scholarly journals P.192 Arterial Hemodynamics and the Clinical Presentation of Cerebral Arteriovenous Malformations

2021 ◽  
Vol 48 (s3) ◽  
pp. S75-S76
Author(s):  
S Lownie ◽  
A Chalil
Keyword(s):  
Arteriovenous Malformations ◽  
Clinical Presentation ◽  
Cerebral Arteriovenous Malformations ◽  
Artery Pressure ◽  
The Past ◽  
Arterial Hemodynamics ◽  
Mean Pressure ◽  
Hemodynamic Characteristics ◽  
The Mean ◽  
The Difference

Background: Arterial Hemodynamics have been implicated in hemorrhage from cerebral arteriovenous malformations (AVMs). The correlation between hemodynamic characteristics and the tendency of AVMs to rupture has been explored in the past, and various theories have been proposed to explain the clinical presentation of AVMs as a hemorrhage vs. seizure. Methods: We monitored feeder artery pressures in 45 patients with AVMS (16 presenting with hemorrhage, 29 without) during super selective angiography and AVM embolization. Results: Mean feeder artery pressure (FP) was found to be 49mm Hg. The mean FP in patients presenting with hemorrhage was somewhat higher than in those without hemorrhage, but the difference was not statistically significant (53.8 mm Hg vs 47.0 mm Hg, p=0.13). Systemic mean pressure was found to correlate with AVM size (r=-0.31, p=0.037). Significant predictors of feeder artery pressure were systemic pressure, AVM size, and the distance of microcatheter from the circle of Willis. Meanwhile, the presence or absence of venous outflow stenosis and the position of the AVM nidus (superficial or deep to the cortical surface) were the most significant predictors of AVM hemorrhage vs seizures. Conclusions: Anatomic factors may be more important than arterial hemodynamic factors in determining the clinical presentation of cerebral AVMs.

scholarly journals P03.08 Large cerebral arteriovenous malformations management with Volume-staged gamma knife radiosurgery

2019 ◽  
Vol 21 (Supplement_3) ◽  
pp. iii26-iii26
Author(s):  
R M Emad Eldin ◽  
W A Reda ◽  
A M El-Shehaby ◽  
K Abdel Karim ◽  
A Nabeel ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Cerebral Arteriovenous Malformations ◽  
Factors Affecting ◽  
Prescription Dose ◽  
The Mean ◽  
Cerebral Avms ◽  
Grade 3

Abstract BACKGROUND Large cerebral arteriovenous malformations (AVM) pose a management dilemma because of the limited success of any single treatment modality by itself. Surgery alone is associated with significant morbidity and mortality. Similarly, embolization alone has limited efficacy. Volume-staged gamma knife radiosurgery (VSGR) has been developed for the treatment of large AVMs, to increase the efficacy and improve safety of treatment of these lesions. The aim of the study was to assess the efficacy and safety of VSGR technique for the treatment of large cerebral AVMs. METHODS The study included patients treated by VSGR between May 2009 and July 2015. All cases had large AVMs (>10 cc). These were 29 patients. RESULTS Twenty-four patients completed radiographic follow up with 15 obliteration cases (62.5%). There was a total of 56 sessions performed. The mean AVM volume was 16 cc (10.1–29.3 cc). The mean prescription dose was 18 Gy (14–22 Gy). The mean follow up duration was 43 months (21–73 months). One patient died during follow up from unrelated cause. Two cases suffered haemorrhage during follow up. Symptomatic edema developed in 5 (17%) patients. The factors affecting obliteration were smaller total volume, higher dose/stage, non-deep location, compact AVM, AVM score less than 3, >18 Gy dose and <15 cc total volume. The factors affecting symptomatic edema were smaller total volume and shorter time between first and last sessions (p 0.012). T2 image changes were affected by SM grade 3 or more (p 0.013) and AVM score 3 or more (p 0.014). CONCLUSION VSGR provides an effective and safe treatment option for large cerebral AVMs. Smaller AVM volume is associated with higher obliteration rate.

