scholarly journals Teenage Male with Cough and Recurrent Bruit

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Sheema Gaffar ◽  
Elliot Tucker
Keyword(s):  
Relative Risk ◽  
Physical Examination ◽  
Arteriovenous Malformations ◽  
The Body ◽  
Vascular Lesions ◽  
Front Line ◽  
Optimal Plan ◽  
Genetics Referral ◽  
Invasive Intervention

A general pediatrician is skilled at continuity; through longitudinal evaluation, they serve as front-line providers in the recognition and referral of unusual pathology. The majority of arteriovenous malformations (AVM) are diagnosed with history and physical examination. AVM are inherently progressive by nature; their expansion is what creates the risk of morbidity. With higher-risk vascular lesions, relative risk is important when discussing management with observation versus with invasive intervention. Size, location, and expected course of progression of the lesion help generate a timeline for action. Collaboration of physicians with diverse expertise generates optimal plan of therapy, particularly when faced with an unusual clinical finding. Genetics referral may be beneficial, as the body of literature on AVM is growing, and databases on associated syndromes are evolving. Establishing concrete follow-up is imperative to assess for recurrence of AVM or development of additional symptoms. This can be with the interventionalist or with the generalist.

Microsurgery for Small Arteriovenous Malformations of the Brain: Results in 110 Consecutive Patients

Neurosurgery ◽  
2000 ◽  
Vol 47 (3) ◽  
pp. 571-577 ◽  
Author(s):  
Justin H. T. Pik ◽  
Michael K. Morgan
Keyword(s):  
Arteriovenous Malformations ◽  
Postoperative Outcome ◽  
Neurological Status ◽  
Acute Onset ◽  
Neurological Deficits ◽  
Vascular Lesions ◽  
History Of ◽  
The Brain ◽  
Results Of Surgery

ABSTRACT OBJECTIVE To examine the results of surgery in 110 consecutive patients with arteriovenous malformations (AVMs) smaller than 3 cm in diameter. These results are compared with the published results of other microsurgical series as well as with results for patients treated with focused irradiation. METHODS From January 1989 to November 1998, 121 patients with AVMs smaller than 3 cm were treated at our institution. One hundred ten patients underwent microsurgical removal of their AVMs. The presentation, preoperative neurological status, and postoperative outcome were recorded. Follow-up was complete for all surgical cases. RESULTS Of the 110 patients, 109 (99%) had angiographically confirmed obliteration of their AVMs. Two patients (1.8%) required reoperation for residual AVM. Two (4.3%) of 46 patients with AVMs in eloquent brain areas experienced worsening of their neurological status after surgery. One (1.6%) of 64 patients was worse neurologically after removal of an AVM in a noneloquent area. CONCLUSION Microsurgical removal is a safe and effective treatment for the majority of AVMs smaller than 3 cm in diameter. Although the treatment is accompanied by a risk of acute onset of neurological deficits, this tends to be transient in the majority of cases. Furthermore, microsurgical excision of small AVMs offers patients immediate protection from the natural history of their vascular lesions.

Microsurgical management of glomus spinal arteriovenous malformations: pial resection technique

2012 ◽  
Vol 16 (6) ◽  
pp. 523-531 ◽  
Author(s):  
Gregory J. Velat ◽  
Steve W. Chang ◽  
Adib A. Abla ◽  
Felipe C. Albuquerque ◽  
Cameron G. McDougall ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformations ◽  
Signs And Symptoms ◽  
Vascular Lesions ◽  
Morbidity Rate ◽  
Surgical Morbidity ◽  
Surgical Interventions ◽  
Spinal Arteriovenous Malformations

