Abstract 1122‐000061: Initial Experience Using the Transvenous Embolization for Intracranial Arteriovenous Malformations in a Reference Endovascular Center

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Giancarlo Saal Zapata ◽  
Giancarlo Saal‐Zapata ◽  
Aaron Rodriguez‐Calienes ◽  
Rodolfo Rodriguez‐Varela
Keyword(s):  
Decompressive Craniectomy ◽  
Clinical Condition ◽  
Arteriovenous Malformations ◽  
Arterial Embolization ◽  
Venous Drainage ◽  
External Ventricular Drainage ◽  
Initial Experience ◽  
Transvenous Embolization ◽  
Complete Obliteration ◽  
The Mean

Introduction : Transvenous embolization (TVE) is used in cases of arteriovenous malformations (AVMs) with specific characteristics such as small size (<3 cm), deep location, single draining vein and the absence of adequate feeders. High complete obliteration rates have been reported. Therefore, our study aimed to analyze our initial experience using the TVE for treatment of AVMs. Methods : Between May 2018 and January 2021, consecutive patients who underwent TVE of AVMs were selected. Demographics, radiological and clinical variables were collected. The modified Rankin Scale (mRS) was used to determine clinical outcomes and was dichotomized (good clinical condition: mRS £2; poor clinical condition: mRS >2). Complete obliteration was defined as the total absence of the nidus and vein, subtotal obliteration was defined as the embolization of >95% of nidus and partial obliteration was defined as the embolization of <95% of nidus. Procedure‐related complications were defined as those that occurred during the procedure and were divided as intraoperative rupture and thrombosis. Results : Twenty‐one patients harboring 21 AVMs were evaluated. Fourteen patients (67%) were women. The mean age was 24.5 ± 14.1 years (7 – 48 years). A good preoperative clinical condition was present in 20 patients. Twenty AVMs were ruptured (95.2%). The most frequent locations were thalamus/basal ganglia in 6 patients (29%), followed by temporal/insular in 5 patients (24%). Spetzler‐Martin grades III, II and I were present in 11, 9 and 1 patients, respectively. The mean number of feeders was 2.1 per AVM. The feeders arised from the MCA in 9 cases, followed by PCA in 5 cases, ACA and AChoA in 3 cases, AICA in 2 cases, and ECA and PCom in 1 case, respectively. The mean number of veins was 1.3 per AVM. Deep venous drainage was present in 12 cases (57%). The mean size of the AVM nidus was 15.7 ± 7.8 mm (3.7 – 34 mm). Previous trans‐arterial embolization was done in 10 patients (47.6%). Pre‐embolization hematoma evacuation was done in 4 patients (19%). An immediate complete obliteration was achieved in 18 patients (85.7%), whereas a subtotal and partial obliteration were achieved in 2 and 1 patients, respectively. A poor post‐operative clinical condition occurred in 4 patients (20%). Procedure‐related complications occurred in 4 patients (20%): 3 cases with intra‐operative rupture of the AVM nidus and 1 case of a thrombus in the M1 treated with stent retriever. Mortality occurred in 3 patients (14.2%) of which two presented intra‐operative rupture with intracerebral hematomas that required decompressive craniectomy. One patient presented a post‐operative bleeding of the AVM nidus that required external ventricular drainage and decompressive craniectomy. Follow‐up angiography was done in 4 cases with total obliteration of all the cases (100%). Conclusions : The transvenous approach has emerged as an alternative to trans‐arterial approach with high grades of immediate total obliteration rates, but with potential procedure‐related complications. Thus, this technique should be used in selected cases in order to achieve complete cure rates.

scholarly journals Endovascular transvenous cure for ruptured brain arteriovenous malformations in complex cases with high Spetzler-Martin grades

2015 ◽  
Vol 122 (5) ◽  
pp. 1229-1238 ◽  
Author(s):  
Christina Iosif ◽  
Georges A. C. Mendes ◽  
Suzana Saleme ◽  
Sanita Ponomarjova ◽  
Eduardo Pedrolo Silveira ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Clinical Status ◽  
Surgical Techniques ◽  
Venous Drainage ◽  
Endovascular Embolization ◽  
Modified Rankin Scale ◽  
Transvenous Embolization ◽  
Scale Scores ◽  
Therapeutic Decision Making ◽  
Brain Avms