Correlation of the Angioarchitectural Features of Cerebral Arteriovenous Malformations with Clinical Presentation of Hemorrhage

Neurosurgery ◽  
1995 ◽  
Vol 37 (5) ◽  
pp. 856???862 ◽  
Author(s):  
Francis Turjman ◽  
Tarik F. Massoud ◽  
Fernando Vi??uela ◽  
James W. Sayre ◽  
Guido Guglielmi ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Clinical Presentation ◽  
Cerebral Arteriovenous Malformations

Clinical and neuroimaging outcome of cerebral arteriovenous malformations after Gamma Knife surgery: analysis of the radiation injury rate depending on the arteriovenous malformation volume

2008 ◽  
Vol 109 (2) ◽  
pp. 191-198 ◽  
Author(s):  
Jung Ho Han ◽  
Dong Gyu Kim ◽  
Hyun-Tai Chung ◽  
Chul-Kee Park ◽  
Sun Ha Paek ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Radiation Effects ◽  
Radiation Injury ◽  
Injury Rate ◽  
Gamma Knife Surgery ◽  
Cerebral Arteriovenous Malformations ◽  
Bleeding Rate ◽  
Reduced Dose ◽  
The Mean

Object In this paper the authors analyzed the clinical and neuroimaging outcomes of patients with cerebral arteriovenous malformations (AVMs) after Gamma Knife surgery (GKS), focusing on the analysis of the radiation injury rate depending on the AVM volume. Methods Between 1997 and 2004, 277 consecutive patients with cerebral AVMs were treated with GKS. Of these patients, 218 were followed up for ≥ 2 years. The mean age was 31 ± 15 years, the median AVM volume was 3.4 cm3 (range 0.17–35.2 cm3), the median marginal dose was 18.0 Gy (range 10.0–25.0 Gy), and the mean follow-up duration was 44 ± 20 months. The authors reduced the prescription dose by various amounts, depending on the AVM volume and location as prescribed in the classic guideline to avoid irreversible radiation injuries. Results The angiographic obliteration rate was 66.4% overall, and it was 81.7, 53.1, and 12.5% for small, medium, and large AVMs, respectively. The overall annual bleeding rate was 1.9%. The annual bleeding rate was 0.44 and 4.64% for small and large AVMs, respectively. Approximately 20% of the patients showed severe postradiosurgery imaging (PRI) changes. The rate of PRI change was 11.4, 33.3, and 9.5% for small, medium, and large AVM volume groups, respectively, and a permanent radiation injury developed in 5.1% of patients. Conclusions By using the reduced dose from what is usually prescribed, the authors were able to obtain outcomes in small AVMs that were comparable to the outcomes described in previous reports. However, medium AVMs appear to still be at risk for adverse radiation effects. Last, in large AVMs, the authors were able to attain a tolerable rate of radiation injury; however, the clinical outcomes were quite disappointing following administration of a reduced dose of GKS for large AVMs.

scholarly journals Osteoarthritis, osteoarthrosis and osteoarthropathy: What is the difference?

2021 ◽  
Vol 2 (1) ◽  
pp. 25-32
Author(s):  
Danilo Jeremić ◽  
Boris Gluščević ◽  
Stanislav Rajković ◽  
Želimir Jovanović ◽  
Branislav Krivokapić
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Presentation ◽  
Joint Disease ◽  
Joint Diseases ◽  
Significant Progress ◽  
Inflammatory Joint Diseases ◽  
The Past ◽  
Inflammatory Arthropathy ◽  
The Difference ◽  
Made In