Object Intramedullary, or glomus, spinal arteriovenous malformations (AVMs) are rare vascular lesions amenable to resection with or without adjuvant embolization. The authors retrospectively reviewed the senior author's (R.F.S.'s) surgical series of intramedullary spinal AVMs to evaluate clinical and radiographic outcomes. Methods Detailed chart and radiographic reviews were performed for all patients with intramedullary spinal AVMs who underwent surgical treatment between 1994 and 2011. Presenting and follow-up neurological examination results were obtained and graded using the modified Rankin Scale (mRS) and McCormick Scale. Surgical technique, outcomes, complications, and long-term angiographic studies were reviewed. Results During the study period, 20 patients (10 males and 10 females) underwent resection of glomus spinal AVMs. The mean age at presentation was 30 ± 17 years (range 7–62 years). The location of the AVMs was as follows: cervical spine (n = 10), thoracic spine (n = 9), and cervicothoracic junction (n = 1). The most common presenting signs and symptoms included paresis or paralysis (65%), paresthesias (40%), and myelopathy (40%). Perioperative embolization was performed in the majority (60%) of patients. Pial AVM resection was performed in 17 cases (85%). Angiographically verified AVM obliteration was achieved in 15 patients (75%). At a mean follow-up duration of 45.4 ± 52.4 months (range 2–176 months), 14 patients (70%) remained functionally independent (mRS and McCormick Scale scores ≤ 2). One perioperative complication occurred, yielding a surgical morbidity rate of 5%. Three symptomatic spinal cord tetherings occurred at a mean of 5.7 years after AVM resection. No neurological decline was observed after endovascular and surgical interventions. No deaths occurred. Long-term angiographic follow-up data were available for 9 patients (40%) at a mean of 67.6 ± 60.3 months (range 5–176 months) following AVM resection. Durable AVM obliteration was documented in 5 (83%) of 6 patients. Conclusions Intramedullary AVMs may be safely resected with satisfactory clinical and angiographic results. The pial resection technique, which provides subtotal AVM nidus resection, effectively devascularized these lesions, as confirmed on postoperative angiography, without violating the spinal cord parenchyma, thereby potentially reducing iatrogenic injury.

Hypofractionated Conformal Stereotactic Radiotherapy for Arteriovenous Malformations

Neurosurgery ◽  
2003 ◽  
Vol 53 (5) ◽  
pp. 1036-1043 ◽  
Author(s):  
Peter Lindvall ◽  
Per Bergström ◽  
Per-Olov Löfroth ◽  
Marwan I. Hariz ◽  
Roger Henriksson ◽  
...  
Keyword(s):  
Stereotactic Radiotherapy ◽  
Arteriovenous Malformations ◽  
University Hospital ◽  
Vascular Lesions ◽  
High Morbidity ◽  
Single Fraction ◽  
Eloquent Areas ◽  
Complete Obliteration ◽  
Cerebral Avms

Abstract OBJECTIVE Arteriovenous malformations (AVMs) are congenital vascular lesions that are associated with high morbidity and mortality if left untreated. There are several options for treatment, including radiotherapy. Safe and effective single-fraction radiotherapy for patients with large AVMs has been considered difficult. METHODS Between December 1986 and June 2001, 36 patients with cerebral AVMs were treated with hypofractionated conformal stereotactic radiotherapy at Umeå University Hospital. Twenty-nine patients have been followed angiographically to date and are reported in this study. RESULTS Twenty-four (83%) of 29 patients (mean AVM volume, 11.5 cm3) underwent complete obliteration of their AVMs. The rates of angiographically verified total obliteration at 2 years after treatment were 56% for AVMs 4 to 10 cm3 and 50% for AVMs larger than 10 cm3. The obliteration rate increased considerably with extended follow-up. Five years after treatment, the obliteration rates were 81% for AVMs 4 to 10 cm3 and 70% for AVMs larger than 10 cm3. CONCLUSION Hypofractionated conformal stereotactic radiotherapy may be an important alternative to single-fraction radiotherapy in patients with large AVMs or AVMs located in eloquent areas, because it allows the administration of a higher radiation dose than is possible to deliver in single-fraction radiosurgery. With our technique of hypofractionated conformal stereotactic radiotherapy, the rate of obliterating AVMs was comparable to that of single-dose radiosurgery, although the volumes of the irradiated AVMs in our study were larger than those reported previously.

Pulmonary Arteriovenous Malformations

2018 ◽  
pp. 315-324
Author(s):  
Jeffrey S. Pollak
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Arteriovenous Malformations ◽  
Pulmonary Arteries ◽  
Vascular Lesions ◽  
Common Symptom ◽  
Pulmonary Arteriovenous Malformations ◽  
Capillary Bed ◽  
Arteries And Veins

Pulmonary arteriovenous malformations (PAVMs) are dilated directly, connecting pulmonary arteries and veins with no capillary bed. They are generally congenital and frequently occur in patients with autosomal-dominant hereditary hemorrhagic telangiectasia (HHT), so they should be screened for PAVM. HHT causes variable-sized arteriovenous malformations (AVMs) from telangiectases to larger connections and affects mucocutaneous surfaces. Epistaxis is the most common symptom, and these vascular lesions can occur in other organs, including the lungs, central nervous system, liver, and gastrointestinal (GI) tract. PAVMs can result in hypoxemia with dyspnea, paradoxical embolization with ischemic stroke and abscess formation, and hemorrhage. Treatment consists of embolization of sufficiently sized lesions; antibiotic prophylaxis before procedures prone to produce bacteremia, such as dental processes that can cause abscesses; and avoidance of air or clots in intravenous (IV) lines. Lifelong follow-up is essential to assess for adequacy of embolization and enlargement of PAVMs that are too small to embolize.

