title: Management of multiple cerebral arteriovenous malformations in a non-pediatric population.
abstract: The occurrence of concomitant multiple cerebral arteriovenous malformations (mAVMs) is often associated with hereditary hemorrhagic telangiectasia (HHT) or craniofacial arteriovenous metameric syndrome (CAMS) and frequently occurs in the pediatric population.
  
  
  
  Between 1995 and 2013, demographic, clinical, and angiographic data of cerebral AVMs have been prospectively collected. We retrospectively analyzed data of patients presenting multiple cerebral AVMs.
  
  
  
  Six patients (mean age, 44 years, male-to-female ratio, 5) presented an angiographic diagnosis of cerebral mAVMs. Only one of them was known to have a HHT. Five patients presented two cerebral AVMs and one patient had three. Three AVMs (23.1 %) presented bleeding at admission. Three patients had supratentorial mAVMs only and the three others had supra and infratentorial AVMs. Only one patient suffered from bleeding of more than one of his mAVMs with an interval of 23 years.
  
  
  
  For asymptomatic AVMs discovered incidentally without angiographic bleeding risk, we propose a therapeutic abstention. In case of AVM rupture and bleeding, the other "associated" AVMs (discovered through a complete angiographic assessment) should also be treated if they are not located in an eloquent area and if the treatment does not present technical difficulties. AVMs with a history of bleeding or associated to angiographic risks have to be treated more aggressively.
authors.affiliation: Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019, Paris, France. thomas.robert43@gmail.com.
authors.forename: Thomas
authors.initials: T
authors.lastname: Robert
authors.affiliation: Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019, Paris, France.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Blanc
authors.affiliation: Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019, Paris, France.
authors.forename: Daniele
authors.initials: D
authors.lastname: Botta
authors.affiliation: Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019, Paris, France.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Ciccio
authors.affiliation: Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019, Paris, France.
authors.forename: Stanislas
authors.initials: S
authors.lastname: Smajda
authors.affiliation: Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019, Paris, France.
authors.forename: Hocine
authors.initials: H
authors.lastname: Redjem
authors.affiliation: Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019, Paris, France.
authors.forename: Robert
authors.initials: R
authors.lastname: Fahed
authors.affiliation: Department of Interventional Neuroradiology, Rothschild Foundation Hospital, 25 Rue Manin, 75019, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Piotin
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D002538:Intracranial Arteriovenous Malformations / Q000150:complications / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology
keywords: Arteriovenous malformation; Cerebral; Cerebral angiography; Intracerebral hemorrhage