scholarly journals A Grading System for Intracranial Arteriovenous Malformations Applicable to Endovascular Procedures

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 139-142 ◽  
Author(s):  
B. Sheikh ◽  
I. Nakahara ◽  
A. El-Naggar ◽  
I. Nagata ◽  
H. Kikuchi
Keyword(s):  
Arteriovenous Malformation ◽  
Endovascular Procedures ◽  
Drainage System ◽  
Venous Drainage ◽  
Endovascular Embolization ◽  
Point Of View ◽  
Grading System ◽  
Intracranial Arteriovenous Malformations ◽  
Intracranial Arteriovenous Malformation ◽  
Grading Systems

A grading system was designed by the first author (B.S.) specifically to predict the difficulty of endovascular obliteration of an intracranial arteriovenous malformation based on the feeding arterial characteristics, and the venous drainage system. We have retrospectively reviewed our cases of intracranial arteriovenous malformation, with special interest in those underwent endovascular embolization. The grading of the AVM was by either our new proposed system or by a surgically oriented grading system. Both systems were compared from the endovascular point of view. Using the present proposed grading system intracranial arteriovenous malformation may range from grade I to grade V. The difficulty of the endovascular embolization correlated well with the new grading system, while in most cases it did not reflect the degree of difficulty of the procedure when a pure surgical grading system was used. This newly designed grading system has a better prediction value to the difficulty of performing endovascular embolization than does other grading systems.

scholarly journals Advances in the endovascular treatment of intracranial arteriovenous malformations

2000 ◽  
Vol 2 (3) ◽  
pp. 315-320
Keyword(s):  
3D Imaging ◽  
Treatment Options ◽  
Interventional Neuroradiology ◽  
Endovascular Embolization ◽  
Functional Magnetic Resonance ◽  
Intracranial Arteriovenous Malformations ◽  
Intracranial Arteriovenous Malformation ◽  
Work Up ◽  
Valuable Role

The three treatment options for intracranial arteriovenous malformation are resection, endovascular embolization, and stereotactic radioneurosurgery, in rare cases, the malformation can be eradicated using only one of these options; most cases require a combination of the options, even all three. The most recent advances have been in interventional neuroradiology with the introduction of highdefinition 3D imaging and hyperselective intranidal endovascular embolization using rnicrocatheters and microguidewires, giving marked advantages in terms of rapidity, efficacy, and safety, Nidal devascularization is now much improved, as shown by the increased interval between embolization sessions, while high-field functional magnetic resonance imaging plays a valuable role in the preembolization work-up and postembolization follow-up.

The Ruptured Arteriovenous Malformation Grading Scale (RAGS): An Extension of the Hunt and Hess Scale to Predict Clinical Outcome for Patients With Ruptured Brain Arteriovenous Malformations

Neurosurgery ◽  
2019 ◽  
Vol 87 (2) ◽  
pp. 193-199 ◽  
Author(s):  
Michael A Silva ◽  
Pui Man Rosalind Lai ◽  
Rose Du ◽  
Mohammad A Aziz-Sultan ◽  
Nirav J Patel
Keyword(s):  
Clinical Outcome ◽  
Arteriovenous Malformation ◽  
Venous Drainage ◽  
Receiver Operating Curve ◽  
Simple Extension ◽  
Grading Systems ◽  
Ruptured Avm ◽  
Grading Scale ◽  
Ordinal Logistic Regression Model

Abstract BACKGROUND Arteriovenous malformation (AVM) rupture is highly morbid. Outcomes after AVM rupture differ from other types of brain hemorrhage. There are no specific widely used grading systems designed to predict clinical outcome after AVM rupture. OBJECTIVE To develop an all-comers scoring system to grade patients with AVM rupture and predict clinical outcome more accurately than grading systems currently in use. METHODS We retrospectively reviewed patients who presented to our institution with a ruptured AVM. Using change in modified Rankin Score (mRS) as our response variable, we generated an ordinal logistic regression model to test for significant predictor variables. The full model was sequentially condensed until the simplest model with the highest area under the receiver operating curve (AUROC) was achieved. RESULTS A total of 115 patients who presented with ruptured AVMs were included in the study, with a mean follow-up time of 4 yr. The Ruptured AVM Grading Scale (RAGS) consists of the Hunt and Hess (HH) score (1-5), patient age (<35 = 0, 35-70 = 1, and >70 = 2), deep venous drainage (1), and eloquence (1). The RAGS score outperformed other neurosurgical grading scales in predicting change in mRS, with an AUROC greater than 0.80 across all follow-up periods. CONCLUSION The RAGS score is a simple extension of the HH scale that predicts clinical outcome after AVM rupture more accurately than other grading systems.

