Choice of tactics of combined treatment of cerebral arteriovenous malformation based on the assessment of vascular endothelial growth factor dynamics. Case report

Cerebral AVMs can be considered one of the most difficult problems in the practice of vascular neurosurgeon. Modern studies indicate that AVMs are a dynamically developing disease, the main role in the progression of which is played by angiogenesis.

CASE REPORT. A 46-year-old patient with AVM of the right temporal lobe with epileptic type of course. After pre-investigation and preoperative preparation the patient underwent two-stage endovascular and microsurgical treatment. The patient was evaluated the dynamics of vascular endothelial growth factor (VEGF) level, which served as a reason for correction of surgical approach.

CONCLUSION. The combination of all studied technological solutions in embolization of cerebral AVMs with the detailing of biological features of the malformation (identification of AVMs prone to growth or recurrence) will allow to create an optimal strategy of surgical treatment of AVMs.

1. Monica Majumdar, Lee A Tan Michael Chen. Critical assessment of the morbidity associated with ruptured cerebral arteriovenous malformations. J Neurointerv Surg. 2016 Feb;8(2):163–7. doi:10.1136/neurintsurg-2014–011517.

2. Keiko Fukuda, Monica Majumdar, Hesham Masoud, Thanh Nguyen, Amir Honarmand, Ali Shaibani4, Sameer Ansari, Lee A Tan5, Michael Chen Multicenter assessment of morbidity associated with cerebral arteriovenous malformation hemorrhages J Neurointerv Surg. 2017 Jul;9(7):664–668. doi: 10.1136/neurintsurg-2016–012485.

3. Stefani MA, Porter PJ, Terbrugge KG, Montanera W, Willinsky RA, Wallace MC. Angioarchitectural factors present in brain arteriovenous malformations associated with hemorrhagic presentation. Stroke. 2002 Apr;33(4):920–4. doi: 10.1161/01.str.0000014582.03429.f7.

4. Stapf C, Mast H, Sciacca RR, Choi JH, Khaw AV, Connolly ES, Pile-Spellman J, Mohr JP. predictors of hemorrhage in patients with untreated brain arteriovenous malformation. Neurology. 2006 May 9;66(9):1350–5. doi: 10.1212/01.wnl.0000210524.68507.87.

5. Kim H, McCulloch CE, Johnston SC, Lawton MT, Sidney S, Young WL. Comparison of 2 approaches for determining the natural history risk of brain arteriovenous malformation rupture. Am J Epidemiol. 2010 Jun 15;171(12):1317–22. doi: 10.1093/aje/kwq082.

6. Turjman F, Massoud TF, Viñuela F, Sayre JW, Guglielmi G, duckwiler G. Correlation of the angioarchitectural features of cerebral arteriovenous malformations with clinical presentation of hemorrhage. Neurosurgery. 1995 Nov;37(5):856–60; discussion 860–2. doi: 10.1227/00006123-199511000-00002.

7. Settecase F, Rayz VL. Advanced vascular imaging techniques. Handb Clin Neurol. 2021;176:81–105. doi: 10.1016/B978-0-444-64034-5.00016-X.

8. Togao O, Obara M, Helle M, Yamashita K, Kikuchi K, Momosaka D, Kikuchi Y, Nishimura A, Arimura K, Wada T, Murazaki H, Iihara K, Van Cauteren M, Hiwatashi A. Vessel-selective 4d-MR angiography using super-selective pseudo-continuous arterial spin labeling may be a useful tool for assessing brain AVM hemodynamics. Eur Radiol. 2020 dec;30(12):6452–6463. doi: 10.1007/s00330-020-07057-4.

9. Rutledge C, Cooke DL, Hetts SW, Abla AA. Brain arteriovenous malformations. Handb Clin Neurol. 2021;176:171–178. doi: 10.1016/B978-0-444-64034-5.00020–1.

10. Rozhchenko L. V., dryagina N. V., Razmologova O. Yu., Ivanov A. Yu. The role of angiogenesis in the progression cerebral avms // Sovremennye problemy nauki i obrazovaniya.— 2016.— № 6., с 63 eLIBRARY ID: 27694804 EDN XIBELR. (In Russ.)

11. Rangel-Castilla L, Russin JJ, Martinez-del-Campo E. Molecular and cellular biology of cerebral arteriovenous malformations: a review of current concepts and future trends in treatment. Neurosurg Focus. 2014; 37(3):1–17

12. Rangel-Castilla L, Spetzler RF, Nakaji P. Normal perfusion pressure breakthrough theory: a reappraisal after 35 years. Neurosurg Rev. 2015 Jul;38(3):399–404; discussion 404–5. doi: 10.1007/s10143-014-0600-4.

13. Parfenov V., Svistov D., Eliava SH. et al. Clinicheskie pekomendacii po diagnostike i lecheniu arteriovenozni malformaci centralyji nervnoi sistemi. Associacia neurochirurgov Rossii. Moskva.2014 p.47

14. Kiiashko S. S., Olushin V. E., Zrelov A.A., Kukanov K. K., Sklyar S. S., Maslova L. N., Ivanova N. E. Static-dynamic disorders in patients after microsurgical resection of the cerebellopontine angle tumors: long-term results. Medical News of North Caucasus. 2022;17(1):10–14. eLIBRARY ID:48247731 EDN: CXVHGH doi: 10.14300/mnnc.2022.17003 (In Russ.)

15. Tadevosyan A. R., Sysoev K. V., Samochernykh K.A., Khachatrian V.A. Arteriovenous malformations and epileptic seizures in children: risk factors of seizures and efficacy of their control depending on the surgical treatment modality. Zhurnal Voprosy Neirokhirurgii Imeni N. N. Burdenko. 2019;83(1):83–89. (In Russ., In Engl.) eLIBRARY ID:37183173 EDN: AMARFZ https://doi.org/10.17116/neiro2019830117583

16. Rozhchenko L. V., Petrov A. E., Goroshchenko S.A., Bobinov V.V., Samochernykh K.A. Endovascular treatment of aneurysms associated with cerebral arteriovenous malformations. Zhurnal Voprosy Neirokhirurgii Imeni N. N. Burdenko. 2022;86(2):25–35. (In Russ., In Engl.) eLIBRARY ID: 48234619 EDN: LPWRWW https://doi.org/10.17116/neiro20228602125

17. Rozhchenko L. V., Dryagina N. V. Modern approaches to treatment of complex cerebral arteriovenous malformations. Translational Medicine. 2020;7(5):43–52. (In Russ.) eLIBRARY ID: 44273485 EDN: ESPPBW https://doi.org/10.18705/2311-4495-2020-7-5–43–52