Multimodality Treatment of Conus Medullaris Arteriovenous Malformations: 2 Decades of Experience With Combined Endovascular and Microsurgical Treatments

Neurosurgery ◽  
2012 ◽  
Vol 71 (1) ◽  
pp. 100-108 ◽  
Author(s):  
David A. Wilson ◽  
Adib A. Abla ◽  
Timothy D. Uschold ◽  
Cameron G. McDougall ◽  
Felipe C. Albuquerque ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Case Series ◽  
Multimodality Treatment ◽  
Bowel Function ◽  
Conus Medullaris ◽  
Vascular Lesions ◽  
First Case ◽  
Microsurgical Resection

Abstract BACKGROUND: Conus medullaris arteriovenous malformations (AVMs) are rare, challenging spinal vascular lesions that cause progressive debilitating myeloradiculopathy. Only sporadic reports of conus AVMs have been published. OBJECTIVE: To better define the presentation, prognosis, and optimal treatment of these lesions, we present the first case series of conus AVMs, reflecting over 2 decades of experience with a multimodality endovascular and surgical approach. METHODS: We retrospectively reviewed the charts of 16 patients with a conus AVM evaluated at our institution from 1989 to 2010. For each patient, the following clinical data were collected: age, sex, symptoms, angiographic findings, type of treatment, complications, degree of angiographic obliteration, recurrence at follow-up, and need for re-treatment. Ambulatory status, Frankel Grade, motor function, and bladder/bowel function were assessed before treatment, at discharge, and at last follow-up. RESULTS: All 16 patients were treated. Eight (50%) patients underwent embolization followed by microsurgical resection, and 8 (50%) underwent microsurgical resection only. The rate of complete angiographic obliteration was 88%. At last follow-up (mean, 70 months), 43% of patients neurologically improved, 43% were stable, and 14% worsened in comparison with before treatment. During follow-up, 3 recurrences were detected, including the only 2 instances of long-term neurological decline. In the absence of recurrence, all patients ambulatory before treatment remained ambulatory at follow-up, whereas 75% of the initially nonambulatory patients regained the ability to walk. CONCLUSION: Although conus AVMs are challenging to treat, excellent long-term outcomes are possible with a multimodality approach. Recurrence is associated with long-term neurological decline and calls for close follow-up.

scholarly journals Cerebral proliferative angiopathy: a review / Angiopatia proliferativa cerebral: uma revisão

2019 ◽  
Vol 64 (1) ◽  
pp. 55
Author(s):  
André Freitas Nunes ◽  
Rafael Gomes dos Santos ◽  
Rodrigo Salmeron de Toledo Aguiar ◽  
José Carlos Esteves Veiga ◽  
Heitor Castelo Branco Rodrigues Alves ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Brain Diseases ◽  
Neurological Deficits ◽  
Vascular Lesions ◽  
Normal Brain ◽  
Invasive Treatment ◽  
Diagnostic Features ◽  
Rare Type