The Management of Vein of Galen Aneurysmal Malformations

Neurosurgery ◽  
2006 ◽  
Vol 59 (suppl_5) ◽  
pp. S3-184-S3-194 ◽  
Author(s):  
Pierre L. Lasjaunias ◽  
Soke M. Chng ◽  
Marina Sachet ◽  
Hortensia Alvarez ◽  
Georges Rodesch ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Normal Growth ◽  
Venous Drainage ◽  
Treatment Method ◽  
Growth Conditions ◽  
Endovascular Embolization ◽  
Therapeutic Window ◽  
Vein Of Galen ◽  
Neurologically Normal ◽  
Level Of Understanding

Abstract OBJECTIVE: The vein of Galen aneurysmal malformation (VGAM) is a choroidal type of arteriovenous malformation involving the vein of Galen forerunner. This is distinct from an arteriovenous malformation with venous drainage into a dilated, but already formed, vein of Galen. Reports of endovascular treatment of VGAM in the literature approach the disease from a purely technical viewpoint and often fail to provide satisfactory midterm results. To focus the therapeutic challenge to a strictly morphological goal overlooks the fundamental aspects of neonatal and infant anatomy and fluid physiology. During the past 20 years, our approach to VGAM has remained the same. Our experience, based on 317 patients with VGAM who were studied in Hospital Bicêtre between October 1981 and October 2002, allows us to describe the angioarchitecture, natural history, and management of VGAM in neonates, infants, and children. METHODS: Of our cohort of 317 patients, 233 patients were treated with endovascular embolization; of these, 216 patients were treated in our hospital. The treatment method of choice was a transfemoral arterial approach to deliver glue at the fistulous zone. RESULTS: Of 216 patients, 23 died despite or because of the embolization (10.6%). Twenty out of the 193 (10.4%) surviving patients were severely retarded, 30 (15.6%) were moderately retarded, and 143 (74%) were neurologically normal on follow-up. CONCLUSION: Our data demonstrate that most treated children survive and undergo normal neurological development; an understanding of the clinical, anatomical, and pathophysiological features of VGAM has, therefore, reversed the former poor prognosis. Our level of understanding about the lesion allows us to predict most situations and remedy them by applying a strict evaluation protocol and working within an optimal therapeutic window. Patient selection and timing remain the keys in the management of this condition. It is more important to restore normal growth conditions than a normal morphological appearance, with the primary therapeutic objective being normal development in a child without neurological deficit.

scholarly journals Endovascular Treatment Accounts for a Change in Brain Arteriovenous Malformation Natural History Risk

2010 ◽  
Vol 16 (2) ◽  
pp. 127-132 ◽  
Author(s):  
X. Lv ◽  
Z. Wu ◽  
C. Jiang ◽  
Y. Li ◽  
X. Yang ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery ◽  
Venous Drainage ◽  
Endovascular Embolization ◽  
Adjusted Relative Risk ◽  
Brain Arteriovenous Malformation ◽  
Kaplan Meier ◽  
Complete Obliteration ◽  
Risk Of Hemorrhage

