Grundsätzlich unterscheidet man intrakraniell die echten Gefäßmissbildungen, nämlich piale AV-Malformationen, durale AV-Fisteln, Kavernome und kapilläre Teleangiektasien. Fälschlicherweise werden mancherorts auch die angeborenen venösen Anomalien (developmental venous anomalies) zu den Gefäßmissbildungen gerechnet, obwohl es sich hier nur um Varianten der embryologischen Entwicklung handelt. Global betrachtet haben piale AVM das höchste Blutungsrisiko aller interkraniellen Gefäßmissbildungen. Bei duralen AV-Fisteln kann man das individuelle Blutungsrisiko durch die genaue Analyse der venösen Drainage sehr gut einschätzen. Kavernome haben ein deutlich geringeres Blutungsrisiko, die Blutungen selber sind selten groß und enden auch nur sehr selten katastrophal. DVAs haben kein Blutungsrisiko, sind aber zu einem Drittel mit Kavernomen vergesellschaftet, nach denen gezielt gesucht werden muss. Kapilläre Teleangiektasien haben kein Blutungsrisiko. Der radiologische Zufallsbefund einer intrakraniellen Gefäßmissbildung darf also nicht zu dem Reflex „Zeitbombe mit Blutungsrisiko im Kopf” führen, sondern sollte zu einer individuellen Aufklärung des Patienten führen.
Abstract
In general, intracranial vascular malformations are divided into pial AVM, dural AV fistula, cavernoma and capillary telangiectasias. Developmental venous anomalies are sometimes thought to be vascular malformations. In fact, they are just a variant of venous drainage. In general, pial AVMs have a high risk of intracerebral bleeding. In dural AV fistulas, the individual bleeding risk can be effectively estimated by analyzing the venous drainage. Cavernomas have a low bleeding risk and the bleeding is rarely life-threatening. DVAs do not have any bleeding risk but 30 % are associated with cavernomas. Capillary telangiectasias also have no bleeding risk. Therefore, a radiological finding of an intracranial vascular malformation should not automatically elicit the reaction “time bomb in your head with a bleeding risk” but should be subjected to an analysis of the bleeding risk for the individual patient.
Key words
brain - vascular - CNS
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