AbstractIntroduction: Cerebral Arteriovenous Malformations (AVMs) are vascular lesions defined by arteriovenous shunting flowing through a nidus of coiled and tortuous vascular connections. Cerebral Proliferative Angiopathy (CPA) is a rare type of AVM with pathological, clinical, diagnostic features and treatment differences from a typical AVM. We aimed to summarize important features of CPA already described and identify important gaps of evidence. Methods: Data was selected by a search of PUBMED with the term “cerebral proliferative angiopathy”. The articles considered relevant were included in this review. We also screened article references and included them as needed. Discussion: CPA shows a diffuse nidus appearance, presence of transdural supply and stenosis of feeding arteries, without dominant feeders or flow-related aneurysms. There is intermingled brain between the vascular spaces. The usual clinical presentation is seizures, headaches, and progressive neurological deficits. Sound diagnosis can be made based on CT, MRI, Angiography and perfusion techniques, which are essential to treatment choices. Invasive treatment is seldom indicated, in order to preserve the normal brain parenchyma, and clinical control of symptoms, associated with a thorough follow-up, is the usual approach in most reported cases. Conclusion: Still much remains to be learned about CPA. Establishing more precise roles of various radiological assessing methods, how they affect the follow-up of patients, and safety and efficacy profiles of different treatment approaches will provide us the tools to give patients a more solid intervention and clearer follow-up.Keywords: Vascular malformations, Intracranial arteriovenous malformations, Brain diseases, Cerebrovascular disordersResumoIntrodução: As malformações arteriovenosas cerebrais (MAVs) são lesões vasculares definidas por comunicação arteriovenosa por meio de conexões vasculares tortuosas. A angiopatia cerebral proliferativa (ACP) é um tipo raro de MAV com características patológicas, clínicas, diagnósticas e de tratamento distintas das MAVs típicas. Objetivou-se resumir características importantes da ACP já descritas na literatura, e identificar lacunas importantes nas evidências. Métodos: Os dados foram selecionados através de busca na base de dados PUBMED, com o termo “cerebral proliferative angiopathy”. Os artigos considerados relevantes foram incluídos nessa revisão, assim como alguns outros artigos presentes nas referências. Discussão: A ACP apresenta-se como um nidus difuso, associada à presença de irrigação transdural, de estenose das artérias que a alimentam, sem suprimento arterial dominante ou aneurismas relacionados ao fluxo. Há parênquima cerebral normal entre os espaços vasculares. Comumente se apresenta com crises epilépticas, cefaleia e déficits neurológicos progressivos. O diagnóstico de certeza pode ser realizado através de TC, RM, angiografia e técnicas de perfusão, e é essencial para a escolha do tratamento. Abordagens invasivas são raramente indicadas a fim de preservar o parênquima cerebral normal. O controle clínico dos sintomas, associado a seguimento rigoroso, é a escolha terapêutica geralmente utilizada na maioria dos relatos. Conclusão: Ainda há muito que se aprender sobre a ACP. Estabelecer os benefícios de cada um dos diversos métodos imaginológicos, como eles influenciam o seguimento dos pacientes, e perfis de segurança e eficácia das diferentes terapêuticas fornecerá ferramentas para melhor decisão terapêutica.Descritores: Malformações vasculares, Malformações arteriovenosas intracranianas, encefalopatias, Transtornos cerebrovasculares 

Transarterial embolization of peripheral arteriovenous malformations with ethylenevinyl alcohol copolymer - feasibility, technical outcomes, and clinical outcomes

VASA ◽  
2016 ◽  
Vol 45 (6) ◽  
pp. 497-504 ◽  
Author(s):  
Tom De Beule ◽  
Jan Vranckx ◽  
Peter Verhamme ◽  
Veerle Labarque ◽  
Marie-Anne Morren ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Arteriovenous Malformations ◽  
Clinical Success ◽  
Transarterial Embolization ◽  
Recurrent Bleeding ◽  
Complete Disappearance ◽  
Ethylene Vinyl Alcohol ◽  
Initial Symptoms

Abstract. Background: The technical and clinical outcomes of catheter-directed embolization for peripheral arteriovenous malformations (AVM) using Onyx® (ethylene-vinyl alcohol copolymer) are not well documented. The purpose of this study was to retrospectively assess the safety, technical outcomes and clinical outcomes of catheter-directed Onyx® embolisation for the treatment of symptomatic peripheral AVMs. Patients and methods: Demographics, (pre-)interventional clinical and radiological data were assessed. Follow-up was based on hospital medical records and telephone calls to the patients’ general practitioners. Radiological success was defined as complete angiographic eradication of the peripheral AVM nidus. Clinical success was defined as major clinical improvement or complete disappearance of the initial symptoms. Results: 25 procedures were performed in 22 patients. The principal indications for treatment were pain (n = 10), limb swelling (n = 6), recurrent bleeding (n = 2), tinnitus (n = 3), and exertional dyspnoea (n = 1). Complete radiological success was obtained in eight patients (36 %); near-complete eradication of the nidus was achieved in the remaining 14 patients. Adjunctive embolic agents were used in nine patients (41 %). Clinical success was observed in 18 patients (82%). Major complications were reported in two patients (9 %). During follow-up, seven patients (32 %) presented with symptom recurrence, which required additional therapy in three patients. Conclusions: Catheter-directed embolisation of peripheral AVMs with Onyx® resulted in major clinical improvement or complete disappearance of symptoms in the vast majority of patients, although complete angiographic exclusion of the AVMs occurred in only a minority of patients.

