scholarly journals The Preoperative Functional Downgrading of Brain AVMs

2021 ◽  
pp. 107-112
Author(s):  
Sabino Luzzi ◽  
Mattia Del Maestro ◽  
Renato Galzio
Keyword(s):  
Surgical Treatment ◽  
Scale Score ◽  
Arteriovenous Malformations ◽  
Preoperative Embolization ◽  
Low Density ◽  
Actual Role ◽  
Key Aspects ◽  
Brain Avms ◽  
Grade Iii

AbstractThe actual role of preoperative embolization of brain arteriovenous malformations (AVMs) is undervalued.The present study aims to describe the effectiveness, safety, technics, and results of the endovascular-based functional downgrading of brain AVMs.Data regarding 31 Spetzler-Martin (SM) grade III AVMs that consecutively underwent a combined endovascular-surgical treatment were reviewed. Clinical and radiological outcomes were evaluated according to modified Ranking Scale score (mRS) and postoperative angiography, respectively.Low-density Onyx was used in all cases, and the timeframe between the embolizations was 10–15 days. Procedures were 1.6 (±0.6) on average. Superselective nidal catheterization was essential to reach the deepest parts of the AVMs, which were the targets. Onyx made the nidus compact and easier to dissect. The Average obliteration rate was 29.6%, with negligible morbidity. Surgery was performed after 3.7 days on average and the AVM exclusion was complete in 83.4% of cases. An mRS score between 0 and 2 was reported in 77.5% of patients, while the best outcome was achieved in small and medium-deep malformations.An effective and safe functional downgrading of brain AVMs must be based upon specific technical key aspects, which make surgery easier and, ultimately, allow for the achievement of the best outcome.

Assessing the Role of Preoperative Embolization in the Surgical Management of Cerebral Arteriovenous Malformations

2017 ◽  
Vol 104 ◽  
pp. 430-441 ◽  
Author(s):  
Andrew S. Luksik ◽  
Jody Law ◽  
Wuyang Yang ◽  
Tomas Garzon-Muvdi ◽  
Justin M. Caplan ◽  
...  
Keyword(s):  
Surgical Management ◽  
Arteriovenous Malformations ◽  
Preoperative Embolization ◽  
Cerebral Arteriovenous Malformations

scholarly journals Surgical Treatment of Spetzler-Martin Grade III to V Cerebral Arteriovenous Malformations: 10 Years Experience in Kyoto University

2012 ◽  
Vol 52 (12) ◽  
pp. 852-858 ◽  
Author(s):  
Yasushi TAKAGI ◽  
Jun C. TAKAHASHI ◽  
Kazumichi YOSHIDA ◽  
Akira ISHII ◽  
Nobuo HASHIMOTO ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Arteriovenous Malformations ◽  
Cerebral Arteriovenous Malformations ◽  
Martin Grade ◽  
Grade Iii

scholarly journals Surgical treatment of a complex Grade III Spetzler-Martin posterior temporal arteriovenous malformation

2017 ◽  
Vol 43 (videosuppl1) ◽  
pp. V9 ◽  
Author(s):  
Amrit Chiluwal ◽  
Amir R. Dehdashti
Keyword(s):  
Video Clip ◽  
Venous Drainage ◽  
External Carotid Artery ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Distinct Subgroup ◽  
Heterogenous Group ◽  
Risk Of Hemorrhage ◽  
Brain Avms ◽  
Grade Iii

Grade III Spetzler-Martin arteriovenous malformations (AVMs) are a distinct subgroup of brain AVMs. Their variety in terms of location, type of venous drainage, and size makes them the most heterogenous group in the AVM classification. The surgical risk of treatment is also variable depending on the specifics of a given Grade III AVM. In this video illustration, the authors describe the technical nuances of surgical resection of a very complex Grade III left posterior temporal AVM. According to supplementary grading, the unruptured aspect and patient age give this lesion a Grade III; therefore, the combined grading gives the patient a score of 6, which puts him at moderate risk of morbidity for surgery. The indication for surgery was based on the patient’s young age, lifetime risk of hemorrhage, and the location of the AVM in the left inferior/posterior temporal gyrus.The patient underwent 2 sessions of preoperative embolization of the posterior cerebral artery and the external carotid artery feeders prior to craniotomy. The day after the second embolization, the patient was operated on via a posterior temporobasal craniotomy. The dural supply attached to the draining vein was left intact during the dural exposure. The detail of the AVM resection is described in the video clip. A total resection was achieved, and the patient’s neurological examination was intact after the procedure.The video can be found here: https://youtu.be/fj5Cxw3kpXQ.