OBJECT Ruptured cerebral arteriovenous malformations (AVMs) with deep localization and high Spetzler-Martin grades are associated with considerable challenges regarding nidus eradication treatment. The authors report their experience with curative endovascular transvenous embolization in a series of patients harboring “untreatable” lesions. METHODS Between January 2008 and June 2013, a transvenous endovascular embolization protocol was implemented at the authors' institution for consecutive patients with ruptured brain AVMs that were considered incurable by classic endovascular and surgical techniques. Therapeutic decision making was based on Spetzler-Martin grades, AVM location, type of venous drainage, and angioarchitectural evaluation. Complete exclusion of the nidus was the objective of treatment. RESULTS Twenty patients (10 male and 10 female, mean age 36.7 ± 17.7 years) were included. Initial Spetzler-Martin grades were III–V for 90.0% of the patients. The lesions were deeply seated in 80% and in eloquent locations in 90% of cases. The preprocedural modified Rankin Scale score was 0–2 for 12 of the 20 patients (60.0%), 3 for 2 patients (10.0%), and 4 for 6 patients (30.0%). The postprocedural clinical status was unchanged for all patients. The procedure was technically feasible in all cases. Procedure-related mortality was 0%. Ninety percent of the patients were independent in their everyday lives (modified Rankin Scale Scores 0–2) at the 6-month follow-up. In all cases but one (95%) the embolization was curative, confirmed by selective DSA at 6 months and 18 months postintervention. CONCLUSIONS Single-session endovascular transvenous embolization seems to be a safe and effective curative treatment for patients harboring complex brain AVMs with high Spetzler-Martin grade.

Abstract TMP120: Endovascular Balloon-Assisted Embolization of Intracranial Arteriovenous Malformations Using Dual Lumen Co-Axial Balloon Microcatheters and Onyx: Initial Experience.

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Bharathi D Jagadeesan ◽  
Mikayel Grigoryan ◽  
Ameer E Hassan ◽  
Andrew W Grande ◽  
Ramachandra P Tummala
Keyword(s):  
Arteriovenous Malformations ◽  
Balloon Catheter ◽  
Arterial Embolization ◽  
Initial Experience ◽  
Intracranial Arteriovenous Malformations ◽  
Balloon Inflation ◽  
Ethylene Vinyl Alcohol ◽  
Catheter Navigation ◽  
Brain Avms ◽  
Vessel Rupture

Background: Ethylene Vinyl alcohol co-polymer (Onyx) is widely used for embolization of intracranial arteriovenous malformations. Traditional catheter based techniques for Onyx infiltration may be associated with reflux of Onyx resulting in cathteter retention, vessel rupture or reflux into en-passage arteries. Balloon assisted Onyx embolization may eliminate some of these problems encountered with traditional catheter based techniques. Herein, we report our initial experience in performing balloon assisted AVM embolization for brain AVMs and dural AVFs using the new Scepter-C and Scepter-XC co- axial dual lumen balloon microcatheters. Methods: Balloon-assisted trans-arterial embolization was carried out in a series of six patients (5 with brain AVMs, one with a dural AVF ) using Onyx delivered through the lumen of Scepter-C or Scepter XC co-axial balloon microcatheters. Following initial balloon-catheter navigation into a feeding artery as close to the nidus of the malformation as possible, and subsequent balloon inflation, embolization was performed using Onyx 18 or Onyx 34 or both. The balloon was delated and removed once adequate embolization had been achieved. Results: A total of ten embolization sessions were performed via fifteen arterial feeders in these five patients. In one out of fifteen vessels (7%), there was a quickly controlled arterial perforation from balloon inflation, in all others embolization goals for each session were successfully achieved with no adverse events. Conclusion: We found that the balloon microcatheters showed excellent navigability and there were no problems with retrieval or repeated inflation and deflation of the balloons. Using this technique, we were able to avoid the need for formation of a proximal Onyx plug and its associated risks. Additionally, fluoroscopy and procedural times seemed lower with this technique compared to conventional embolization methods.

