title: Management of cerebral arteriovenous malformations associated with symptomatic congestive intracranial hypertension.
abstract: We report on management strategies and clinical outcomes in 4 cases of acute symptomatic congestive intracranial hypertension associated with cerebral arteriovenous malformations (AVMs). Congestion resulted from high-volume shunts exhausting the drainage capacity of the cerebral venous system in 3 patients, and from sudden venous outflow obstruction in 1 patient. Two AVMs were suggested to be surgically accessible, whereas two AVMs were deemed to be inoperable. Surgically accessible AVMs were treated with embolization followed by complete surgical resection. Inoperable AVMs were treated with partial embolization. Both AVM embolization followed by surgical resection and partial AVM embolization effectively reduced intracranial pressure and achieved sustained patient recovery. Hence, an endovascular approach may be considered to manage AVM-related congestive intracranial hypertension either in combination with surgical AVM removal, or as a palliative approach in inoperable AVMs.
authors.affiliation: Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. rosenkranz@uke.de
authors.forename: Michael
authors.initials: M
authors.lastname: Rosenkranz
authors.forename: Jan
authors.initials: J
authors.lastname: Regelsberger
authors.forename: Hermann
authors.initials: H
authors.lastname: Zeumer
authors.forename: Ulrich
authors.initials: U
authors.lastname: Grzyska
mesh_terms: D000293:Adolescent; D000328:Adult; D001164:Arteriovenous Fistula / Q000473:pathology*; D017023:Coronary Angiography / Q000379:methods; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications* / Q000473:pathology; D019586:Intracranial Hypertension / Q000150:complications* / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male