Cerebrovascular malformations

• Arterial Aneurysms
• Arteriovenous Malformations (AVMs)
• Dural Fistulas
• Cavernomas
• Venous Angiomas or Developmental Venous Anomaly (DVA)
• Telangiectasias

Spinal vascular malformations

• Spinal Arteriovenous Malformations
• Dural Arteriovenous Fistulas
• Perimedullary Fistulas
• Cavernomas

1. Arteriovenous Malformations and Cerebral Dural Fistulas

These malformations may present suddenly with hemorrhage, the location of which varies:

• Subarachnoid hemorrhage (or meningeal) — bleeding around the brain, in the subarachnoid spaces
• Cerebral or cerebellar hemorrhage — bleeding inside the brain or cerebellum
• Cerebromeningeal hemorrhage — combining bleeding in the subarachnoid spaces and in the cerebral tissue (hematoma)

These malformations may also be discovered incidentally, during a CT scan or MRI performed for another reason, or manifest through epileptic seizures caused by cortical irritation related to changes in blood flow.

2. Intracerebral or Spinal Cavernomas

Cavernomas may manifest with sudden bleeding that can cause neurological deficit depending on their location, or with an epileptic seizure.

3. Isolated Venous Angiomas

Isolated venous angiomas are congenital and completely asymptomatic — they are therefore benign and require no treatment. They may be associated with a cavernoma, which can explain the presence of symptoms in case of bleeding from the latter.

4. Cerebral Telangiectasias

A cerebral telangiectasia is a small malformation of the brain capillaries corresponding to an abnormal dilation of these vessels. It forms a fragile but generally benign area, requiring no treatment.

5. Spinal Dural Fistulas

Spinal dural fistulas do not bleed but cause the progressive appearance of:

• Sciatic-type pain
• Weakness when walking
• Sphincter disorders progressively worsening

There is often a diagnostic delay as other pathologies (particularly lumbar hernia) may be suspected. A complete spinal MRI (panmedullary) is necessary to guide the diagnosis, then confirmed by spinal arteriography.

6. Perimedullary Fistulas

Perimedullary fistulas may bleed, but generally manifest in the same way as spinal dural fistulas — through progressive neurological and sphincter symptoms.

CERVCO Network

The Neurosurgery Department participates in CERVCO — the Reference Center for Rare Vascular Diseases of the Brain and Eye.

• Improve the management of rare vascular diseases in collaboration with all clinicians at the national level and in coordination with patient and family associations concerned
• Implement care protocols adapted to these conditions and update them regularly based on research advances
• Disseminate reliable and accessible information for patients, their families, and all healthcare professionals involved in their care
• Develop research to improve understanding of the mechanisms of these rare diseases and optimize therapeutic strategies

Research and Training

The neurosurgery, interventional neuroradiology, and neurology departments develop dynamic research and training activities in the field of cerebral and spinal vascular pathologies, with the following objectives:

• Better understand the origin and mechanisms of development of aneurysms and arteriovenous malformations (AVMs), in order to optimize their therapeutic management
• Develop combined procedures associating neurosurgery and endovascular treatment
• Improve understanding of the vascularization of certain skull base meningiomas to adapt surgical strategies
• Better characterize certain pathologies, such as so-called "benign" idiopathic intracranial hypertension — Headache Emergency Center (CUC) at Lariboisière Hospital
• Strengthen training in vascular neurosurgery within Prof. Sébastien Froelich's experimental neurosurgery laboratory

Medical Teams