The transvenous retrograde pressure cooker technique for the curative embolization of high-grade brain arteriovenous malformations

2020 ◽  
pp. neurintsurg-2020-016566
Author(s):  
Masaomi Koyanagi ◽  
Pascal John Mosimann ◽  
Hannes Nordmeyer ◽  
Markus Heddier ◽  
Juergen Krause ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
High Grade ◽  
Transvenous Embolization ◽  
Cure Rate ◽  
Brain Arteriovenous Malformations ◽  
Long Term Follow Up ◽  
Occlusion Rate ◽  
Grade 3

BackgroundTransvenous embolization of brain arteriovenous malformations (AVMs) can be curative. We aimed to evaluate the cure rate and safety of the transvenous retrograde pressure cooker technique (RPCT) using coils and n-butyl-2-cyanoacrylate as a venous plug.MethodsAll AVM patients treated via transvenous embolization between December 2004 and February 2017 in a single center were extracted from our database. Inclusion criteria were: inability to achieve transarterial cure alone; AVM < 3 cm; and single main draining vein. Outcome measures were immediate and 90 days' angiographic AVM occlusion rate, and morbidity and mortality at 30 days and 12 months, according to the modified Rankin Scale (mRS) score.ResultsFifty-one patients (20 women; median age 47 years) were included. A majority (71%) were high grade (3 to 5 in the Spetzler–Martin classification). AVMs were deeply seated in 30 (59%) and cortical in 21 patients (41%). Thirty-three patients were previously embolized transarterially (65%). All patients but one were cured within a single session with the RPCT (96%). Cure was confirmed on follow-up digital subtraction angiography at 3 months in 82% of patients. Three patients experienced intracranial hemorrhage (6%), one requiring surgical evacuation. There were no deaths. One treatment-related major permanent deficit was observed (2.0%). Mean mRS before treatment, at 30 days, and 12 months after RPCT was 1.5, 1.5, and 1.3, respectively.ConclusionsThe retrograde pressure cooker technique can be curative in carefully selected high-grade AVMs. Long-term follow-up and prospective studies are needed to confirm our results.

NATURAL HISTORY OF BRAIN ARTERIOVENOUS MALFORMATIONS

Neurosurgery ◽  
2008 ◽  
Vol 63 (5) ◽  
pp. 823-831 ◽  
Author(s):  
Juha A. Hernesniemi ◽  
Reza Dashti ◽  
Seppo Juvela ◽  
Kristjan Väärt ◽  
Mika Niemelä ◽  
...  
Keyword(s):  
Risk Factors ◽  
Arteriovenous Malformations ◽  
Univariate Analysis ◽  
Incidence Rates ◽  
Cox Proportional Hazards ◽  
Follow Up Study ◽  
Brain Arteriovenous Malformations ◽  
Long Term Follow Up

Abstract OBJECTIVE Long-term follow-up studies in patients with brain arteriovenous malformations (AVM) have yielded contradictory results regarding both risk factors for rupture and annual rupture rate. We performed a long-term follow-up study in an unselected, consecutive patient population with AVMs admitted to the Department of Neurosurgery at Helsinki University Central Hospital between 1942 and 2005. METHODS Patients with untreated AVMs were followed from admission until death, occurrence of AVM rupture, initiation of treatment, or until the end of 2005. Patients with at least 1 month of follow-up were included in further analysis. Annual and cumulative incidence rates of AVM rupture as well as several potential risk factors for rupture were analyzed using Kaplan-Meier life table analyses and Cox proportional hazards regression models. RESULTS We identified 238 patients with a mean follow-up period of 13.5 years (range, 1 month–53.1 years). The average annual risk of hemorrhage from AVMs was 2.4%. The risk was highest during the first 5 years after diagnosis, decreasing thereafter. Risk factors predicting subsequent AVM hemorrhage in univariate analysis were young age, previous rupture, deep and infratentorial locations, and exclusively deep venous drainage. Previous rupture, large AVM size, and infratentorial and deep locations were independent risk factors according to multivariate models. CONCLUSION According to this long-term follow-up study, AVMs with previous rupture and large size, as well as with infratentorial and deep locations have the highest risk of subsequent hemorrhage. This risk is highest during the first few years after diagnosis but remains significant for decades.

