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Clinical Characteristics, Angioarchitecture and Management of Tectum Mesencephali Arteriovenous Malformations

A Retrospective Case Series

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Abstract

Purpose

Tectum mesencephali arteriovenous malformations (TM-AVMs) are rare lesions deeply located close to eloquent structures making them challenging to treat. We aimed to present clinical presentation, angiographic features and treatment strategies of TM-AVMs through a single center retrospective case series.

Methods

A TM-AVMs is defined as a nidus located in the parenchyma or on the pia mater of the posterior midbrain. Records of consecutive patients admitted with TM-AVMs over a 21-year period were retrospectively analyzed. Vascular anatomy of the region is also reviewed.

Results

In this study 13 patients (1.63% of the complete cohort; 10 males), mean age 48 years, were included. All patients presented with intracranial hemorrhage and two patients (15%) died after an early recurrent bleeding. Mean size of the TM-AVMs was 10.1 ± 5 mm. Multiple arterial feeders were noted in every cases. Of the patients 11 underwent an exclusion treatment, 8 via embolization (6 via arterial access and 2 via venous access) and 4 via stereotactic radiosurgery (SRS) (1 patient received both). Overall success treatment rate was 7/11 patients (64% overall; 63% in the embolization group, 25% in the SRS group). Two hemorrhagic events led to a worsened outcome, one during embolization and one several years after SRS. All other patients remained clinically stable or improved.

Conclusion

The TM-AVMs are rare but stereotypic lesions found in a hemorrhagic context. Multiple arterial feeders are always present. Endovascular treatment seems to be an effective technique with relatively low morbidity; SRS had a low success rate but was only use in a limited number of patients.

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Abbreviations

BV:

Basal vein

CoA:

Collicular artery

ICH:

Intracerebral hemorrhage

IVH:

Intraventricular hemorrhage

LMV:

Lateral mesencephalic vein

MPChA:

Medial posterior choroidal artery

mRS:

Modified Rankin scale

MSCA:

Medial superior cerebellar artery

PcCV:

Precentral cerebellar vein

PMV:

Posterior mesencephalic vein

SPV:

Superior petrosal vein

SRS:

Stereotactic radiosurgery

TM:

Tectum mesencephali

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Acknowledgements

We thank Mrs. Diane Rottner for the anatomical drawings (dianerottner.com).

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. APHP. Department of Neuroradiology, Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France

    Jonathan Cortese, Eimad Shotar, Stéphanie Lenck, Kévin Premat, Dominique Hasboun, Atika Talbi, Téodor Grand, Nader-Antoine Sourour & Frédéric Clarençon

  2. Sorbonne University, Paris, France

    Mariette Delaitre, Kévin Premat, Dominique Hasboun, Bertrand Mathon & Frédéric Clarençon

  3. APHP. Department of Neurosurgery, Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France

    Anne-Laure Boch, Bertrand Mathon & Charles-Ambroise Valery

  4. APHP. Department of Anesthesiology and Neuro-critical Care, Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France

    Mehdi Drir

  5. GRC BioFast, Sorbonne University, Paris, France

    Frédéric Clarençon

Authors
  1. Jonathan Cortese
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  2. Mariette Delaitre
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  12. Mehdi Drir
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  13. Nader-Antoine Sourour
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  14. Frédéric Clarençon
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Contributions

JC, MD, SL, NAS, CAV, ES and FC acquired the data. JC, ES and FC developed the project, analyzed the data, and drafted the manuscript. JC, DH, ES, KP and FC revised the anatomical description. All authors critically revised the paper for important intellectual content and provided final approval of the version published. All authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Frédéric Clarençon.

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Conflict of interest

N.-A. Sourour is consultant for Medtronic, Balt Extrusion, Microvention. F. Clarençon reports conflict of interest with Medtronic, Guerbet, Balt Extrusion, Penumbra (paid lectures; unrelated to the study), Codman Neurovascular and Microvention (core lab; unrelated to the study). J. Cortese, M. Delaitre, E. Shotar, S. Lenck, K. Premat, D. Hasboun, A. Talbi, T. Grand, A.-L. Boch, B. Mathon, C.-A. Valery and M. Drir declare that they have no competing interests.

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Study data are available from the corresponding author upon reasonable request.

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Cortese, J., Delaitre, M., Shotar, E. et al. Clinical Characteristics, Angioarchitecture and Management of Tectum Mesencephali Arteriovenous Malformations. Clin Neuroradiol 32, 445–454 (2022). https://doi.org/10.1007/s00062-021-01047-9

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  • DOI: https://doi.org/10.1007/s00062-021-01047-9

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