This study estimated the risk and rates of intracranial hemorrhage (ICH) in patients harboring brain arteriovenous malformation (BAVM) after endovascular embolization. One hundred and forty-four consecutive patients with BAVM treated with endovascular embolization between 1998 and 2003 were retrospectively reviewed. The risk of ICH subsequent to endovascular embolization was studied using Kaplan-Meier curves. We reviewed 144 patients with BAVM treated with endovascular embolization. Two hundred and sixty-nine procedures were performed, 69 were performed with silk sutures, 18 with coils, 137 with NBCA and 36 with Onyx18. Twenty-three (16.0%) patients were treated with additional gamma-knife radiosurgery and one (0.7%) with additional surgical AVM excision. Complete obliteration of BAVMs was achieved in 20 patients (13.9%). During a mean follow-up of 5.9 years for the ICH group and 6.9 years for the non-ICH group, hemorrhages occurred in 11 (17.7%) of the ICH patients and in nine (11%) of the non-ICH group (p>0.1). The annual risk of hemorrhage was 3.0% and 1.6%, respectively. In the multivariate regression model, the adjusted relative risk (RR) for hemorrhage at initial presentation was 1.6 (95% CI 1.2–3.2; p>0.1). Deep venous drainage, male sex, age or AVM size were not significantly associated with subsequent hemorrhage. ICH and non-ICH groups did not differ in progression to subsequent ICH after endovascular embolization (log-rank X2 = 1.339, p>0.1) in survival analyses. The overall annual hemorrhage risk for all patients after endovascular embolization was 2.1%. Endovascular embolization alone or combined with gamma-knife radiosurgery or surgical treatment are able to decrease ICH occurrence compared to abstention.

scholarly journals Rescue N-butyl-2 cyanoacrylate embolectomy using a Solitaire FR device after venous glue migration during arteriovenous malformation embolization: technical note

2016 ◽  
Vol 125 (1) ◽  
pp. 173-176 ◽  
Author(s):  
Robert Fahed ◽  
Frédéric Clarençon ◽  
Nader-Antoine Sourour ◽  
Dorian Chauvet ◽  
Lise Le Jean ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Gamma Knife Radiosurgery ◽  
Venous Drainage ◽  
Complete Removal ◽  
Endovascular Embolization ◽  
Technical Note ◽  
Venous Hypertension ◽  
Embolic Agent ◽  
Venous Flow ◽  
Solitaire Fr

One of the procedural risks in arteriovenous malformation (AVM) embolization is possible migration of the embolic agent into the venous drainage with an incomplete nidus occlusion, which may lead to severe hemorrhagic complications. This report presents the case of a 29-year-old man who presented with a deep intraparenchymal hematoma on the left side secondary to the spontaneous rupture of a claustral AVM. Upon resorption of the hematoma, the patient underwent an initial therapeutic session of N-butyl-2 cyanoacrylate endovascular embolization, with the purpose of reducing the AVM volume and flow before performing Gamma Knife radiosurgery. After glue injection into one of the arterial feeders, the control angiography showed a partial migration of the glue cast into the straight sinus, with most of the nidus still visible. Because of the bleeding risk due to possible venous hypertension, it was decided to try to retrieve the glue from the vein by using a stent retriever via jugular access. This maneuver allowed a nearly complete removal of the glue cast, thereby restoring normal venous flow drainage. The patient showed no clinical worsening after the procedure. To the authors’ knowledge, this is the first report of the use of the Solitaire FR device as a rescue glue retriever. This method should be considered by physicians in cases of unintended glue migration into the venous circulation during AVM embolization.

Dural arteriovenous malformation of the skull base with intraosseous vascular nidus

1994 ◽  
Vol 81 (4) ◽  
pp. 620-623 ◽  
Author(s):  
Ghaus M. Malik ◽  
Asim Mahmood ◽  
Bharat A. Mehta
Keyword(s):  
Arteriovenous Malformation ◽  
Skull Base ◽  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Dural Arteriovenous Malformation ◽  
Intracranial Arteriovenous Malformations ◽  
Content Type ◽  
Small Subgroup ◽  
Fine Print ◽  
Dural Venous Sinuses

✓ Intracranial arteriovenous malformations (AVM's) have been classified as pure pial, pure dural, and mixed pial and dural. Dural AVM's are relatively uncommon, with 377 cases documented up to 1990. These lesions were believed to be situated within the walls of the sinuses, but during the last decade researchers discovered a small subgroup of dural AVM's in extrasinusal locations such as the skull base and tentorium. Two of the 17 patients who were studied between 1976 and 1993 had dural AVM's that were entirely intraosseous except for their venous drainage, which was via the dural venous sinuses. Although such intraosseous dural AVM's have not been previously described, the authors elected to group these malformations with dural AVM's because their venous drainage was intracranial and angiograms revealed identical features.

