brain diagnostic imaging Case Report Cerebral hemorrhage etiology Intracranial arteriovenous malformations Intracranial hemorrhage Neuroradiology Radiosurgery Rupture LINAC Brain diagnostic imaging RBAS MRI Radiosurgery Intracranial hemorrhage Arteriovenous malformations complications Brain blood supply Neuroradiology Case report ALK-1 VRT SM TOBAS ED Arteriovenous malformations therapy MR ICA Rupture MCA Cerebral hemorrhage etiology Arteriovenous malformations diagnostic imaging ICH Intracranial arteriovenous malformations AVF CT SSS AV ROS AVM ARUBA
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Summary:	First described by Virchow in the 19th century, intracranial arteriovenous malformations (AVMs) are complex, tangle-shaped vascular lesions with a number of associated neuroparenchymal, hemodynamic, and angio-architectural changes. However, the clinical description of extracranial AVMs dates back to the Ebers Papyrus (c. 1500 BC), with a still unknown definitive underlying etiology thus far. AVMs are rare lesions, with approximately 0.15% incidence and 0.001-0.5% prevalence, but of high importance as they tend to affect young patients who are frequently otherwise healthy. In the majority of cases, AVMs present as sudden intracranial hemorrhages that require immediate intervention, but incidentally-detected unruptured AVMs are only found in ∼15% of cases, leaving a confusing dilemma regarding the appropriate next step, particularly given the several therapeutic interventions available and clinical trials that were vulnerable to follow-up criticism. Herein, we present a case of an incidentally detected asymptomatic AVM in a 15-year-old boy via advanced imaging techniques that was initially misinterpreted as a post-traumatic subarachnoid hemorrhage on routine imaging studies. In providing a comprehensive overview of pathological classification schemes and the currently available diagnostic options for these silent dilemmatic AVMs, we highlight three management techniques: microsurgical resection, endovascular embolization, and stereotactic surgery, with the best option depends mostly on addressing lesion resection properly with minimal associated mortality and morbidity.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3 Equal contribution.
ISSN:	1930-0433 1930-0433
DOI:	10.1016/j.radcr.2024.08.154