scholarly journals Mid-term results of pelvic organ prolapse repair using a transvaginal mesh: the experience in Sherbooke, Quebec

2013 ◽  
Vol 4 (3) ◽  
pp. 188
Author(s):  
Louis-Olivier Gagnon ◽  
Le-Mai Tu
Keyword(s):  
Pelvic Organ ◽  
Reoperation Rate ◽  
Transvaginal Mesh ◽  
Low Grade ◽  
High Grade ◽  
Cure Rate ◽  
Incontinence Surgery ◽  
Long Term Follow Up

Objective: The objective was to report our experience on theimplantation of the Prolift system since 2005.Methods: Fifty-six patients were operated on between July 2005and August 2008 by 1 surgeon. The patients were implanted withthe transvaginal mesh, the Prolift system, for the treatment of recurrentor high-grade (Baden-Walker stage III or IV) multiple compartmentpelvic organ prolapse (POP) associated with symptoms.A concomitant anti-incontinence surgery was performed in 38patients (68%).Results: The population had a mean age of 68 (range 46-88), abody mass index of 27 (range 21-40) and a parity average of 3(range 1-16). Previous POP repair had been performed in 17 patients(30%) and a hysterectomy in 43 (77%). The operating room timewas on average 98 minutes (range 70-135), blood loss 81 mL(range 50-300) and hospital stay 3 days (range 1-10). With a medianfollow-up of 21 months, we found that the cure rate for POP was91% (48/53) and the reoperation rate was 8% (4/53). Perioperativecomplications included 1 rectal laceration and 1 prolonged bleeding.Short-term postoperative complications included 10 episodesof transient urinary retention that required immediate tape releasein 4 patients. Long-term complications included 5 POP recurrences,2 low grade and 3 high grade.Conclusion: The Prolift system appears to be a relatively safe andeffective alternative to conventional surgeries for the treatment ofrecurrent or high-grade multiple compartment POP, because of ahigh mid-term cure rate and a satisfactory complication profile.However, long-term follow-up is still needed to confirm these results.Objectif : Notre objectif ici est de parler de notre expérience avecl’implantation du système Prolift depuis 2005.Méthodologie : Entre juillet 2005 et août 2008, 56 patientes ontété opérées par le même chirurgien. Les patientes ont subi uneimplantation du système de bandelette transvaginale Prolift, pourle traitement d’un prolapsus pelvien pluricompartimental récurrentou de grade élevé (stade III ou IV de Baden-Walker) associéà des symptômes. Une chirurgie anti-incontinence concomitantea été réalisée chez 38 patientes (68 %).Résultats : L’âge moyen de la population de l’étude était de 68 ans(entre 46 et 88 ans), l’indice de masse corporelle moyen était de27 (entre 21 et 40), et en moyenne, la parité était de 3 (entre 1 et16). Une intervention antérieure de correction d’un prolapsus pelvienavait été effectuée chez 17 patientes (30 %), et une hystérectomie,chez 43 patientes (77 %). En moyenne, la durée de l’interventionétait de 98 minutes (de 70 à 135), la perte sanguine, de 81 mL (de50 à 300) et la durée du séjour à l’hôpital, de 3 jours (de 1 à 10).Après un suivi médian de 21 mois, le taux de guérison observépour le prolapsus pelvien était de 91 % (48/53) et le taux de répétitionde l’opération était de 8 % (4/53). (Trois patientes perdues ausuivi ne sont pas incluses dans le taux de guérison.) Les complicationspériopératoires incluent une lacération rectale et un épisodede saignement prolongé. Les complications postopératoires à courtterme incluent 10 épisodes de rétention urinaire transitoire nécessitantun retrait immédiat de la bandelette chez 4 patientes. Lescomplications à long terme incluent 5 récidives du prolapsus pelvien,2 de faible grade et 3 de grade élevé.Conclusion : Le système Prolift semble être une solution de rechangerelativement sûre et efficace aux interventions traditionnelles pourle traitement du prolapsus pelvien pluricompartimental récurrentou de grade élevé, en raison d’un taux élevé de guérison à moyenterme et d’un profil de complications acceptable. Cependant, unsuivi à long terme est toujours requis pour valider ces résultats.