scholarly journals Intracranial arteriovenous malformations

2018 ◽  
Vol 19 (4) ◽  
pp. 34-38
Author(s):  
Arthur A. Pereira Filho ◽  
Jafar J. Jafar
Keyword(s):  
Arteriovenous Malformations ◽  
Treatment Plan ◽  
Treatment Decision ◽  
Diagnostic Techniques ◽  
Endovascular Embolization ◽  
Treatment Modalities ◽  
Team Approach ◽  
Intracranial Arteriovenous Malformations ◽  
Intracranial Arteriovenous Malformation ◽  
Leading Role

Objective: The purpose of this report is to review intracranial arteriovenous malformations, present strategies for the evaluation and selection of optimal treatment modalities, and to discuss factors important to formulating a successful treatment plan. Methods: The authors performed a critical literature review in order to highlight recent and classic studies about intracranial arteriovenous malformations. Results: Recent advances in diagnostic techniques, microsurgery, endovascular therapy, and stereotactic radiosurgery have significantly improved the treatment outcome of vascularmalformations of the central nervous system. In patients who are minimally symptomatic, in normal neurologic condition, or whose treatment risk is high, not recommending any treatment can be an excellent viable option. For the others, microsurgery, endovascular embolization, and stereotacticradiosurgery offer complementary advantages and improve the chances of a lifetime cure. Conclusion: A thorough knowledge of the natural history ofintracranial arteriovenous malformations is fundamental to the treatment decision making process. A multidisciplinary team approach with the neurosurgeon taking a leading role is as well essential for a successful intracranial arteriovenous malformation management.

Intracranial Arteriovenous Malformation: Relationship between Clinical Factors and Surgical Complications

Neurosurgery ◽  
1989 ◽  
Vol 24 (1) ◽  
pp. 75-79 ◽  
Author(s):  
H. Hunt Batjer ◽  
Michael D. Devous ◽  
G. Burton Seibert ◽  
Phillip D. Purdy ◽  
Frederick J. Bonte
Keyword(s):  
Arteriovenous Malformation ◽  
Surgical Complications ◽  
Arteriovenous Malformations ◽  
Clinical Factors ◽  
Intracranial Arteriovenous Malformations ◽  
Intracranial Arteriovenous Malformation ◽  
Good Outcome ◽  
Age Related ◽  
History Of ◽  
Feeding Vessels

Abstract Serious morbidity and hyperemic states continue to complicate the treatment of certain intracranial arteriovenous malformations (AVMs). Clinical and radiographic characteristics of 62 patients treated over 3 years were analyzed to determine if hyperemic complications (HCs) (defined as unusual perioperative edema or hemorrhage) and outcome could be predicted. Twenty-five (40%) of the patients were less than 30 years old, 28 (45%) were between 30 and 50, and 9 (15%) were more than 50. A history of hemorrhage was found in 48%, and 34% presented with progressive deficits. Thirteen (21%) developed evidence of HCs; 51 (82%) ultimately had a good outcome, 4 (6%) had a poor outcome, and 7 (11%) died. The incidence of HCs was higher in patients whose AVMs recruited perforating vessels (53%) than those without (7%) (P < 0.001). The presence of preoperative angiographic steal carried a 35% risk of HCs whereas its absence carried a 13% risk (P < 0.05). The sum of the diameters of the feeding vessels was also predictive P < 0.05). Outcome was clearly age-related: good outcome was achieved in 92% of the patients less than 30 years old, 86% of those 30 to 50, and 44% of patients older than 50 (P < 0.05). Left hemispheric AVMs showed less morbidity than right (P < 0.05) as did those without perforating vessel recruitment (P < 0.07). HCs had a dramatic impact on outcome with 92% of patients without HCs having good outcome and 46% of those with HCs recovering well (P < 0.001).

scholarly journals Staged transarterial endovascular embolization of a malignant dural arteriovenous fistula using Onyx and n-butyl cyanoacrylate

