scholarly journals Curative and adjunctive AVM Onyx embolization of AVMs through the choroidal arteries

2017 ◽  
Vol 23 (4) ◽  
pp. 392-398 ◽  
Author(s):  
Xianli Lv ◽  
Xiulan Hu ◽  
Wei Li ◽  
Hongwei He ◽  
Chuhan Jiang ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Endovascular Embolization ◽  
Anterior Choroidal Artery ◽  
Complete Obliteration ◽  
Lateral Posterior ◽  
Cerebral Avms ◽  
Anterior Choroidal ◽  
Choroidal Artery ◽  
Deep Location

Objective The anterior or posterior choroidal artery is often recruited to supply deep location arteriovenous malformations (AVMs). This study is to report curative and adjunctive AVM Onyx embolization through these arteries. Methods This study retrospectively reviewed six patients with cerebral AVMs who underwent endovascular embolization through the choroidal arteries between October 2015 and October 2016. Embolization was performed as a curative procedure in five patients and adjunctive procedure in one patient. Results Four patients underwent embolization through the anterior choroidal artery (AchA), and two patients underwent embolization through the lateral posterior choroidal artery (LPchA). One of the four patients in whom embolization was from the AchA (distal to the plexal point) developed transient hemiparesis. Complete obliteration was confirmed by angiography at the last follow-up in five patients. Conclusions Onyx embolization of cerebral AVMs through the choroidal arteries is possible as a curative or adjunctive procedure.

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.

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)

Microsurgical Treatment of Recurrent Conus Medullaris Arteriovenous Malformation: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (2) ◽  
pp. E44-E44
Author(s):  
M Neil Woodall ◽  
Robert F Spetzler
Keyword(s):  
Arteriovenous Malformations ◽  
Treatment Options ◽  
Conus Medullaris ◽  
Endovascular Embolization ◽  
Spinal Angiography ◽  
Microsurgical Treatment ◽  
Complete Obliteration ◽  
Retrospective Nature ◽  
Posterior Spinal Arteries

Abstract Arteriovenous malformations (AVMs) involving the conus medullaris have a unique angioarchitecture due to their involvement of the arterial basket of the conus medullaris, which represents an arterial anastomotic network between the anterior spinal artery (ASA) and posterior spinal arteries (PSAs) at the level of the conus medullaris.1 These lesions consist of a combination of a true AVM nidus, which is usually extramedullary, and direct shunts between the ASA, PSAs, and the venous system. Patients may present with radiculopathy, myelopathy, or subarachnoid hemorrhage.2 A 40-yr-old woman status post T11-L1 laminoplasty for resection of a ruptured conus AVM 6 yr prior presented with routine follow-up angiography suggestive of an arteriovenous fistula. She was counseled regarding treatment options including endovascular embolization and microsurgical ligation or resection, and she elected to proceed with surgical treatment. At the time of surgery, a recurrent AVM was noted. A 2-dimensional intraoperative video illustrates the microsurgical treatment of her recurrent conus AVM. The patient recovered well postoperatively. Spinal angiography demonstrated complete obliteration of the lesion. The patient experienced transient urinary retention that was self-limited but otherwise was without any new neurological deficit. Due to the retrospective nature of this report, informed consent was not required. Video used with permission from Barrow Neurological Institute, all rights reserved.

scholarly journals Curative Glubran 2 Embolization of Cerebral Arteriovenous Malformations Patient Selection and Initial Results

2014 ◽  
Vol 20 (6) ◽  
pp. 722-728 ◽  
Author(s):  
Jie Liu ◽  
Ming Lv ◽  
Xianli Lv ◽  
Hongwei He ◽  
Aihua Liu ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Clinical Results ◽  
Hemorrhagic Complication ◽  
Cerebral Arteriovenous Malformations ◽  
Complete Obliteration ◽  
Glubran 2 ◽  
Cerebral Avms