scholarly journals Treatment Outcomes of Unruptured Arteriovenous Malformations With a Subgroup Analysis of ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations)-Eligible Patients

Neurosurgery ◽  
2015 ◽  
Vol 76 (5) ◽  
pp. 563-570 ◽  
Author(s):  
John D. Nerva ◽  
Alessandra Mantovani ◽  
Jason Barber ◽  
Louis J. Kim ◽  
Jason K. Rockhill ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Functional Outcome ◽  
Scale Score ◽  
Subgroup Analysis ◽  
Arteriovenous Malformations ◽  
Preoperative Embolization ◽  
Low Grade ◽  
Modified Rankin Scale ◽  
Brain Arteriovenous Malformations

Abstract BACKGROUND: The design and conclusions of A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) trial are controversial, and its structure limits analysis of patients who could potentially benefit from treatment. OBJECTIVE: To analyze the results of a consecutive series of patients with unruptured brain arteriovenous malformations (BAVMs), including a subgroup analysis of ARUBA-eligible patients. METHODS: One hundred five patients with unruptured BAVMs were treated over an 8-year period. From this series, 90 adult patients and a subgroup of 61 patients determined to be ARUBA eligible were retrospectively reviewed. A subgroup analysis for Spetzler-Martin grades I/II, III, and IV/V was performed. The modified Rankin Scale was used to assess functional outcome. RESULTS: Persistent deficits, modified Rankin Scale score deterioration, and impaired functional outcome occurred less frequently in ARUBA-eligible grade I/II patients compared with grade III to V patients combined (P = .04, P = .04, P = .03, respectively). Twenty-two of 39 patients (56%) unruptured grade I and II BAVMs were treated with surgery without and with preoperative embolization, and all had a modified Rankin Scale score of 0 to 1 at the last follow-up. All patients treated with surgery without and with preoperative embolization had radiographic cure at the last follow-up. CONCLUSION: The results of ARUBA-eligible and unruptured grade I/II patients overall show that excellent outcomes can be obtained in this subgroup of patients, especially with surgical management. Functional outcomes for ARUBA-eligible patients were similar to those of patients who were randomized to medical management in ARUBA. On the basis of these data, in appropriately selected patients, we recommend treatment for low-grade BAVMs.

scholarly journals Preoperative embolization of high-flow peripheral AVMs using plug and push technique with low-density NBCA/Lipiodol

2020 ◽  
Vol 2020 (9) ◽  
Author(s):  
Anh Binh Ho ◽  
Ngoc Son Nguyen ◽  
Vu Huynh Le ◽  
Duc Dung Nguyen ◽  
Anh Khoa Phan ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
High Flow ◽  
Preoperative Embolization ◽  
Low Density ◽  
Single Treatment ◽  
Type Iv ◽  
Pulsatile Mass ◽  
Successful Case ◽  
The Right ◽  
Embolization Procedure

Abstract Arteriovenous malformations (AVMs) embolization is considered as a promising option either its single treatment or in combination with surgery, and the use of low-density N-butyl cyanoacrylate (NBCA)/Lipiodol is acceptable mixture agents but its application should be performed by experienced endovascular teams. We describe a successful case preoperative embolization of high-flow AVMs with low-density NBCA/Lipiodol. A 26-year-old male patient was hospitalized with a big pulsatile mass at the right thigh. Doppler ultrasound showed a mass with high systolic, and diastolic velocities coming from the right superficial femoral artery. Angiogram showed a large and high-flow AVM type IV, according to Yakes classification. Low-density NBCA/Lipiodol 12.5% were performed to obstruct all the nidus and feeding arteries. Extirpation surgery was implemented 4 days after the complete embolization procedure.

Role of Preoperative Embolization in Surgical Treatment of the Carotid Body Paragangliomas

2019 ◽  
Vol 30 (3) ◽  
pp. e267-e270 ◽  
Author(s):  
Hakki Caner Inan ◽  
Haydar Murat Yener ◽  
Emin Karaman ◽  
Osman Kizilkiliç ◽  
Harun Cansiz ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Carotid Body ◽  
Preoperative Embolization

scholarly journals The Role of Computed Cranial Tomography (CT) in Epilepsy

1983 ◽  
Vol 10 (1) ◽  
pp. 16-21 ◽  
Author(s):  
A. Guberman
Keyword(s):  
Tuberous Sclerosis ◽  
Neurological Examination ◽  
Arteriovenous Malformations ◽  
Brain Lesions ◽  
Consecutive Series ◽  
Low Density ◽  
Partial Seizures