Osteoarthritis, osteoarthrosis, and osteoarthropathy are diseases that doctors encounter daily in their practice. The use of all three terms is customary, often without a clear justification as to why a particular term is used for a particular case. In the past several decades, doctors mainly differentiated among these diseases based on clinical presentation and radiography. In the past several years, however, significant progress has been made in the field of biochemical, immunological, and cytohistological research, which has provided explanations for the pathogenesis of these conditions, enabled defining differences amongst them and facilitated the use of appropriate terms for each one of these diseases. The term arthritis (osteoarthritis) should be used exclusively for primarily inflammatory joint diseases-rheumatoid arthritis, juvenile arthritis, reactive arthritis (Reiter's syndrome). If the etiology is infectious, this must also be emphasized-septic (purulent) arthritis, tuberculous arthritis. Arthrosis (osteoarthrosis) relates to changes in the joints occurring due to pathological processes within the joint itself, but which, in their basis, are not inflammatory. Arthropathy is a term for joint disease stemming from another diseased organ or system of organs.

Gamma Knife surgery for basal ganglia and thalamic arteriovenous malformations

2012 ◽  
Vol 116 (4) ◽  
pp. 899-908 ◽  
Author(s):  
Ching-Hsiao Cheng ◽  
R. Webster Crowley ◽  
Chun-Po Yen ◽  
David Schlesinger ◽  
Mark E. Shaffrey ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Mr Imaging ◽  
Gamma Knife ◽  
Treatment Option ◽  
Arteriovenous Malformations ◽  
Gamma Knife Surgery ◽  
Neurological Deficits ◽  
Cerebral Arteriovenous Malformations ◽  
History Of ◽  
The Mean

Object Gamma Knife surgery (GKS) has emerged as the treatment of choice for small- to medium-sized cerebral arteriovenous malformations (AVMs) in deep locations. The present study aims to investigate the outcomes of GKS for AVMs in the basal ganglia and thalamus. Methods Between 1989 and 2007, 85 patients with AVMs in the basal ganglia and 97 in the thalamus underwent GKS and were followed up for more than 2 years. The nidus volumes ranged from 0.1 to 29.4 cm3 (mean 3.4 cm3). The mean margin dose at the initial GKS was 21.3 Gy (range 10–28 Gy). Thirty-six patients underwent repeat GKS for residual AVMs at a median 4 years after initial GKS. The mean margin dose at repeat GKS was 21.1 Gy (range 7.5–27 Gy). Results Following a single GKS, total obliteration of the nidus was confirmed on angiograms in 91 patients (50%). In 12 patients (6.6%) a subtotal obliteration was achieved. No flow voids were observed on MR imaging in 14 patients (7.7%). Following single or repeat GKS, total obliteration was angiographically confirmed in 106 patients (58.2%) and subtotal obliteration in 8 patients (4.4%). No flow voids on MR imaging were observed in 18 patients (9.9%). The overall obliteration rates following one or multiple GKSs based on MR imaging or angiography was 68%. A small nidus volume, high margin dose, low number of isocenters, and no history of embolization were significantly associated with an increased rate of obliteration. Twenty-one patients experienced 25 episodes of hemorrhage in 850 risk-years following GKS, yielding an annual hemorrhage rate of 2.9%. Four patients died in this series: 2 due to complications of hemorrhage and 2 due to unrelated diseases. Permanent neurological deficits caused by radiation were noted in 9 patients (4.9%). Conclusions Gamma Knife surgery offers a reasonable chance of obliterating basal ganglia and thalamic AVMs and does so with a low risk of complications. It is an optimal treatment option in patients for whom the anticipated risk of microsurgery is too high.

Correlation of the Angioarchitectural Features of Cerebral Arteriovenous Malformations with Clinical Presentation of Hemorrhage

Neurosurgery ◽  
1995 ◽  
Vol 37 (5) ◽  
pp. 856-861 ◽  
Author(s):  
Francis Turjman ◽  
Tarik F. Massoud ◽  
Fernando Viñuela ◽  
James W. Sayre ◽  
Guido Guglielmi ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Clinical Presentation ◽  
Cerebral Arteriovenous Malformations

scholarly journals Feeding Artery Pressure and Venous Drainage Pattern Are Primary Determinants of Hemorrhage From Cerebral Arteriovenous Malformations