The liquid embolic agents currently used for embolization of cerebral arteriovenous malformations are Onyx and NBCA. Glubran 2, a cyanoacrylate-based synthetic glue, has recently been applied for embolization of cerebral arteriovenous malformations (AVMs). We report the clinical results of selected cerebral AVMs treated with Glubran 2 targeting for curative embolization. Between October 2011 and March 2013, 31 patients with cerebral AVMs were selected for curative embolization with Glubran 2. There were 19 men and 12 women with a mean age of 32 years (range 4–65 years). Initial clinical presentation included hemorrhage in 28 and seizures in three patients. AVM location was frontal in eight patients, parietal in four, occipital in eight temporal in six, cerebellar in two and cerebellar vermis in three patients. Follow-up was performed clinically and with angiography examination at three to six months. Clinical outcomes were evaluated based on the modified Rankin Scale (mRS). A mean of 2.5 (range, 1–12) feeding pedicles were embolized per patient. Complete angiographic obliteration of AVM was achieved in 27 patients. A hemorrhagic complication was observed in one patient, an ischemic complication in one patient and technical complications in four patients. There was no procedure-related disabling neurological deficit or death at discharge. Additional gamma knife radiosurgery was performed in five patients, including one patient with recurrent AVM. All of the patients had favorable clinical outcomes at three to six month follow-up (mRS≤2). The curative embolization technique with Glubran 2 for selected cerebral AVMs achieved a high initial complete obliteration rate with an acceptable complication frequency.

scholarly journals Patency of anterior circulation branch vessels after Pipeline embolization: longer-term results from 82 aneurysm cases

2017 ◽  
Vol 126 (4) ◽  
pp. 1064-1069 ◽  
Author(s):  
Leonardo Rangel-Castilla ◽  
Stephan A. Munich ◽  
Naser Jaleel ◽  
Marshall C. Cress ◽  
Chandan Krishna ◽  
...  
Keyword(s):  
Arterial Occlusion ◽  
Side Branch ◽  
Terminal Branch ◽  
Anterior Choroidal Artery ◽  
Anterior Circulation ◽  
Branch Vessel ◽  
Anterior Choroidal ◽  
Choroidal Artery ◽  
Ophthalmic Arteries

OBJECTIVE The Pipeline Embolization Device (PED) has become increasingly used for the treatment of intracranial aneurysms. Given its high metal surface area coverage, there is concern for the patency of branch vessels that become covered by the device. Limited data exist regarding the patency of branch vessels adjacent to aneurysms that are covered by PEDs. The authors assessed the rate of intracranial internal carotid artery, anterior circulation branch vessel patency following PED placement at their institution. METHODS The authors retrospectively reviewed the records of 82 patients who underwent PED treatment between 2009 and 2014 and in whom the PED was identified to cover branch vessels. Patency of the anterior cerebral, posterior communicating, anterior choroidal, and ophthalmic arteries was evaluated using digital subtraction angiography preoperatively and postoperatively after PED deployment and at longer-term follow-up. RESULTS Of the 127 arterial branches covered by PEDs, there were no immediate postoperative occlusions. At angiographic follow-up (mean 10 months, range 3–34.7 months), arterial side branches were occluded in 13 (15.8%) of 82 aneurysm cases and included 2 anterior cerebral arteries, 8 ophthalmic arteries, and 3 posterior communicating arteries. No cases of anterior choroidal artery occlusion were observed. Patients with branch occlusion did not experience any neurological symptoms. CONCLUSIONS In this large series, the longer-term rate of radiographic side branch arterial occlusion after coverage by a flow diverter was 15.8%. Terminal branch vessels, such as the anterior choroidal artery, remained patent in this series. The authors' series suggests that branch vessel occlusions are clinically silent and should not deter aneurysm treatment with flow diversion.

scholarly journals Patency of the anterior choroidal artery covered with a flow-diverter stent

2015 ◽  
Vol 123 (6) ◽  
pp. 1540-1545 ◽  
Author(s):  
Hiroaki Neki ◽  
Jildaz Caroff ◽  
Pakrit Jittapiromsak ◽  
Nidhal Benachour ◽  
Cristian Mihalea ◽  
...  
Keyword(s):  
Choroid Plexus ◽  
Clinical Symptoms ◽  
Flow Diverter ◽  
Anterior Choroidal Artery ◽  
Parent Vessel ◽  
Flow Diverter Stent ◽  
Anterior Choroidal ◽  
Long Course ◽  
Choroidal Artery

