1. Introduction
Cerebral
vascular malformations are widely classified
as arteriovenous malformations(AVMs),cavernous
malformation , venous malformations and
telangiectasias based strictly on pathology , mixed
or transitional types of malformations
The most common of the vascular malformation is
the AVM (about 80%)

2. AVMs
DEF. Are congenital ,high-flow ,high
pressure lesions with primary Risk of
devastating intracerebral hemorrhage

3. Pathology
The
exact pathogenesis is not known
A genetic factor has been postulated
AVMs commonly affect distal arterial
branches
Often found in the border zone region
shared by the distal anterior , middle
andor posterior cerebral arteries

4. Primitive
circulation begins with a capillary
mesh over the entire brain at about fourth
week of embryogenesis

5. An
AVM is a cluster of congenital
arteriovenous communication without
intervening capillaries
The arteries and veins are tortuous and
dilated . Nidus is the actual site of the
abnormal communication. In most, the AVM
is visible in cortex

6. Location
They
are more commonly supratentorial
particularly in parietal lobe
Middle cerebral
Posterior cerebral
Anterior cerebral territories are involved in
declining frequencies, nearly 10%.
10-15% of patients with this lesions are found
to have aneurysm

7. Location

8. Clinical presentation
Intracranial
AVMs are typically ,
diagnosed before the patient has reached
the age of 40 years

9. Hemorrhage
 Spont. Hemorrhage most common 41-79%
Intraparenchymal
, SDH or SAH
In 5-10% of case IVH
Seizures 2nd most common symptoms 20-25%
Focal
neurological deficit about 10% of AVMs
Headache about 10-15% present with headache
alone
Cognitive
deficits
especially in children

10. (Grade of AVMs(Spetzler-Martin
Lesion characteristic
Points Assigned
SIZE
Small
: diameter <3cm
Medium : diameter 3-6cm
Large
: diameter >6cm
1
2
3
Location
Noneloquent site
Eloquent
0
1
Pattern of venous drainage
Superficial only
Any deep
0
1

11. Investigations
CT
SCANS
CT ANGIO
MRI (MRA & MRV)
DSA (digital subtraction angiography)

12. Management
Management
strategies include
Microsurgery
Endovascular
or radiosurgery either alone or in
combination .
Surgical excision remains the gold standard.

13. Axial
magnetic resonance imaging with
gadolinium shows an enhancing lesion in the
left parietal cortex

14. Digital
subtraction angiography (DSA) of the same
patient shows an arteriovenous malformation(AVM)
with a middle cerebral arterial feeder and a cortical
draining vein to the superior sagittal sinus.

15.  Intraoperative image of the same AVM shows the nidus on the
cortical surface. Note the large draining vein with oxygenated
blood going superiorly. Here, intraoperative cortical stimulation
was attempted because of the eloquent location of the nidus

16. .Post resection image

17. THANK YOU
Dr.Abdullah Alsubaiee