scholarly journals Classification of brain arteriovenous malformations located in motor-related areas based on location and anterior choroidal artery feeding

2021 ◽  
pp. svn-2020-000591
Author(s):  
Yuming Jiao ◽  
Hao Li ◽  
Weilun Fu ◽  
Jiancong Weng ◽  
Ran Huo ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Internal Capsule ◽  
Motor Deficit ◽  
Type I ◽  
Anterior Choroidal Artery ◽  
Posterior Limb ◽  
Type Iv ◽  
Anterior Choroidal ◽  
Choroidal Artery

ObjectiveSurgical management of arteriovenous malformations (AVMs) involving motor cortex or fibre tracts (M-AVMs) is challenging. This study aimed to construct a classification system based on nidus locations and anterior choroidal artery (AChA) feeding to pre-surgically evaluate motor-related and seizure-related outcomes in patients undergoing resection of M-AVMs.Methods and materialsA total of 125 patients who underwent microsurgical resection of M-AVMs were retrospectively reviewed. Four subtypes were identified based on nidus location: (I) nidus involving the premotor area and/or supplementary motor areas; (II) nidus involving the precentral gyrus; (III) nidus involving the corticospinal tract (CST) and superior to the posterior limb of the internal capsule; (IV) nidus involving the CST at or inferior to the level of posterior limb of the internal capsule. In addition, we divided type IV into type IVa and type IVb according to the AChA feeding. Surgical-related motor deficit (MD) evaluations were performed 1 week (short-term) and 6 months (long-term) after surgery.ResultsThe type I patients exhibited the highest incidence (62.0%) of pre-surgical epilepsy among the four subtypes. Multivariate analysis showed that motor-related area subtypes (p=0.004) and diffuse nidus (p=0.014) were significantly associated with long-term MDs. Long-term MDs were significantly less frequent in type I than in the other types. Type IV patients acquired the highest proportion (four patients, 25.0%) of long-term poor outcomes (mRS >2). Type IVb patients showed a significantly higher incidence of post-surgical MDs than type IVa patients (p=0.041). The MDs of type III or IV patients required more recovery time. Of the 62 patients who had pre-surgical seizures, 90.3% (56/62) controlled their seizures well and reached Engel class I after surgery.ConclusionsCombining the consideration of location and AChA feeding, the classification for M-AVMs is a useful approach for predicting post-surgical motor function and decision-making.

scholarly journals A Case of Anterior Choroidal Artery Occlusion and Stroke Secondary to External Compression

2021 ◽  
pp. 369-374
Author(s):  
Satya Narayana Patro ◽  
Khawaja Hassan Haroon ◽  
Khansabegum Tamboli ◽  
Abdulaziz Zafar ◽  
Suhail Hussain ◽  
...  
Keyword(s):  
Medial Temporal Lobe ◽  
Optic Tract ◽  
Internal Capsule ◽  
Cerebral Peduncle ◽  
Anterior Choroidal Artery ◽  
Vessel Occlusion ◽  
External Compression ◽  
Posterior Limb ◽  
Anterior Choroidal ◽  
Choroidal Artery

The anterior choroidal artery (AChA) is a small artery commonly arising from the supraclinoid segment of the internal carotid artery (ICA). The significance of the AChA is related to its strategic supply to various important structures of the brain, such as the optic tract, the posterior limb of the internal capsule, the cerebral peduncle, the lateral geniculate body, medial temporal lobe, medial area of pallidum, and the choroid plexus [<i>J Neurol</i>. 1988;235:387–91]. The AChA syndrome in its complete form consists of the triad of hemiplegia, hemisensory loss, and hemianopia. However, incomplete forms are more frequent in clinical practice [<i>Stroke</i>. 1994;25:837–42]. Isolated infarction in the AChA territory is relatively rare. The presumed pathogenic mechanisms of AChA infarction are cardiac emboli, large-vessel atherosclerosis, dissection of the ICA, small-vessel occlusion, or other determined or undetermined causes [<i>Stroke</i>. 1994;25:837–42 and <i>J Neurol Sci</i>. 2009;281:80–4].

scholarly journals Embolization of the choroidal artery in the treatment of cerebral arteriovenous malformations

2017 ◽  
Vol 126 (4) ◽  
pp. 1114-1122 ◽  
Author(s):  
Alaa Elkordy ◽  
Hidenori Endo ◽  
Kenichi Sato ◽  
Yasushi Matsumoto ◽  
Ryushi Kondo ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Open Surgery ◽  
Gamma Knife Radiosurgery ◽  
Internal Capsule ◽  
Endovascular Embolization ◽  
Anterior Choroidal Artery ◽  
Cerebral Avms ◽  
Anterior Choroidal ◽  
Choroidal Artery

OBJECTIVE The anterior and posterior choroidal arteries are often recruited to supply arteriovenous malformations (AVMs) involving important paraventricular structures, such as the basal ganglia, internal capsule, optic radiation, lateral geniculate body, and medial temporal lobe. Endovascular embolization through these arteries is theoretically dangerous because they supply eloquent territories, are of small caliber, and lack collaterals. This study aimed to investigate the safety and efficacy of embolization through these arteries. METHODS This study retrospectively reviewed 13 patients with cerebral AVMs who underwent endovascular embolization through the choroidal arteries between 2006 and 2014. Embolization was performed as a palliative procedure before open surgery or Gamma Knife radiosurgery. Computed tomography and MRI were performed the day after embolization to assess any surgical complications. The incidence and type of complications and their association with clinical outcomes were analyzed. RESULTS Decreased blood flow was achieved in all patients after embolization. Postoperative CT detected no hemorrhagic complications. In contrast, postoperative MRI detected that 4 of the 13 patients (30.7%) developed infarctions: 3 patients after embolization through the anterior choroidal artery, and 1 patient after embolization through the lateral posterior choroidal artery. Two of the 4 patients in whom embolization was from the cisternal segment of the anterior choroidal artery (proximal to the plexal point) developed symptomatic infarction of the posterior limb of the internal capsule, 1 of whom developed morbidity (7.7%). The treatment-related mortality rate was 0%. Additional treatment was performed in 12 patients: open surgery in 9 and Gamma Knife radiosurgery in 3 patients. Complete obliteration was confirmed by angiography at the last follow-up in 10 patients. Recurrent bleeding from the AVMs did not occur in any of the cases during the follow-up period. CONCLUSIONS Ischemic complications are possible following the embolization of cerebral AVMs through the choroidal artery, even with modern neurointerventional devices and techniques. Although further study is needed, embolization through the choroidal artery may be an appropriate treatment option when the risk of surgery or radiosurgery is considered to outweigh the risk of embolization.