Multimodality treatment of posterior fossa arteriovenous malformations

2008 ◽  
Vol 108 (6) ◽  
pp. 1152-1161 ◽  
Author(s):  
Michael E. Kelly ◽  
Raphael Guzman ◽  
John Sinclair ◽  
Teresa E. Bell-Stephens ◽  
Regina Bower ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Multimodality Treatment ◽  
Neurological Complications ◽  
Cure Rate ◽  
Complete Obliteration ◽  
The Mean ◽  
Risk Of Hemorrhage ◽  
Negative Predictor

Object Posterior fossa arteriovenous malformations (AVMs) are relatively uncommon and often difficult to treat. The authors present their experience with multimodality treatment of 76 posterior fossa AVMs, with an emphasis on Spetzler–Martin Grades III–V AVMs. Methods Seventy-six patients with posterior fossa AVMs treated with radiosurgery, surgery, and endovascular techniques were analyzed. Results Between 1982 and 2006, 36 patients with cerebellar AVMs, 33 with brainstem AVMs, and 7 with combined cerebellar–brainstem AVMs were treated. Natural history data were calculated for all 76 patients. The risk of hemorrhage from presentation until initial treatment was 8.4% per year, and it was 9.6% per year after treatment and before obliteration. Forty-eight patients had Grades III–V AVMs with a mean follow-up of 4.8 years (range 0.1–18.4 years, median 3.1 years). Fifty-two percent of patients with Grades III–V AVMs had complete obliteration at the last follow-up visit. Three (21.4%) of 14 patients were cured with a single radiosurgery treatment, and 4 (28.6%) of 14 with 1 or 2 radiosurgery treatments. Twenty-one (61.8%) of 34 patients were cured with multimodality treatment. The mean Glasgow Outcome Scale (GOS) score after treatment was 3.8. Multivariate analysis performed in the 48 patients with Grades III–V AVMs showed radiosurgery alone to be a negative predictor of cure (p = 0.0047). Radiosurgery treatment alone was not a positive predictor of excellent clinical outcome (GOS Score 5; p > 0.05). Nine (18.8%) of 48 patients had major neurological complications related to treatment. Conclusions Single-treatment radiosurgery has a low cure rate for posterior fossa Spetzler–Martin Grades III–V AVMs. Multimodality therapy nearly tripled this cure rate, with an acceptable risk of complications and excellent or good clinical outcomes in 81% of patients. Radiosurgery alone should be used for intrinsic brainstem AVMs, and multimodality treatment should be considered for all other posterior fossa AVMs.

Dural Arteriovenous Malformations and Papilledema

Neurosurgery ◽  
1988 ◽  
Vol 22 (6P1-P2) ◽  
pp. 1079-1084 ◽  
Author(s):  
Mark J. Gelwan ◽  
In Sup Choi ◽  
Alejandro Berenstein ◽  
John M. D. Pile-Spellman ◽  
Mark J. Kupersmith
Keyword(s):  
Arteriovenous Malformations ◽  
Sinus Thrombosis ◽  
Arterial Embolization ◽  
Venous Drainage ◽  
Transverse Sinus ◽  
Venous Hypertension ◽  
Venous Sinus Thrombosis ◽  
Selective Arterial Embolization ◽  
First Case ◽  
Cerebrospinal Fluid Absorption

Abstract We examined and managed two patients with posterior fossa dural arteriovenous malformations (DAVMs) and papilledema. Both DAVMs had venous drainage into the transverse, straight, and sigmoid dural venous sinuses. The mechanism of papilledema in the first case was presumed venous hypertension resulting in impaired cerebrospinal fluid absorption, as the malformation drained into the single transverse sinus. This was cured by selective arterial embolization of the causative DAVM. The second patient had venous sinus thrombosis that impaired venous drainage despite embolization. A lumboperitoneal shunt was necessary to treat the elevated intracranial pressure.

Technical Note: Extreme Lateral Supracerebellar Approach for Resection of Superior Cerebellar Peduncle Arteriovenous Malformations

2021 ◽  
Author(s):  
Georgios Klironomos ◽  
Amrit K Chiluwal ◽  
Amir R Dehdashti
Keyword(s):  
Arteriovenous Malformations ◽  
External Ventricular Drainage ◽  
Technical Note ◽  
Complete Resection ◽  
Surgical Approaches ◽  
Superior Cerebellar Peduncle ◽  
The Mean ◽  
Cerebellar Peduncle ◽  
Intraoperative Rupture

