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. 2020 Jul;162(7):1741-1747.
doi: 10.1007/s00701-020-04328-3. Epub 2020 Apr 18.

Histopathology of brain AVMs part II: inflammation in arteriovenous malformation of the brain

Roosa Wright  1 , Patrik Järvelin  1 , Henri Pekonen  1 , Sara Keränen  1   2 , Tuomas Rauramaa  1   3 , Juhana Frösen  4   5   6   7
Affiliations
Free PMC article

Histopathology of brain AVMs part II: inflammation in arteriovenous malformation of the brain

Roosa Wright et al. Acta Neurochir (Wien). 2020 Jul.
Free PMC article

Abstract

Background: Hemorrhage from an arteriovenous malformation of the brain (bAVM) has been associated with focal inflammation of the bAVM. Intrigued by the possibility of anti-inflammatory drug therapy to stabilize bAVMs and prevent hemorrhage, we investigated the association of bAVM inflammation with other histological features and clinical presentation.

Materials and methods: Tissue samples from 85 surgically treated bAVMs were studied with histology and CD45 immunostainings. The histological data was compared with the clinical history of the patient. Univariate analysis and logistic regression were performed.

Results: Inflammation was found in all studied bAVMs and did not associate with rupture (p = 0.442). While multiple types of inflammatory cells were present, macrophages were clearly the dominant inflammatory cell type, especially in samples with strong inflammation (87% of the samples). Of those bAVMs that had strong inflammation, only 56% had presented with clinically evident rupture. However, hemosiderin which is a sign of prior hemorrhage was detected in 78.4% (58/74) of samples with strong inflammation and was associated with it (p = 0.003). Inflammation in the nidus and parenchyma was associated with perivascular inflammation (p < 0.001). Multivariate analysis did not reveal any independent histological or clinical risk factor for inflammation.

Conclusions: Since strong inflammation is present in both unruptured and ruptured bAVMs, it is not just a reaction to rupture. Our observations suggest that inflammation of the bAVM may indeed predispose to fragility and hemorrhage of the nidal vessels. Further studies in the role of inflammation in the untreated clinical course of bAVMs are indicated.

Keywords: Arteriovenous malformation; Brain; Inflammation; Microhemorrhage; Rupture; Vascular degeneration.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Hematoxylin and eosin staining on sections from unruptured and ruptured bAVM tissues. Strong inflammation was present in parenchyma both unruptured (a) and ruptured (b) bAVMs. In addition to inflammation of the brain parenchyme adjacent to the bAVM nidus, also, perivascular inflammation was found both in unruptured (c) and ruptured (d) bAVMs. Neutrophil adhesion and infiltration of the bAVM vessels was seen in both unruptured (e) and ruptured (f) bAVMs
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