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Vol. 32. Issue 4.
Pages 203-208 (July - August 2021)
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Vol. 32. Issue 4.
Pages 203-208 (July - August 2021)
Case Report
Angiographically occult and spontaneously thrombosed large brain arteriovenous malformation
Malformación arteriovenosa cerebral grande, angiográficamente oculta y espontáneamente trombosada
Antonio Montalvo-Afonsoa, Pedro David Delgado-Lópezb,
Corresponding author
pedrodl@yahoo.com

Corresponding author.
, María Teresa Lista-Araujoc, Antonio Rodríguez-Salazarb
a Servicio de Neurocirugía, Hospital General Universitario Gregorio Marañón, Madrid, España. C/Doctor Esquerdo 46, 28009 Madrid, Spain
b Servicio de Neurocirugía, Hospital Universitario de Burgos, Burgos, España, Avda Islas Baleares 3, 09006 Burgos, Spain
c Servicio de Anatomía Patológica, Hospital Universitario de Burgos, Burgos, España, Avda Islas Baleares 3, 09006 Burgos, Spain
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Abstract

Treatment for brain arteriovenous malformations (AVM) include combinations of surgery, radiosurgery and embolization. Very rarely, spontaneous obliteration may occur, especially among small lesions with single superficial vein drainage and prior bleeding. We report the case of a large symptomatic AVM, without history of hemorrhage or prior treatment, in which self-obliteration was noted at surgery. Although MRI suggested the presence of an AVM, no evidence of arterial anomaly was observed in the brain angiography. At surgery, a large cortical nidus with tortuous arterial vessels, resembling that of an AVM but without blood flow, was identified. Complete resection was easily performed without relevant bleeding. The histopathologic study confirmed the diagnosis of a thrombosed AVM. Despite the low probability of recanalization, surgical resection of a suspected spontaneously obliterated AVM may be warranted, in order to reach a definitive diagnosis and to avoid the risk of an eventual bleeding, especially among younger patients.

Keywords:
Arteriovenous malformation
Angiographically occult AVM
Spontaneous obliteration
Thrombosis
Seizure
Unruptured AVM
Abbreviations:
AVM
SpOAVM
CT
MRI
AOVM
Resumen

El tratamiento de las malformaciones arteriovenosas (MAV) cerebrales incluye combinaciones de cirugía, radiocirugía y embolización. Muy rara vez, ocurre una obliteración espontánea, fundamentalmente en MAV pequeñas, con drenaje venoso único superficial y antecedente de sangrado previo. Presentamos un caso de MAV sintomática grande, sin sangrado ni tratamientos previos, en la que se constató auto-trombosis espontánea. Aunque las imágenes de resonancia sugerían la presencia de una MAV, la arteriografía no mostró anomalía arterial compatible. En la cirugía se evidenció un nidus cortical con vasos tortuosos, idéntico a una MAV clásica, aunque sin flujo sanguíneo, por lo que pudo resecarse sin dificultad. La anatomía patológica confirmó la presencia de una MAV trombosada. A pesar del relativamente bajo riesgo de recanalización, la cirugía de una posible MAV trombosada puede ser una opción recomendable, con objeto de llegar al diagnóstico definitivo y evitar un eventual riesgo de sangrado, especialmente en personas jóvenes.

Palabras clave:
Malformación arteriovenosa
MAV angiográficamente oculta
Obliteración espontánea
Trombosis
Crisis
MAV no rota

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