Medina embolization device for the treatment of intracranial aneurysms: 18 months’ angiographic results

2018 ◽  
Vol 11 (5) ◽  
pp. 516-522 ◽  
Author(s):  
Idriss Haffaf ◽  
Frédéric Clarençon ◽  
Eimad Shotar ◽  
Claudia Rolla-Bigliani ◽  
Saskia Vande Perre ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Thromboembolic Complication ◽  
Detachable Coil ◽  
Mean Delay ◽  
Scale Scores ◽  
Long Term Follow Up ◽  
Occlusion Rate ◽  
Wide Neck

Background and purposeThe Medina embolization device (MED) is a new flow disruption device combining the design of a detachable coil with an intrasaccular flow disrupter. Safety and short-term angiographic effectiveness of this device have recently been reported. However, long-term angiographic results are lacking. We report herein the 18 months’ angiographic outcome in patients treated for a wide-neck intracranial aneurysm with the MED.Materials and methodsNineteen patients (17 female, mean age 50 years) with 20 wide-neck intracranial aneurysms (six ruptured; 14 unruptured) were treated by the MED between January 2015 and June 2016. Procedure-related complications were systematically recorded; discharge and 6–9 months' follow-up modified Rankin Scale scores were assessed. Angiographic mid-term and long-term follow-up were performed with a mean delay of 6.4±1.5 months (n=16 aneurysms) and 17.7±4.2 months (n=15 aneurysms), respectively. Occlusion rates were evaluated after the procedure and at the mid-term and long-term follow-up using the Roy-Raymond scale.ResultsEmbolization with the MED was feasible in all except two cases (2/20, 10%). One per-procedural perforation was recorded (1/20, 5%) and one MED deployment failed because of the aneurysm’s shape (1/20, 5%). Three cases of thromboembolic complications were observed (3/20, 15%). Only one thromboembolic complication was responsible for clinical sequelae. Grade A occlusion rate was 61% (11/18) after the procedure, 75% at 6 months' follow-up (12/16), and 80% (12/15) at long-term follow-up. Two cases (2/18, 11%) of recanalization at mid-term were documented angiographically. No recanalization occurred between the mid-term and long-term follow-up.ConclusionMED is a hybrid embolization device, combining properties of a conventional coil with those of an intrasaccular flow disrupter. Our series focusing on long-term angiographic follow-up shows a satisfactory long-term occlusion rate. Larger series with longer angiographic follow-up times are warranted to confirm these preliminary results.

Surgery for Unruptured Spetzler-Martin Grade 3 Brain Arteriovenous Malformations

Neurosurgery ◽  
2015 ◽  
Vol 77 (3) ◽  
pp. 362-370 ◽  
Author(s):  
Michael Kerin Morgan ◽  
Nazih Assaad ◽  
Miikka Korja
Keyword(s):  
Neurological Deficit ◽  
Arteriovenous Malformations ◽  
Late Recurrence ◽  
Adverse Outcomes ◽  
Brain Arteriovenous Malformations ◽  
Complete Obliteration ◽  
Martin Grade ◽  
Grade 3 ◽  
Permanent Neurological Deficit

Abstract BACKGROUND: There is uncertainty regarding the management of unruptured Spetzler-Martin grade 3 brain arteriovenous malformations (SMG3 ubAVM). OBJECTIVE: To analyze our series of patients treated by surgery. METHODS: A single-surgeon database of consecutively enrolled bAVMs (between 1989 and 2014) was analyzed. Adverse outcomes due to surgery were assigned within the first 6 weeks following surgery and outcome was prospectively recorded and assigned at the last follow-up visit by using modified Rankin Scale (mRS) score. RESULTS: Of the 137 reviewed patients, 112 (82%) were treated by surgery, 15 (11%) were treated elsewhere or by radiosurgery, and 10 (7%) were recommended for conservative management. Surgery for SMG3 ubAVM was associated with adverse outcomes with a new permanent neurological deficit of mRS &gt;1 in 23 of 112 (21%) patients. Permanent neurological deficit leading to a mRS &gt;2 from surgery was 3.6% (95% confidence interval, 1.1%-9.1%). Late recurrence of a bAVM occurred in 3 of 103 (2.9%) patients who had complete obliteration of bAVM confirmed immediately after surgery and who were subsequently later followed with radiological studies during the mean follow-up period of 3.0 years (range, 6 days to 18.8 years). CONCLUSION: When discussing surgical options for SMG3 ubAVM, a thorough understanding of the significance and incidence of adverse events and outcomes is required to fully inform patients. For our series, the additional subclassification of SMG ubAVM (based on variables contributing to the SMG or age) would not have been of use.

