Are Parenchymal AVMs Congenital Lesions?
Are Parenchymal AVMs Congenital Lesions?
A long-held dogma in neurosurgery is that parenchymal arteriovenous malformations (AVMs) are congenital. However, there is no strong evidence supporting this theory. An increasing number of documented cases of de novo formation of parenchymal AVMs cast doubt on their congenital nature and suggest that indeed the majority of these lesions may form after birth. Further evidence suggesting the postnatal development of parenchymal AVMs comes from the exceedingly rare diagnosis of these lesions in utero despite the widespread availability of high-resolution imaging modalities such as ultrasound and fetal MRI. The exact mechanism of AVM formation has yet to be elucidated, but most likely involves genetic susceptibility and environmental triggering factors. In this review, the authors report 2 cases of de novo AVM formation and analyze the evidence suggesting that they represent an acquired condition.
Along-held dogma in neurosurgery is that parenchymal arteriovenous malformations (AVMs) are congenital lesions. This dogma is based on the observation that these lesions can occur in children and adults alike, but there is little convincing evidence as to its scientific truth. Over the past 2 decades, our understanding of parenchymal AVMs has improved and more information has been gained about their molecular and genetic basis. An increasing number of convincing observations of de novo AVM formation have put into question the long-held dogma that these lesions are congenital. In this review, we describe 2 cases of de novo AVMs and analyze the evidence suggesting that indeed parenchymal AVMs are not congenital lesions but most likely represent an acquired condition probably not dissimilar to their dural counterparts.
Abstract and Introduction
Abstract
A long-held dogma in neurosurgery is that parenchymal arteriovenous malformations (AVMs) are congenital. However, there is no strong evidence supporting this theory. An increasing number of documented cases of de novo formation of parenchymal AVMs cast doubt on their congenital nature and suggest that indeed the majority of these lesions may form after birth. Further evidence suggesting the postnatal development of parenchymal AVMs comes from the exceedingly rare diagnosis of these lesions in utero despite the widespread availability of high-resolution imaging modalities such as ultrasound and fetal MRI. The exact mechanism of AVM formation has yet to be elucidated, but most likely involves genetic susceptibility and environmental triggering factors. In this review, the authors report 2 cases of de novo AVM formation and analyze the evidence suggesting that they represent an acquired condition.
Introduction
Along-held dogma in neurosurgery is that parenchymal arteriovenous malformations (AVMs) are congenital lesions. This dogma is based on the observation that these lesions can occur in children and adults alike, but there is little convincing evidence as to its scientific truth. Over the past 2 decades, our understanding of parenchymal AVMs has improved and more information has been gained about their molecular and genetic basis. An increasing number of convincing observations of de novo AVM formation have put into question the long-held dogma that these lesions are congenital. In this review, we describe 2 cases of de novo AVMs and analyze the evidence suggesting that indeed parenchymal AVMs are not congenital lesions but most likely represent an acquired condition probably not dissimilar to their dural counterparts.
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