OBJECT The concept of the flow-diverter stent (FDS) is to induce aneurysmal thrombosis while preserving the patency of the parent vessel and any covered branches. In some circumstances, it is impossible to avoid dangerously covering small branches, such as the anterior choroidal artery (AChA), with the stent. In this paper, the authors describe the clinical and angiographic effects of covering the AChA with an FDS. METHODS Between April 2011 and July 2013, 92 patients with intracranial aneurysms were treated with the use of FDSs in the authors’ institution. For 20 consecutive patients (21.7%) retrospectively included in this study, this involved the unavoidable covering of the AChA with a single FDS during endovascular therapy. AChAs feeding the choroid plexus were classified as the long-course group (14 cases), and those not feeding the choroid plexus were classified as the short-course group (6 cases). Clinical symptoms and the angiographic aspect of the AChA were evaluated immediately after stent delivery and during follow-up. Neurological examinations were performed to rule out hemiparesis, hemihypesthesia, hemianopsia, and other cortical signs. RESULTS FDS placement had no immediate effect on AChA blood flow. Data were obtained from 1-month clinical follow-up in all patients and from midterm angiographic follow-up in 17 patients (85.0%), with a mean length of 9.8 ± 5.4 months. No patient in either group complained of transient or permanent symptoms related to an AChA occlusion. In all cases, the AChA remained patent without any flow changes. CONCLUSIONS The results of this study suggest that when impossible to avoid, the AChA may be safely covered with a single FDS during intracranial aneurysm treatment, irrespective of anatomy and anastomoses.

Flow diversion for anterior choroidal artery (AChA) aneurysms: a multi-institutional experience

2017 ◽  
Vol 10 (7) ◽  
pp. 634-637 ◽  
Author(s):  
Visish M Srinivasan ◽  
Michael George Zaki Ghali ◽  
Jacob Cherian ◽  
Maxim Mokin ◽  
Ajit S Puri ◽  
...  
Keyword(s):  
Cerebral Arteries ◽  
Cerebral Aneurysms ◽  
Flow Diversion ◽  
Small Subset ◽  
Collateral Flow ◽  
Anterior Choroidal Artery ◽  
Vessel Patency ◽  
Anterior Choroidal ◽  
Choroidal Artery

BackgroundAnterior choroidal artery (AChA) aneurysms represent a small subset of cerebral aneurysms. The Pipeline Embolization Device (PED) has been successfully applied to various aneurysms of the supraclinoid internal carotid artery (ICA). The treatment of these aneurysms requires special attention due to the eloquent territory supplied by the AChA. We report the largest and first dedicated series of flow diversion treatment of AChA aneurysms.MethodsFour institutional neurointerventional databases were reviewed for cases of intracranial aneurysms treated with PED. Patient and aneurysm data as well as angiographic imaging were reviewed for all cases of AChA aneurysms treated with PED. AChA aneurysms were defined as aneurysms distal to the AChA and proximal to the ICA terminus, with or without the incorporation of the AChA.ResultsEighteen AChA aneurysms were treated during the study period. All aneurysms were successfully treated with a mean follow-up of 19.1 months. The large majority of aneurysms (15/18, 83.3%) were completely obliterated. No patients suffered from intra- or post-procedural complications. A1 stenosis was a common occurrence, seen in 10 of 16 (62.5%) covered anterior cerebral arteries (ACAs), although all were asymptomatic. All AChAs remained patent at last follow-up.ConclusionsThe PED can be used successfully in AChA aneurysms with a good safety and efficacy profile. All AChAs remained patent. Collateral flow networks, especially for the ACA, affect long-term branch vessel patency. Treatment with PED for AChA aneurysms appears to be a reasonable option to consider and should be evaluated in a larger cohort.

Endovascular coil embolization of anterior choroidal artery aneurysms

2009 ◽  
Vol 111 (5) ◽  
pp. 963-969 ◽  
Author(s):  
Hyun-Seung Kang ◽  
Bae Ju Kwon ◽  
O-Ki Kwon ◽  
Cheolkyu Jung ◽  
Jeong Eun Kim ◽  
...  
Keyword(s):  
Coil Embolization ◽  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Thromboembolic Events ◽  
Anterior Choroidal Artery ◽  
Endovascular Coil Embolization ◽  
Anterior Choroidal ◽  
Choroidal Artery

