Occipital arteriovenous malformations and migraine

Cephalalgia ◽  
2011 ◽  
Vol 31 (12) ◽  
pp. 1320-1324 ◽  
Author(s):  
Francesca Galletti ◽  
Paola Sarchielli ◽  
Mohamed Hamam ◽  
Cinzia Costa ◽  
Letizia M Cupini ◽  
...  
Keyword(s):  
Observational Study ◽  
Clinical Features ◽  
Arteriovenous Malformations ◽  
Migraine Headache ◽  
Spreading Depression ◽  
Clinical Presentation ◽  
Occipital Lobe ◽  
Endovascular Embolization ◽  
Cerebral Arteriovenous Malformations ◽  
The Relationship

Background: Headache has been reported to be the first clinical presentation in several patients with cerebral arteriovenous malformations (AVMs). Headache associated with AVMs often shows characteristics of migraine with and without aura. Angiographic characteristics of AVMs, such as their location, could determine the ‘migraine-like’ features of attacks. Methods: We performed an observational study of the clinical and angiographic characteristics of a cohort of 40 consecutive patients with AVMs who had been admitted to our institute for endovascular embolization over a 4-year period. Headache was characterized according to ICHD-II criteria. The relationship between headaches and the angioarchitectural features of AVMs was also analysed. Results: Migraine-like headache was the first clinical manifestation in 22.5% of patients. The location of the malformation was significantly associated with migraine-like presentation (p = 0.03) and the occipital lobe was the predominant site. Conclusions: An occipital location may be linked with spreading depression, a pathogenic mechanism of migraine. Headache associated with arteriovenous malformations in the occipital lobe, although secondary in nature, could have clinical features similar to migraine.

Morbidity and mortality associated with sequential flow reduction embolization technique of cerebral arteriovenous malformations using n-butyl cyanoacrylate

2020 ◽  
pp. neurintsurg-2020-016223
Author(s):  
Alfred P See ◽  
Mahmoud H Mohammaden ◽  
Mark Rizko ◽  
Christopher J Stapleton ◽  
Sepideh Amin-Hanjani ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Endovascular Embolization ◽  
Morbidity And Mortality ◽  
Treatment Modalities ◽  
Cerebral Arteriovenous Malformations ◽  
Major Morbidity ◽  
Factors Affecting ◽  
Flow Reduction ◽  
Ruptured Avm ◽  
Targeting Strategy

BackgroundEndovascular embolization of cerebral arteriovenous malformations (AVM) with liquid n-butyl cyanoacrylate (n-BCA) serves multiple purposes including AVM occlusion and flow reduction in preparation for other treatment modalities. The objective was to study the clinical, structural, and angiographic factors affecting complications associated with AVM treatment by sequential n-BCA embolizations for nidal occlusion versus quantitative flow reduction in preparation for surgical resection or radiosurgery.MethodsWe performed a retrospective review of all patients who underwent endovascular embolization of cerebral AVM at our institution between 1998 and 2019, during which time the technique of traditional embolization evolved to a strategy of targeted sequential flow reduction guided by serial flow imaging based on quantitative magnetic resonance angiography, in conjunction with a shift away from nidal penetration.ResultsAmong 251 patients, 47.8% of patients presented with ruptured AVM. On average, each patient underwent 2.4 embolizations, for a total of 613 sessions. Major morbidity related to embolization occurred in 18 (7.2%) patients, but this occurred disproportionately in the traditional embolization strategy (n=16, 8%) in contrast with the flow-targeting strategy (n=2, 3.8%). Four patients (1.6%) died in the overall group, and these all occurred with the traditional embolization strategy (2% of 199 patients); no deaths occurred in the flow-targeting strategy (n=52).ConclusionEmbolization with n-BCA targeted to sequential flow reduction and feeder occlusion with limited nidal penetration prior to definitive surgical or radiosurgical treatment can be safely performed with low overall morbidity and mortality.

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

scholarly journals A challenging entity of endovascular embolization with ONYX for brainstem arteriovenous malformation: Experience from 13 cases

2017 ◽  
Vol 23 (5) ◽  
pp. 497-503 ◽  
Author(s):  
Hengwei Jin ◽  
Zhan Liu ◽  
Qing Chang ◽  
Chang Chen ◽  
Huijian Ge ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Intracranial Hemorrhage ◽  
Arteriovenous Malformations ◽  
Clinical Presentation ◽  
Gamma Knife Radiosurgery ◽  
Endovascular Embolization ◽  
Treatment Modalities ◽  
Patient Demographics ◽  
Partially Occluded

Objective Brainstem arteriovenous malformations (AVMs) are rare lesions with a high risk of intracranial hemorrhage and are challenging to treat. We present our experience of endovascular embolization with Onyx in these aggressive lesions. Materials and methods Between 2007 and 2016, 13 patients with brainstem AVMs were embolized with Onyx at our center. Twelve patients presented with intracranial hemorrhage and one with headache. Retrospective examinations of patient demographics, clinical presentation, angiographic features, treatment modalities, postoperative complications and outcomes were carried out. Results The AVMs were in the midbrain in 10 patients (one anterior and nine posterior or dorsal), in the posterior pons in two and pontomedullary in one. Complete occlusion was achieved in three patients. Gamma knife radiosurgery was performed in six patients who were near-completely or partially embolized. Postoperative complications, including five cases of ischemia and one case of hemorrhage, resulted in four cases of neurological deterioration and two deaths. Clinical follow-up was obtained in 10 patients at a mean period of 45.2 months (range 3 to 93 months). During the follow-up, good clinical outcomes were observed in seven patients with posterior or dorsal midbrain AVMs, and one patient with a posterior pons AVM that was partially occluded died of intracranial hemorrhage. Conclusion Endovascular embolization for brainstem AVM with Onyx is a technical challenge and the reflux of Onyx may cause severe complications. Individualized treatment is needed based on the specific subtype of brainstem AVM.