The anterior one third of the posterior limb of the internal capsule is also supplied by the anterior choroidal artery

2019 ◽  
Vol 406 ◽  
pp. 116455 ◽  
Author(s):  
Takashi Koizumi ◽  
Yasumasa Yamamoto ◽  
Yoshinari Nagakane ◽  
Yasuhiro Tomii ◽  
Toshiki Mizuno
Keyword(s):  
Internal Capsule ◽  
Anterior Choroidal Artery ◽  
Posterior Limb ◽  
Anterior Choroidal ◽  
Choroidal Artery

Sylvian Fissure Arteriovenous Malformations

Neurosurgery ◽  
1987 ◽  
Vol 21 (1) ◽  
pp. 7-14 ◽  
Author(s):  
Kenichiro Sugita ◽  
Toshiki Takemae ◽  
Shigeaki Kobayashi
Keyword(s):  
Arteriovenous Malformations ◽  
Sylvian Fissure ◽  
Neurological Deficits ◽  
Surgical Results ◽  
Anterior Choroidal Artery ◽  
Points Of View ◽  
Characteristic Features ◽  
Anterior Choroidal ◽  
Choroidal Artery ◽  
Angiographic Findings

Abstract We have operated on 16 cases of arteriovenous malformation (AVM) in and around the sylvian fissure. We call these lesions “sylvian fissure AVMs” and classify them into four subdivisions, namely, pure, lateral, medial, and deep AVMs. By others, they have been variously called AVMs of the basal ganglia, insula, anterior choroidal artery, frontal lobe, or temporal lobe. These sylvian fissure AVMs showed similar angiographic findings: the feeders in all cases were branches of the middle cerebral artery; in some cases, additional feeders from the anterior and posterior choroidal and posterior communicating arteries were present also. We describe the characteristic features of these AVMs from the anatomical and surgical points of view. The surgical results were satisfactory in 15 cases (no additional neurological deficits), and 1 patient died. (Neurosurgery 21: 7-14, 1987)

Anterior Choroidal Artery Territory Infarction: Lesions Confined to versus beyond the Internal Capsule

2013 ◽  
Vol 35 (3) ◽  
pp. 228-234 ◽  
Author(s):  
Hoyon Sohn ◽  
Dong-Wha Kang ◽  
Sun U. Kwon ◽  
Jong S. Kim
Keyword(s):  
Internal Capsule ◽  
Anterior Choroidal Artery ◽  
Anterior Choroidal ◽  
Choroidal Artery

scholarly journals A New Classification of Anterior Choroidal Artery Aneurysms and Its Clinical Application

2021 ◽  
Vol 13 ◽  
Author(s):  
Yu Duan ◽  
Xuanfeng Qin ◽  
Qinqzhu An ◽  
Yikui Liu ◽  
Jian Li ◽  
...  
Keyword(s):  
Flow Diverter ◽  
Type I ◽  
Type Ii ◽  
Anterior Choroidal Artery ◽  
New Classification ◽  
Class 1 ◽  
Anterior Choroidal ◽  
The Relationship ◽  
Choroidal Artery

Background and Purpose: The aim of this study was to compare the different subtypes of anterior choroidal artery (AChoA) aneurysm based on a new classification and to analyze the risk factors according to individual endovascular treatment (EVT).Methods: In the new classification, AChoA aneurysms are classified into independent type (I type) and dependent type (II type) based on the relationship between the AChoA and the aneurysm. II type aneurysms have three subtypes, IIa (neck), IIb (body), and IIc (direct). We retrospectively analyzed 52 cases of AChoA aneurysm treated in our center between 2015 to 2019. There were 13 (25.0%) I type aneurysms, 24 (46.2%) IIa aneurysms, 15 (28.8%) IIb aneurysms, and no IIc type; 28 cases had a subarachnoid hemorrhage. According to our preoperative EVT plan for the different subtypes: II type should achieve Raymond-Roy Occlusion Class 1 (RROC 1) where possible. To protect the AChoA, it is best to preserve the neck of the IIa type aneurysms (RROC 2), and RROC 3 is enough for IIb type.Results: Ten asymptomatic cases with minimal aneurysms were treated conservatively. Of the other cases, 42 were treated with individualized EVT (26 with a simple coil, 6 with balloon-assisted coiling, 7 with stent-assisted coiling, and 3 by flow diverter. Different subtypes had different RROC (Z = 14.026, P = 0.001). IIb type aneurysms (χ2 = 7.54, P = 0.023) were one of the factors related to temporary or permanent AChoA injury during surgery. Overall, two patients (IIa = 1, IIb = 1) developed contralateral hemiparesis.Conclusions: The new classification diagram clearly shows the features of all types of AChoA aneurysm and makes EVT planning more explicit. The II type (particularly IIb) was a potential risk factor for AChoA injury.

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