Object Anterior choroidal artery (AChA) aneurysms are difficult to treat, and the clinical outcome of patients is occasionally compromised by ischemic complications after clipping operations. The purpose of this study was to document the outcome and follow-up results of endovascular coil embolization in patients with AChA aneurysms. Methods Between July 1999 and March 2008, 88 patients with 90 AChA aneurysms (31 ruptured and 59 unruptured aneurysms) were treated with endovascular coil embolization in 91 sessions. There were 87 small aneurysms (< 10 mm) and 3 large aneurysms, with a mean aneurysm volume of 60.9 ± 83.3 mm3. Preprocedural oculomotor nerve palsy associated with AChA aneurysms was noted in 8 patients. Efficacy and safety were evaluated based on the degree of initial occlusion, procedure-related complications, patient outcome based on the Glasgow Outcome Scale score, and follow-up results. Results The degree of angiographic occlusion of the aneurysms was complete for 15 aneurysms (17%), near complete for 69 aneurysms (77%) and partial for 6 aneurysms (7%). There were 4 (4.4%) symptomatic procedure-related complications (3 thromboembolic events and 1 procedural hemorrhage). The procedural hemorrhage resulted in death; however, the thromboembolic events only caused transient deficits. A favorable outcome (Glasgow Outcome Scale score of 5 or 4) was achieved in 90% (79 of 88) of the patients at the time of discharge. No patient showed signs of bleeding or rebleeding during the follow-up period (mean 25 months). Major aneurysm recanalization occurred in 2 cases. The AChA aneurysm–associated oculomotor nerve palsy tended to become aggravated transiently after coil embolization and then completely recovered over the course of 2–9 months. Conclusions Coil embolization is a safe and effective treatment modality in cases of AChA aneurysms. Coil embolization enables procedural recognition of arterial compromise and immediate reestablishment of flow, thus contributing to a favorable outcome.

scholarly journals Endovascular Embolization of Distal Anterior Choroidal Artery Aneurysms Associated with Moyamoya Disease

2010 ◽  
Vol 16 (4) ◽  
pp. 433-441 ◽  
Author(s):  
S. Yang ◽  
J.-L. Yu ◽  
H.-L. Wang ◽  
B. Wang ◽  
Q. Luo
Keyword(s):  
Prognostic Factors ◽  
Literature Review ◽  
Moyamoya Disease ◽  
Lateral Ventricle ◽  
Endovascular Embolization ◽  
Parent Artery ◽  
Anterior Choroidal Artery ◽  
Temporal Horn ◽  
Anterior Choroidal ◽  
Choroidal Artery

We evaluated the feasibility of endovascular embolization for the management of distal anterior choroidal artery (AChA) aneurysms associated with moyamoya disease and performed a literature review to summarize their clinical features and treatment. We describe two cases of moyamoya disease-associated distal AChA aneurysms treated by endovascular embolization. In both cases, a good outcome was observed. We performed a MEDLINE (1980–2010) search which identified 13 similar cases. Our analysis of the clinical data from these 15 cases led us to conclude that (i) endovascular embolization is an effective and feasible treatment for distal AChA aneurysms associated with moyamoya disease; (ii) aneurysm location and the preservation of the parent artery are two major prognostic factors for moyamoya disease-associated distal AChA aneurysms subjected to craniotomy or endovascular therapy; (iii) the parent artery should be preserved when the aneurysm is located in the temporal horn of the lateral ventricle, but sacrificed when it is located in the trigone of the lateral ventricle.

Choroidal arteries in the diagnosis of thalamic tumors

1972 ◽  
Vol 36 (3) ◽  
pp. 287-298 ◽  
Author(s):  
M. Theodore Margolis ◽  
Harry B. Hoffman ◽  
Thomas H. Newton
Keyword(s):  
Anterior Choroidal Artery ◽  
Carotid Angiography ◽  
Content Type ◽  
Medial Nucleus ◽  
Lateral Posterior ◽  
Anterior Choroidal ◽  
Choroidal Artery ◽  
Characteristic Manner ◽  
Thalamic Tumors ◽  
Fine Print

✓ Arteriograms of 12 patients with space-occupying lesions involving the thalamus were compared with 100 vertebral and carotid arteriograms reported as normal. It was found that masses that involve the thalamus primarily or secondarily affect the choroidal arteries in a characteristic manner. The most commonly involved vessel is the lateral posterior choroidal artery. The medial posterior choroidal artery may also be affected because of its contribution to the dorsal medial nucleus of the thalamus and its occasional course around the pulvinar. Because the anterior choroidal artery is reciprocal in size to the lateral posterior choroidal artery, the lesion will often be demonstrated on carotid angiography.

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