Stroke ◽  
1998 ◽  
Vol 29 (6) ◽  
pp. 1167-1176 ◽  
Author(s):  
D. Hoang Duong ◽  
William L. Young ◽  
Meng C. Vang ◽  
Robert R. Sciacca ◽  
Henning Mast ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Feeding Artery ◽  
Cerebral Arteriovenous Malformations ◽  
Drainage Pattern ◽  
Artery Pressure

Systemic Expression of Matrix Metalloproteinase-9 in Patients With Cerebral Arteriovenous Malformations

Neurosurgery ◽  
2010 ◽  
Vol 66 (2) ◽  
pp. 343-348 ◽  
Author(s):  
Robert M. Starke ◽  
Ricardo J. Komotar ◽  
Brian Y. Hwang ◽  
David K. Hahn ◽  
Marc L. Otten ◽  
...  
Keyword(s):  
Matrix Metalloproteinase ◽  
Arteriovenous Malformations ◽  
Enzyme Linked Immunosorbent Assay ◽  
Healthy Controls ◽  
Cerebral Arteriovenous Malformations ◽  
Blood Samples ◽  
The Mean ◽  
Level 1 ◽  
Metalloproteinase 9

Abstract OBJECTIVE Increased expression angiogenic factors, such as matrix metalloproteinases (MMPs), are associated with the formation of cerebral arteriovenous malformations (AVMs). The objective of this study was to determine plasma levels of MMP-9 of patients with AVMs. METHODS Blood samples were drawn from 15 patients with AVMs before treatment, 24 hours postembolization, 24 hours postresection, and 30 days postresection. Blood samples were also obtained from 30 healthy controls. Plasma MMP-9 concentrations were measured via enzyme-linked immunosorbent assay. RESULTS The mean plasma MMP-9 level in AVM patients at baseline was significantly higher than in control patients: 108.04 ± 16.11 versus 41.44 ± 2.44 ng/mL, respectively. The mean plasma MMP-9 level 1 day after embolization increased to 172.35 ± 53.76 ng/mL, which was not significantly elevated over pretreatment levels. One day after resection, plasma MMP-9 levels increased significantly over pretreatment levels to 230.97 ± 51.00 ng/mL. Mean plasma MMP-9 concentrations 30 days after resection decreased to 92.8 ± 18.7 ng/mL, which was not different from pretreatment levels but was still significantly elevated over control levels. MMP-9 levels did not correlate with patient sex, age, presentation, or AVM size. CONCLUSION Plasma MMP-9 levels are significantly elevated over controls at baseline, increase significantly immediately after surgery, and decrease to pretreatment levels during follow-up.

90 Subglottic Spread of Glottic Carcinoma: The Significance of Laryngeal Size as Related to Gender

1995 ◽  
Vol 113 (2) ◽  
pp. P186-P186
Author(s):  
Douglas K. Frank ◽  
Lawrence Meiteles ◽  
Eugene Wenk
Keyword(s):  
Anterior Commissure ◽  
Cricoid Cartilage ◽  
Glottic Carcinoma ◽  
Anatomic Study ◽  
The Past ◽  
Laryngeal Surgery ◽  
The Mean ◽  
The Difference ◽  
Inferior Border ◽  
Superior Border