Unruptured Cerebral Arteriovenous Malformations Presenting with Intracranial Hypertension

Neurosurgery ◽  
1988 ◽  
Vol 23 (4) ◽  
pp. 484-490 ◽  
Author(s):  
Daniel L. Barrow
Keyword(s):  
Intracranial Hypertension ◽  
Arteriovenous Malformations ◽  
Perfusion Pressure ◽  
Pseudotumor Cerebri ◽  
Surgical Removal ◽  
Cerebral Arteriovenous Malformations ◽  
Normal Perfusion Pressure Breakthrough ◽  
The Relationship

Abstract Two cases of unruptured pial arteriovenous malformations (AVMs) presenting with intracranial hypertension and papilledema are reported. In the absence of previous hemorrhage or associated hydrocephalus, such a manifestation of pial AVMs is quite unusual. Both patients experienced prompt and sustained resolution of papilledema after surgical removal of the malformation. One case was complicated by the normal perfusion pressure breakthrough phenomenon postoperatively. The pathophysiology of intracranial hypertension associated with unruptured pial AVMs and the relationship to pseudotumor cerebri are discussed.

Effectiveness and Pitfall of Embolization of Cerebral Arteriovenous Malformations

1999 ◽  
Vol 5 (1_suppl) ◽  
pp. 151-156 ◽  
Author(s):  
S. Miyachi ◽  
M. Negoro ◽  
T. Okamoto ◽  
O. Suzuki ◽  
J. Yoshida
Keyword(s):  
High Risk ◽  
Functional Imaging ◽  
Brain Function ◽  
Arteriovenous Malformations ◽  
High Flow ◽  
Surgical Removal ◽  
Cerebral Arteriovenous Malformations ◽  
Total Occlusion ◽  
Embolic Materials ◽  
The Relationship

We studied the course of perisurgical complications of 66 AVMs and discussed the approapriate precautions. Of 66 patients with AVMs, 14 underwent postembolization surgical removal, and 43 underwent radiosurgery. Four patients were cured with total occlusion of their AVM by embolization alone. 48 patients achieved a more than 70% occlusion of the nidus. We observed 12 complications including 3 permanent and 9 temporary. Four complications occurred immediately after the embolization due to overembolization or thromboembolism, and 7 were observed several hours later which might have been caused by retrograde thrombosis or a chemical reaction to the glue. While presurgical embolization deep-seated feeders must be embolized along with fistulous or high-flow feeders, 4 cases of 2nd embolization following radiosurgery showed that meningeal feeders developed or recanalized in cases embolized with absorbable particles. Thus, preradiosurgically, fistulous and meningeal feeders should be treated, and the nidus must be packed with embolic materials with no risk of recanalization. Successful nidus packing performed in 10 AVMs yielded a further nidus reduction before radiosurgery. The intranidal aneurysms which pose a high risk of rebleeding were also embolized. In order to avoid complications in the embolization of AVM, the angioarchitecture, hemodynamics and the relationship to brain function should be well recognized by preoperative functional imaging and superselective angiograms, and adequate embolic materials should be properly injected. As an embolization strategy, the priority of the target feeders should depend on the treatment to follow, and aggressive embolization of risky feeders or causing abrupt hemodynamic change should be avoided.

scholarly journals Outcome of Endovascular Treatment of Cerebral Arteriovenous Malformations with Ethylene Vinyl Alcohol Coploymer

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H E Mohram ◽  
M A Habib ◽  
S H Mourad ◽  
A H Abozeid ◽  
A M M Salem
Keyword(s):  
Arteriovenous Malformations ◽  
Interventional Procedures ◽  
Endovascular Embolization ◽  
Vascular Territory ◽  
Cure Rate ◽  
Cerebral Arteriovenous Malformations ◽  
University Hospitals ◽  
Curative Intent ◽  
Ethylene Vinyl Alcohol ◽  
Cerebral Avms

Abstract Background Cerebral AVMs are very rare lesions, and this rarity contributes to the difficulty of treating them. There is no consensus concerning the method of treatment to be chosen among neurosurgery, radiosurgery or embolization. Onyx embolization could serve as a curative option with accepted morbidity and mortality. The introduction of Onyx and of catheters with detachable tips has no doubt increased the rate of endovascular occlusion, and decreased the risks associated with treatment in our experience. Objective The aim of the study was to assess the outcome of the use of Onyx in the treatment of intracranial AVMs as curative embolization or before neuro- or radiosurgery Patients and Methods This analytical prospective study was conducted on 25 patients who were diagnosed with cerebral arteriovenous malformations and underwent endovascular embolization with EVOH copolymer with curative intent during the study period. Interventional procedures were done in the neuro – endovascular unit, neurosurgery department Ain Shams University Hospitals and associate neuroendovascular unit in El Matarya Teaching Hospital in the period between September 2014 and April 2017. Results Actually comparing these results especially concerning the cure rate along with other studies was somewhat confusing and problematic owing to the diversity in results between studies across the last 15 years. Conclusion For the cases that are not fulfilling these criteria, embolization should be offered as preparing step for other modality of treatment. In our experience, for curative embolization, the AVM should be small sized (< 3 cm), supplied by one vascular territory, with feeders that can tolerate reflux up to 2–3 cm, with clear proximal parts of the draining veins, and not located in deep structures.

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