Abstract BACKGROUND The surgical approaches to the region of the cerebello-mesencephalic sulcus and superior cerebellar peduncle (SCP) remain a neurosurgical challenge. OBJECTIVE To present the use of the extreme lateral supracerebellar infratentorial (SC-IT) approach to treat arteriovenous malformations (AVMs) of the SCP, which is a different entity compared to brainstem AVMs METHODS We treated 4 patients with SCP AVMs in the last 5 yr at our institution. The mean age was 49.7 yr. The average nidus size was 2.12 cm. Of those, 3 patients presented with hemorrhage and 1 with headache and tinnitus. Extreme lateral SC-IT approach was used in all cases. RESULTS Complete resection was achieved in all cases as verified with postoperative angiogram. In 1 case, intraoperative rupture with intraventricular hemorrhage was encountered, and the patient required temporary external ventricular drainage. There was no permanent complication or neurological deficit. The modified Rankin Scale (at discharge or follow-up) was less than 2 in all cases. CONCLUSION The AVMs located primarily in the SCP are distinct compared to brainstem AVMs, and their management should be different. Extreme lateral SC-IT approach should be considered as a viable alternative surgical approach for resection of these AVMs, and excellent surgical results can be achieved.

Outcome after hemorrhage following Gamma Knife surgery for cerebral arteriovenous malformations

2009 ◽  
Vol 110 (5) ◽  
pp. 1003-1009 ◽  
Author(s):  
Manish Kumar Kasliwal ◽  
Shashank Sharad Kale ◽  
Aditya Gupta ◽  
Narayanam Anantha Sai Kiran ◽  
Manish Singh Sharma ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Venous Hypertension ◽  
Gamma Knife Surgery ◽  
New Delhi ◽  
Cerebral Arteriovenous Malformations ◽  
Complete Obliteration ◽  
Cerebral Avms ◽  
Risk Of Hemorrhage

Object Although the effects of Gamma Knife surgery (GKS) on the risk of hemorrhage are poorly understood, a certain subset of patients does suffer bleeding after GKS. This study was undertaken to analyze the outcome of patients sustaining hemorrhage after GKS; it is the most feared complication of radiosurgical management of cerebral arteriovenous malformations (AVMs). Methods Between May 1997 and June 2006, 494 cerebral AVMs in 489 patients were treated using a Leksell Gamma Knife Model B, and follow-up evaluations were conducted until June 2007 at the All India Institute of Medical Sciences in New Delhi. Fourteen patients who sustained a hemorrhage after GKS formed the study group. In most of these patients conservative management was chosen. Results The mortality rate was 0% and there was a 7% risk of sustaining a severe deficit following rebleeding after GKS. None of the patients sustained rebleeding after complete obliteration. Patients with Spetzler-Martin Grade III or less had increased chances of hemorrhage after GKS (p < 0.002). The presence of deep venous drainage, aneurysm, venous hypertension, or periventricular location on angiography was common in patients with hemorrhage after GKS. Conclusions The risk of hemorrhage that remains following GKS for cerebral AVMs is highest in the 1st year after treatment. The present study showed a relatively good outcome even in cases with hemorrhage following GKS, with no deaths and minimal morbidity, further substantiating the safety and efficacy of the procedure.

Evolution of the Management of Tentorial Dural Arteriovenous Malformations

Neurosurgery ◽  
2003 ◽  
Vol 52 (4) ◽  
pp. 750-762 ◽  
Author(s):  
Patrick R. Tomak ◽  
Harry J. Cloft ◽  
Akihiko Kaga ◽  
C. Michael Cawley ◽  
Jacques Dion ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Therapeutic Strategy ◽  
Transarterial Embolization ◽  
Treatment Strategies ◽  
Venous Drainage ◽  
Neurological Deficits ◽  
Transvenous Embolization ◽  
Single Institution ◽  
Clinical Presentations

Abstract OBJECTIVE Tentorial dural arteriovenous malformations (DAVMs) are uncommon lesions associated with an aggressive natural history. Controversy exists regarding their optimal treatment. We present a single-institution series of tentorial DAVMs treated during a 12-year period, address the current controversies, and present the rationale for our current therapeutic strategy. METHODS Twenty-two patients with tentorial DAVMs were treated between 1988 and 2000. Treatment consisted of transarterial or transvenous embolization, surgical resection, disconnection of venous drainage, or a combination of these therapies. The clinical presentations, radiological features, treatment strategies, and results were studied. RESULTS Eighteen patients (82%) presented with intracranial hemorrhage or progressive neurological deficits. Retrograde leptomeningeal venous drainage was documented in 22 cases (100%), classifying the lesions as Borden Type III. Angiographic follow-up monitoring was performed for 0 to 120 months and clinical follow-up monitoring for 1 to 120 months. Posttreatment angiography demonstrated obliteration in 22 cases (100%). Two patients experienced neurological decline after endovascular treatment and died. All of the 20 surviving patients exhibited clinical improvement; there were no episodes of rehemorrhage or new neurological deficits. Outcomes were excellent in 17 cases (77%), good in 2 cases (9%), and fair in 1 case (5%), and there were 2 deaths (9%). CONCLUSION Tentorial DAVMs are aggressive lesions that require prompt total angiographic obliteration. Disconnection of the venous drainage from the fistula may be accomplished with transarterial embolization to the venous side, transvenous embolization, or surgical disconnection of the fistula. We think that extensive nidal resections carry more risk and are unnecessary. We do not think there is a role for stereotactic radiosurgery in the treatment of these lesions.