Objective: Although it is accepted that there are size differences between female and male larynges, criteria for conservation laryngeal surgery for glottic carcinoma have not specifically addressed this matter. A laryngeal cadaveric anatomic study was undertaken to determine if the current criteria for conservation laryngeal surgery for glottic carcinoma is uniformly applicable to the female larynx. The past several decades have seen an increase in tobacco use among women, accompanied by an increased incidence of laryngeal cancer, thus underlying the relevance of a study of this nature Methods: Anterior midline measurements between key landmarks of the larynges of 10 female and seven male cadavers were carried out and assessed. These measurements included the following: (1) anterior commissure to inferior border of thyroid ala distance; (2) anterior commissure to superior border of cricoid cartilage distance; and (3) anterior commissure to inferior border of cricoid cartilage distance Results: The mean anterior commissure to inferior border of thyroid ala distance was 8.3 mm (range, 6 to 10 mm) in females and 11.8 mm (range, 10 to 13 mm) in males. The mean anterior commissure to superior border of cricoid cartilage distance was 17.5 mm (range, 15 to 21 mm) in females and 21.4 mm (range, 18 to 25 mm) in males. The mean anterior commissure to inferior border of cricoid cartilage distance was 23.7 mm (range, 20 to 27 mm) in females and 30 mm (range 26 to 35 mm) in males Conclusions: The female cadaveric larynges were, on average, smaller than those of the male counterparts studied with regard to all investigated parameters. Of specific interest was the difference in the mean anterior commissure to inferior border of thyroid ala distance between female and male specimens. Classic teaching indicates that conservation laryngeal surgery for glottic carcinoma with less than 10 mm of anterior subglottic spread is oncologically sound, because tumor would theorectically be contained within the thyroid ala. Our data suggest that use of conservation laryngeal techniques in some female patients having glottic carcinoma with less than 10 mm anterior subglottic spread may be contraindicated, because spread to the level of the cricothyroid membrane (and thus extralaryngeal access) can occur well within this distance

Staged radiosurgery for extra-large cerebral arteriovenous malformations: method, implementation, and results

2008 ◽  
Vol 109 (Supplement) ◽  
pp. 65-72 ◽  
Author(s):  
Wen-Yuh Chung ◽  
Cheng-Ying Shiau ◽  
Hsiu-Mei Wu ◽  
Kang-Du Liu ◽  
Wan-Yuo Guo ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Arteriovenous Malformations ◽  
High Signal ◽  
Minor Bleeding ◽  
Cerebral Arteriovenous Malformations ◽  
Presenting Symptoms ◽  
Second Stage ◽  
The Mean ◽  
Cerebral Avms

Object The effectiveness and safety of radiosurgery for small- to medium-sized cerebral arteriovenous malformations (AVMs) have been well established. However, the management for large cerebral AVMs remains a great challenge to neurosurgeons. In the past 5 years the authors performed preplanned staged radiosurgery to treat extra-large cerebral AVMs. Methods An extra-large cerebral AVM is defined as one with nidus volume > 40 ml. The nidus volume of cerebral AVM is measured from the dose plan—that is, as being the volume contained within the best-fit prescription isodose. From January 2003 to December 2007, the authors treated 6 patients with extra-large AVMs by preplanned staged GKS. Staged radiosurgery is implemented by rigid transformation with translation and rotation of coordinates between 2 stages. The average radiation-targeted volume was 60 ml (range 47–72 ml). The presenting symptoms were seizure in 4 patients and a bleeding episode in 2. One patient had undergone a previous craniotomy and evacuation of hematoma. The mean interval between the 2 radiosurgical sessions was 6.9 months (range 4.5–9.1 months). The prescribed marginal dose given to the nidus volume in each stage ranged from 16 to 18.6 Gy. The expected marginal dose of total nidus was 17–19 Gy. Regular follow-up MR imaging was performed every 6 months. The mean follow-up period was 28 months (range 12–54 months). Results Most of the patients exhibited clinical improvement: relief of headache and reduced frequency of seizure attack. All patients had significant regression of nidus observed on MR imaging follow-up. Two patients had angiogram-confirmed complete obliteration of the nidus 45 and 60 months after the second-stage radiosurgical session. One patient experienced minor bleeding 8 months after the second-stage radiosurgery with mild headache. She had satisfactory recovery without clinical neurological deficit after conservative treatment. Conclusions These preliminary results indicate that staged radiosurgery is a practical strategy to treat patients with extra-large cerebral AVMs. It takes longer to obliterate the AVMs. The observed high signal T2 changes after the radiosurgery appeared clinically insignificant in 6 patients followed up for an average of 28 months. Longer follow-up is necessary to confirm its long-term safety.

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