Malformações arteriovenosas cerebrais não rotas: revisão sistemática e metanálise de morbimortalidade nos estudos ARUBA- elegíveis.
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Data
2022-10-07
Autores
Pinheiro, Leon Cleres Penido
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Universidade Estadual Paulista (Unesp)
Resumo
Malformações arteriovenosas (MAVs) são lesões vasculares de alto fluxo relacionadas a conexões anômalas entre artérias e veias, através de um emaranhado de vasos malformados denominados nidus. MAVs são lesões raras no cérebro, mas constituem importante causa de sangramento em adultos jovens. Hemorragia cerebral é a manifestação clínica mais frequente, ocorre na metade dos portadores de MAVs e são fatais no primeiro episódio de sangramento em 25% dos casos. Outros fatores de risco para sangramento, além de hemorragia prévia, incluem localização profunda da lesão, drenagem venosa profunda e associação com aneurismas. O diagnóstico de MAV é confirmado por exames de imagem, como tomografia computadorizada, ressonância magnética e por exames angiográficos. O tratamento para MAVs com sangramento prévio pode ser feito por ressecção microcirúrgica da lesão, embolização endovascular, radiocirurgia estereotáxica ou por combinação destes procedimentos. Para MAVs íntegras não há consenso sobre a conduta mais adequada, se deve ser feito acompanhamento clínico ou intervenção terapêutica, tendo em vista os riscos relacionados ao tratamento. Em síntese, a escolha do tipo de tratamento deve considerar vários indicadores, como tamanho e local da lesão, drenagem vascular, a idade e o contexto clínico do paciente, bem como a experiência do serviço e os riscos relacionados ao tratamento.
Abstract Arteriovenous malformations (AVMs) are high flow vascular lesions related to anomalous connections between arteries and veins through a complex tangle of dysplastic small vessels called nidus. Although rare in the brain, AVMs are an important cause of cerebral hemorrhage in young adults. Hemorrhagic stroke is the most common clinical presentation affecting 50% of patients and are fatal in the first episode of bleeding in 25% of cases. Besides previous hemorrhage, other risk factors for bleeding include deep location of the lesion, deep venous drainage and associated aneurisms. The diagnosis of brain AVMs is based on imaging methods such as computed tomography, magnetic resonance imaging and catheter angiography, which provide important information about the structure and hemodynamics of the lesion. Treatment for AVMs may be performed by microsurgical resection of the lesion, endovascular embolization, stereotactic radiosurgery, all modalities as single method or in combination. For unruptured AVMs there is no consensus on the most appropriate type of management, whether clinical follow-up or therapeutic intervention due to treatment related risks. In conclusion the choice of treatment should consider several indicators such as the topography and size of the lesion, the vascular drainage, patient’s age, surgeon experience and the risks related to the intervention.
Abstract Arteriovenous malformations (AVMs) are high flow vascular lesions related to anomalous connections between arteries and veins through a complex tangle of dysplastic small vessels called nidus. Although rare in the brain, AVMs are an important cause of cerebral hemorrhage in young adults. Hemorrhagic stroke is the most common clinical presentation affecting 50% of patients and are fatal in the first episode of bleeding in 25% of cases. Besides previous hemorrhage, other risk factors for bleeding include deep location of the lesion, deep venous drainage and associated aneurisms. The diagnosis of brain AVMs is based on imaging methods such as computed tomography, magnetic resonance imaging and catheter angiography, which provide important information about the structure and hemodynamics of the lesion. Treatment for AVMs may be performed by microsurgical resection of the lesion, endovascular embolization, stereotactic radiosurgery, all modalities as single method or in combination. For unruptured AVMs there is no consensus on the most appropriate type of management, whether clinical follow-up or therapeutic intervention due to treatment related risks. In conclusion the choice of treatment should consider several indicators such as the topography and size of the lesion, the vascular drainage, patient’s age, surgeon experience and the risks related to the intervention.
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Malformações arteriovenosas intracranianas, Arteriovenosas, Cerebro - Tratamento, Diagnóstico