title: Proliferation activity is significantly elevated in partially embolized cerebral arteriovenous malformations.
abstract: BACKGROUND
  The natural history of cerebral arteriovenous malformations (AVMs) is yet to be determined. It has been shown that angiogenic factors are involved in the pathogenesis of AVMs, in particular in partially embolized lesions. This study was conducted to investigate the expression of angiogenic and proliferative factors in relation to different clinical conditions and treatment modalities.
  
  
  METHODS
  Immunohistochemistry was performed for 145 consecutive cases of cerebral AVMs. The specimens were stained with antibodies against VEGF, bFGF, Ki 67, CD 34 and CD 31. Expression was correlated with clinical presentation (haemorrhage, seizures or other symptoms), AVM localization, size, eloquence and venous drainage, as well as with preoperative AVM embolization.
  
  
  RESULTS
  Whereas no correlation was found between the expression of angiogenic factors and different clinical conditions, we observed a significantly increased proliferation activity as shown by Ki 67 expression in patients with intracerebral haemorrhage (p = 0.02) and in patients with preoperative embolization (p = 0.02).
  
  
  CONCLUSIONS
  Increased proliferation activity in partially embolized AVMs supports a 'no-touch' strategy and clinical observation in high-risk AVMs and demands complete AVM elimination in treatable lesions.
authors.affiliation: Department of Neurosurgery, University Hospital Essen, Hufelandstrasse 55, Essen, Germany. sandalcioglu@uk-essen.de
authors.forename: I Erol
authors.initials: IE
authors.lastname: Sandalcioglu
authors.forename: Siamak
authors.initials: S
authors.lastname: Asgari
authors.forename: Doreen
authors.initials: D
authors.lastname: Wende
authors.forename: Johannes A P
authors.initials: JA
authors.lastname: van de Nes
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Dumitru
authors.forename: Yuan
authors.initials: Y
authors.lastname: Zhu
authors.forename: Elke R
authors.initials: ER
authors.lastname: Gizewski
authors.forename: Dietmar
authors.initials: D
authors.lastname: Stolke
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sure
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000378:metabolism; D016022:Case-Control Studies; D049109:Cell Proliferation; D002648:Child; D005260:Female; D016222:Fibroblast Growth Factor 2 / Q000378:metabolism; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000378:metabolism / Q000473:pathology*; D020766:Intracranial Embolism / Q000378:metabolism / Q000473:pathology*; D019394:Ki-67 Antigen / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D019408:Platelet Endothelial Cell Adhesion Molecule-1 / Q000378:metabolism; D012189:Retrospective Studies; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism; D055815:Young Adult
chemical_list: D018952:Antigens, CD34; D019394:Ki-67 Antigen; D019408:Platelet Endothelial Cell Adhesion Molecule-1; D042461:Vascular Endothelial Growth Factor A; D016222:Fibroblast Growth Factor 2