407 Cure rate after long-term follow-up in head and neck cancer

1995 ◽  
Vol 31 ◽  
pp. S88-S89
Author(s):  
J.J. Grau ◽  
J. Estapé ◽  
J. Traserra ◽  
M. Galán ◽  
M. Daniels
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Cure Rate ◽  
Long Term Follow Up

Long-Term Follow-up of Patients with Stage T1 High-Grade Transitional Cell Carcinoma Managed by Bacille Calmette-Guérin Immunotherapy

Urology ◽  
2007 ◽  
Vol 69 (1) ◽  
pp. 78-82 ◽  
Author(s):  
David Margel ◽  
Raanan Tal ◽  
Shai Golan ◽  
Dani Kedar ◽  
Dov Engelstein ◽  
...  
Keyword(s):  
Transitional Cell Carcinoma ◽  
Cell Carcinoma ◽  
Transitional Cell ◽  
High Grade ◽  
Bacille Calmette Guerin ◽  
Long Term Follow Up ◽  
Stage T1

scholarly journals Supratentorial Brain AVM Embolization with Onyx-18 and Post-Embolization Management

2009 ◽  
Vol 15 (3) ◽  
pp. 275-282 ◽  
Author(s):  
J. W. Pan ◽  
H.J. Zhou ◽  
R.Y. Zhan ◽  
S. Wan ◽  
M. Yan ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Subsequent Treatment ◽  
Additional Surgery ◽  
Brain Avm ◽  
Initial Symptoms ◽  
Complete Obliteration ◽  
Long Term Follow Up ◽  
Long Term Prognosis

Onyx is increasingly used in endovascular therapy of intracranial arteriovenous malformations (AVMs). However, the embolic effect and post-embolization management are still under discussion. We report our experience in the treatment of supratentorial brain arteriovenous malformations (SBAVMs) with Onyx and discuss post-embolic management. From June 2006 to July 2008, 20 patients with SBAVM were embolized with Onyx. There were 14 men and six women ranging from 14 to 64 years of age (mean 38.3 years). Initial symptoms included spontaneous hemorrhage (n=12), headaches (n=4), seizure (n=3) and incidentally disclosed after head trauma (n=1). After the endovascular procedure, all had subsequent treatment (follow-up angiogram, stereotactic radiosurgery or microsurgery) according to the obliteration degree. At angiography, seven patients (35%, 7/20) were completely obliterated (over 95% closure) after embolization while one suffered a small subarachnoid hemorrhage without permanent clinical sequelae. Four patients (20%, 4/20) were subtotally obliterated (over 80% closure), one patient who suffered severe cerebral edema after embolization underwent decompressive craniectomy, two patients had additional radiosurgery and one patient had follow-up angiogram. Nine patients (45%, 9/20) were partially obliterated (20–80% closure), five patients had additional surgery, two patients had additional radiosurgery and two patients had follow-up angiogram (one patient had intraventricular hemorrhage three months after embolization). Of all 20 AVMs, an average of 2.2 ml Onyx was used per patient and average volume reduction was 80% (range, 30%–99%). Onyx is suitable for embolization of SBAVMs because of its diffuse controllable properties. We suggest clinical follow-up after complete obliteration, additional radiosurgery or angiographic follow-up after subtotal obliteration and additional surgery after partially obliteration. More cases with long-term follow-up are needed to evaluate the long-term prognosis of our post-embolization management.

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