Evaluation of gamma thalamotomy for parkinsonian and other tremors: survival of neurons adjacent to the thalamic lesion after gamma thalamotomy

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 120-127 ◽  
Author(s):  
Chihiro Ohye ◽  
Tohru Shibazaki ◽  
Junji Ishihara ◽  
Jie Zhang
Keyword(s):  
Tissue Reaction ◽  
Vascular Lesions ◽  
Thalamic Lesion ◽  
Mr Images ◽  
Unsatisfactory Result ◽  
Content Type ◽  
Rhythmic Discharge ◽  
Latent Interval ◽  
Fine Print

Object. The effects of gamma thalamotomy for parkinsonian and other kinds of tremor were evaluated. Methods. Thirty-six thalamotomies were performed in 31 patients by using a 4-mm collimator. The maximum dose was 150 Gy in the initial six cases, which was reduced to 130 Gy thereafter. The longest follow-up period was 6 years. The target was determined on T2-weighted and proton magnetic resonance (MR) images. The point chosen was in the lateral-most part of the thalamic ventralis intermedius nucleus. This is in keeping with open thalamotomy as practiced at the authors' institution. In 15 cases, gamma thalamotomy was the first surgical procedure. In other cases, previous therapeutic or vascular lesions were visible to facilitate targeting. Two types of tissue reaction were onserved on MR imaging: a simple oval shape and a complex irregular shape. Neither of these changes affected the clinical course. In the majority of cases, the tremor subsided after a latent interval of approximately 1 year after irradiation. The earliest response was demonstrated at 3 months. In five cases the tremor remained. In four of these cases, a second radiation session was administered. One of these four patients as well as another patient with an unsatisfactory result underwent open thalamotomy with microrecording. In both cases, depth recording adjacent to the necrotic area revealed normal neuronal activity, including the rhythmic discharge of tremor. Minor coagulation was performed and resulted in immediate and complete arrest of the remaining tremor. Conclusions. Gamma thalamotomy for Parkinson's disease seems to be an alternative useful method in selected cases.

Gamma knife radiosurgery as a single treatment modality for large cerebral arteriovenous malformations

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 113-119 ◽  
Author(s):  
D. Hung-Chi Pan ◽  
Wan-Yuo Guo ◽  
Wen-Yuh Chung ◽  
Cheng-Ying Shiau ◽  
Yue-Cune Chang ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Radiation Treatment ◽  
Gamma Knife Radiosurgery ◽  
Consecutive Series ◽  
Content Type ◽  
Obliteration Rate ◽  
Complete Obliteration ◽  
Fine Print

Object. A consecutive series of 240 patients with arteriovenous malformations (AVMs) treated by gamma knife radiosurgery (GKS) between March 1993 and March 1999 was evaluated to assess the efficacy and safety of radiosurgery for cerebral AVMs larger than 10 cm3 in volume. Methods. Seventy-six patients (32%) had AVM nidus volumes of more than 10 cm3. During radiosurgery, targeting and delineation of AVM nidi were based on integrated stereotactic magnetic resonance (MR) imaging and x-ray angiography. The radiation treatment was performed using multiple small isocenters to improve conformity of the treatment volume. The mean dose inside the nidus was kept between 20 Gy and 24 Gy. The margin dose ranged between 15 to 18 Gy placed at the 55 to 60% isodose centers. Follow up ranged from 12 to 73 months. There was complete obliteration in 24 patients with an AVM volume of more than 10 cm3 and in 91 patients with an AVM volume of less than 10 cm3. The latency for complete obliteration in larger-volume AVMs was significantly longer. In Kaplan—Meier analysis, the complete obliteration rate in 40 months was 77% in AVMs with volumes between 10 to 15 cm3, as compared with 25% for AVMs with a volume of more than 15 cm3. In the latter, the obliteration rate had increased to 58% at 50 months. The follow-up MR images revealed that large-volume AVMs had higher incidences of postradiosurgical edema, petechiae, and hemorrhage. The bleeding rate before cure was 9.2% (seven of 76) for AVMs with a volume exceeding 10 cm3, and 1.8% (three of 164) for AVMs with a volume less than 10 cm3. Although focal edema was more frequently found in large AVMs, most of the cases were reversible. Permanent neurological complications were found in 3.9% (three of 76) of the patients with an AVM volume of more than 10 cm3, 3.8% (three of 80) of those with AVM volume of 3 to 10 cm3, and 2.4% (two of 84) of those with an AVM volume less than 3 cm3. These differences in complications rate were not significant. Conclusions. Recent improvement of radiosurgery in conjunction with stereotactic MR targeting and multiplanar dose planning has permitted the treatment of larger AVMs. It is suggested that gamma knife radiosurgery is effective for treating AVMs as large as 30 cm3 in volume with an acceptable risk.

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