SUMMARY:To evaluate the usefulness of CT in detecting unexpected brain lesions in epileptics, scan results were analyzed in a consecutive series of 196 adult epileptics in whom there was no known etiology for their seizures nor any abnormality on neurological examination. Nineteen additional epileptics, selected on the basis of an unexpected positive CT were also included for analysis.In the consecutive series, the overall incidence of abnormal scans was 16% with the highest yield (44%) found in patients with partial elementary seizures. Partial seizures secondarily generalized were correlated with a significantly higher CT positivity than purely partial seizures. Patients with seizures for less than six months more frequently showed CT abnormalities than patients with a longer history.In 25 of 51 cases with abnormal scans a specific lesion amenable to therapy was detected, including 16 neoplasms and 5 arteriovenous malformations. Other lesions included generalized or focal atrophy, infarcts, calcified lesions of tuberous sclerosis, unexplained calcifications and focal low-density or enhancing lesions.

Surgical Treatment of Arteriovenous Malformations: Role of Preoperative Staged Embolization

2018 ◽  
pp. 109-113 ◽  
Author(s):  
Mattia Del Maestro ◽  
Sabino Luzzi ◽  
Massimo Gallieni ◽  
Donatella Trovarelli ◽  
Aldo Victor Giordano ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Arteriovenous Malformations

scholarly journals Surgical selection and outcomes among elderly patients with brain arteriovenous malformations

2020 ◽  
Vol 49 (4) ◽  
pp. E9
Author(s):  
Jan-Karl Burkhardt ◽  
Ethan A. Winkler ◽  
Joshua S. Catapano ◽  
Robert F. Spetzler ◽  
Michael T. Lawton
Keyword(s):  
Elderly Patients ◽  
Arteriovenous Malformations ◽  
Age Groups ◽  
The Elderly ◽  
Preoperative Embolization ◽  
Neurological Outcomes ◽  
Brain Arteriovenous Malformations ◽  
Group 2 ◽  
Brain Avms ◽  
Group 1

OBJECTIVEStudies of resection of brain arteriovenous malformations (AVMs) in the elderly population are scarce. This study examined factors influencing patient selection and surgical outcome among elderly patients.METHODSPatients 65 years of age and older who underwent resection of an unruptured or ruptured brain AVM treated by two surgeons at two centers were identified. Patient demographic characteristics, AVM characteristics, clinical presentation, and outcomes measured using the modified Rankin Scale (mRS) were analyzed. For subgroup analyses, patients were dichotomized into two age groups (group 1, 65–69 years old; group 2, ≥ 70 years old).RESULTSOverall, 112 patients were included in this study (group 1, n = 61; group 2, n = 51). Most of the patients presented with hemorrhage (71%), a small nidus (< 3 cm, 79%), and a low Spetzler-Martin (SM) grade (grade I or II, 63%) and were favorable surgical candidates according to the supplemented SM grade (supplemented SM grade < 7, 79%). A smaller AVM nidus was statistically significantly more likely to be present in patients with infratentorial AVMs (p = 0.006) and with a compact AVM nidus structure (p = 0.02). A larger AVM nidus was more likely to be treated with preoperative embolization (p < 0.001). Overall outcome was favorable (mRS scores 0–3) in 71% of the patients and was statistically independent from age group or AVM grading. Patients with ruptured AVMs at presentation had significantly better preoperative mRS scores (p < 0.001) and more favorable mRS scores at the last follow-up (p = 0.04) than patients with unruptured AVMs.CONCLUSIONSOutcomes were favorable after AVM resection in both groups of patients. Elderly patients with brain AVMs treated microsurgically were notable for small nidus size, AVM rupture, and low SM grades. Microsurgical resection is an important treatment modality for elderly patients with AVMs, and supplemented SM grading is a useful tool for the selection of patients who are most likely to achieve good neurological outcomes after resection.

ROLE OF FRAMELESS STEREOTAXY IN THE SURGICAL TREATMENT OF CEREBRAL ARTERIOVENOUS MALFORMATIONS

Neurosurgery ◽  
2007 ◽  
Vol 61 (suppl_1) ◽  
pp. 1108-1118
Author(s):  
Stephen M. Russell ◽  
Henry H. Woo ◽  
Seth S. Joseffer ◽  
Jafar J. Jafar
Keyword(s):  
Surgical Treatment ◽  
Arteriovenous Malformations ◽  
Frameless Stereotaxy ◽  
Cerebral Arteriovenous Malformations
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