2019 ◽  
Vol 46 (Suppl_2) ◽  
pp. V1
Author(s):  
Silvia Gesheva ◽  
William T. Couldwell ◽  
Vance Mortimer ◽  
Philipp Taussky ◽  
Ramesh Grandhi
Keyword(s):  
Arteriovenous Malformations ◽  
Dural Arteriovenous Fistula ◽  
Transarterial Embolization ◽  
Venous Drainage ◽  
Transverse Sinus ◽  
Endovascular Embolization ◽  
Intracranial Arteriovenous Malformations ◽  
Dural Venous Sinus ◽  
Cortical Venous Drainage ◽  
Primary Modality

Dural arteriovenous fistulae (dAVFs) are vascular anomalies formed by abnormal connections between branches of dural arteries and dural veins or dural venous sinus(es). These pathologic shunts constitute 10%–15% of all intracranial arteriovenous malformations. The hallmark of malignant dAVFs is the presence of cortical venous drainage, a finding that increases the likelihood of nonhemorrhagic neurologic deficit, intracranial hemorrhage, and mortality if left unaddressed. Endovascular approaches have become the primary modality for the treatment of dAVFs. The authors present a case of staged endovascular transarterial embolization of a malignant dAVF running parallel to the left transverse sinus in a patient with headaches and pulsatile tinnitus. The fistula was completely treated using Onyx and n-butyl cyanoacrylate.The video can be found here: https://youtu.be/GSAto_wlC3I.

Role of Venous Drainage in Cerebral Arteriovenous Malformation Surgery, as Related to the Development of Postoperative Hyperperfusion Injury

Neurosurgery ◽  
2002 ◽  
Vol 51 (4) ◽  
pp. 921-929 ◽  
Author(s):  
Carlo Schaller ◽  
Horst Urbach ◽  
Johannes Schramm ◽  
Bernhard Meyer
Keyword(s):  
Arteriovenous Malformation ◽  
Drainage System ◽  
Venous Drainage ◽  
Venous Hypertension ◽  
Cerebral Arteriovenous Malformation ◽  
Venous Circulation ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract OBJECTIVE To elucidate the role of venous drainage in cerebral arteriovenous malformation (AVM) surgery, with respect to the development of postoperative hyperperfusion injury. METHODS For 52 patients with supratentorial AVMs, cortical capillary oxygenation (SaO2) was assessed intraoperatively, before and after resection, in the vicinity of the AVMs, by using a microspectrophotometric method. Assessed areas were defined as being related to feeding arteries or draining veins or as distant areas. Patients were divided into three groups on the basis of postoperative angiographic findings, as follows: Group 1, all former draining veins preserved (8 patients); Group 2, ≥1 former draining vein visible (12 patients); Group 3, no former draining veins visible (32 patients). Patients and SaO2 values were pooled and compared by using paired and unpaired t tests (P < 0.05). Venous circulation times were calculated from digital subtraction angiography films. RESULTS The postresectional relative increases in SaO2 values were highest in draining vein areas (+40.8%, compared with +25% in feeder areas and +25.5% in distant areas). Five postoperative hyperemic complications occurred (9.6%), none in Group 1 (with all draining veins preserved), two (16.7%) in Group 2, and three (9.4%) in Group 3 (with all draining veins occluded). The lowest preresectional SaO2 values (31.7 ± 6.2%) were measured in the drainer areas of the five patients who subsequently developed hyperperfusion injuries. Among those patients, postresectional increases in SaO2 values were significantly greater in drainer areas (+167.8%) than in feeder areas (+28.3%) or distant areas (+25.8%). Postoperative venous circulation times in former draining veins in Group 2 were significantly greater than those in Group 1 (8.9 ± 1.5 s versus 6.3 ± 0.6 s). Circulation times in normal veins in the five patients with hyperperfusion injury increased from 5.6 ± 1.0 seconds (preoperatively) to 8.4 ± 1.9 seconds (postoperatively). CONCLUSION Postoperative hyperperfusion injury after resection of cerebral AVMs can be explained on the basis of unconstrained arterial inflow into cortical areas, which are rendered hypoxic/ischemic by longstanding preoperative venous hypertension. The risk for postoperative breakthrough complications seems higher in the presence of multiple draining veins, which also participate in the physiological venous drainage system of the ipsilateral hemisphere.

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