Surgical approaches to trigonal arteriovenous malformations

1987 ◽  
Vol 67 (4) ◽  
pp. 511-517 ◽  
Author(s):  
Hunt Batjer ◽  
Duke Samson
Keyword(s):  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Parahippocampal Gyrus ◽  
Surgical Approaches ◽  
Middle Temporal Gyrus ◽  
Intracranial Arteriovenous Malformations ◽  
Content Type ◽  
Lateral Posterior ◽  
The Mean ◽  
Multiple Episodes

✓ Only about 5% of intracranial arteriovenous malformations (AVM's) are located predominantly within the ventricular system. Between July, 1981, and February, 1986, 15 patients were treated at the authors' institution for AVM's within the ventricular trigone. The mean age of this patient population was 24 years, and two-thirds were female. Intracranial hemorrhage was by far the most frequent presenting symptom and intraventricular hemorrhage occurred in 11 cases, with multiple episodes being documented in five. Arterial supply of the malformations was quite uniform, with the lateral posterior choroidal or posterior temporal branch of the posterior cerebral artery (PCA) being the most frequent source. Venous drainage was similarly stereotypic, with predominant outflow into the galenic system in all but one patient. An interhemispheric surgical approach was used in eight patients, a middle or inferior temporal gyrus incision was performed in six, and a subtemporal route was chosen in a single patient. Operative results suggest that these lesions can be removed with reasonable safety. An interhemispheric approach is recommended if the nidus projects medially from the trigone and is observed medial to the P2-P3 junction of the PCA on angiography. A middle temporal gyrus approach is suggested if the nidus is lateral to the P2-P3 junction, even when the lesion is located in the dominant hemisphere. A subtemporal approach should be reserved for inferiorly projecting AVM's with cortical representation on the fusiform or parahippocampal gyrus in the nondominant hemisphere.

Interhemispheric Approaches to Arteriovenous Malformations: 3-Dimensional Operative Video

2018 ◽  
Vol 16 (5) ◽  
pp. 637-637
Author(s):  
Vijay Agarwal ◽  
Daniel L Barrow
Keyword(s):  
Cerebral Artery ◽  
Arteriovenous Malformations ◽  
Anterior Cerebral Artery ◽  
Superior Sagittal Sinus ◽  
Venous Drainage ◽  
Sagittal Sinus ◽  
Complete Obliteration ◽  
Future Risk ◽  
Risk Of Hemorrhage ◽  
Neurologically Intact

Abstract We present 2 illustrative cases of interhemispheric approaches to right sided arteriovenous malformations (AVMs). The first patient is a healthy 54-yr-old female who presented with left-sided hearing loss and pulsatile tinnitus, and was neurologically intact. Imaging demonstrated a right sided interhemispheric AVM, fed by the anterior cerebral artery with superficial venous drainage to the superior sagittal sinus. The AVM was thought to be asymptomatic and the patient chose to have her AVM treated surgically to eliminate future risk of hemorrhage. We elected to approach this lesion via a contralateral interhemispheric approach to avoid retraction of the right hemisphere. Intraoperative angiogram demonstrated complete obliteration of the malformation and the patient was neurologically intact postoperatively. The second patient is a 41-yr-old healthy male who presented with progressive bifrontal headaches and was also neurologically intact. Imaging revealed a right interhemispheric AVM fed by the anterior cerebral artery and with superficial venous drainage to the superior sagittal sinus. Although the patient's headaches may have been related, the patient's decision to undergo surgical resection was primarily to eliminate future risk of hemorrhage. The difference with this patient was that imaging revealed the presence of two draining veins on the left side that would potentially be injured via a contralateral approach. As a result, we elected to approach this lesion ipsilaterally. Intraoperative angiogram showed complete obliteration of the malformation with intact venous drainage, and the patient was neurologically intact postoperatively. Contralateral vs ipsilateral interhemispheric approaches are compared and contrasted.

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