Characteristics of Brain Arteriovenous Malformations Presenting with Seizures without Acute or Remote Hemorrhage

We report on the predictors of seizure presention in unruptured brain arteriovenous malformations (AVMs). Between 1999 and 2008, 302 consecutive patients with AVMs were referred to our institution for endovascular treatment. Seventy-four patients (24.5%) experienced seizures without hemorrhage before treatment. We tested for statistical associations between angioarchitectural characteristics and seizure presentation. When we compared the 74 patients with seizures without hemorrhage with the 228 patients who did not experience seizures initially (total of 302 patients), male sex, cortical AVM location, AVM size of more than 3 cm, superficial venous drainage and presence of varices in the venous drainage were statistically associated with seizures (P=0.016, P=0.002, P=0.022, P=0.005, and P=0.022, respectively). Posterior fossa and deep locations and coexisting aneurysms were statistically associated with no seizures. The angioarchitectural characteristics of AVM associated with seizure presentation include male sex, cortical AVM location, AVM size of more than 3 cm, superficial venous drainage and presence of varices in the venous drainage.

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Imaging Characteristics and Endovascular Treatment of Brain Arteriovenous Malformations Mainly Fed by the Posterior Cerebral Artery

Frontiers in Neurology ◽

10.3389/fneur.2020.609461 ◽

2021 ◽

Vol 11 ◽

Author(s):

Kun Hou ◽

Chao Li ◽

Han Su ◽

Jinlu Yu

Keyword(s):

Endovascular Treatment ◽

Cerebral Artery ◽

Arteriovenous Malformations ◽

Posterior Cerebral Artery ◽

Postoperative Bleeding ◽

Venous Drainage ◽

Type I ◽

Type Ii ◽

Brain Arteriovenous Malformations ◽

Imaging Characteristics

Background: A BAVM that is mainly supplied by the posterior cerebral artery (PCA) lies deeply in the middle of the bilateral posterior hemispheres. Few studies have investigated the imaging characteristics and endovascular treatment (EVT) of brain arteriovenous malformations (BAVMs) in this area.Methods: A retrospective study was performed for patients who were diagnosed with PCA-BAVMs from January 2015 to December 2019. The PCA-BAVMs were divided into type I and type II according to their feeding arteries. Type I PCA-BAVMs were supplied by the posterior choroidal artery (PchA) from the PCA. They could be further subdivided into type Ia and type Ib. Type II PCA-BAVMs were supplied by the temporal or occipital branch from the PCA. They could also be further subdivided into type IIa and IIb. Targeted embolization of the risk factors was the main aim of EVT.Results: Forty-two patients were identified, with age ranging from 6 to 63 years. Twenty-four cases belonged to type I (57.1%, 24/42), including 6 Ia cases and 18 Ib cases. Eighteen cases belonged to type II (42.9%, 18/42), including 7 IIa cases and 11 IIb cases. Immediate complete or nearly complete embolization was achieved in 17 (40.5%, 17/42) cases. Partial embolization was achieved in 25 (59.5%, 25/42) cases. Two (4.8%, 2/42) patients experienced intraoperative or postoperative bleeding. The GOS scores at discharge were 3, 4, and 5 in 2 (4.8%, 2/42), 2 (4.8%, 2/42), and 38 (90.4%, 38/42) cases, respectively. There was no statistical difference between patients in type I and type II groups regarding age, BAVM rupture, SM grade, immediate extent of obliteration, and prognosis. Deep venous drainage was more common in patients of the type I group (P < 0.001).Conclusions: Our classification of the PCA-BAVMs was based on the segmentation of the PCA, which is a reasonable approach and could guide the strategy of EVT. EVT is a reasonable option for the PCA-BAVMs. The main aim of EVT is to secure the weak structures. A targeted EVT aimed at the ruptured part of the BAVM can reduce the risk of early rebleeding.

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Endovascular Advances for Brain Arteriovenous Malformations

Neurosurgery ◽

10.1227/neu.0000000000000176 ◽

2014 ◽

Vol 74 (suppl_1) ◽

pp. S74-S82 ◽

Cited By ~ 57

Author(s):

R. Webster Crowley ◽

Andrew F. Ducruet ◽

Cameron G. McDougall ◽

Felipe C. Albuquerque

Keyword(s):

Endovascular Treatment ◽

Surgical Resection ◽

Arteriovenous Malformations ◽

Treatment Options ◽

Brain Arteriovenous Malformations ◽

Short Period ◽

Cerebral Avms ◽

Brain Avms ◽

The Brain ◽

The Way

Abstract Arteriovenous malformations (AVMs) of the brain represent unique challenges for treating physicians. Although these lesions have traditionally been treated with surgical resection alone, advancements in endovascular and radiosurgical therapies have greatly expanded the treatment options for patients harboring brain AVMs. Perhaps no subspecialty within neurosurgery has seen as many advancements over a relatively short period of time as the endovascular field. A number of these endovascular innovations have been designed primarily for cerebral AVMs, and even those advancements that are not particular to AVMs have resulted in substantial changes to the way cerebral AVMs are treated. These advancements have enabled the embolization of cerebral AVMs to be performed either as a stand-alone treatment, or in conjunction with surgery or radiosurgery. Perhaps nothing has impacted the treatment of brain AVMs as substantially as the development of liquid embolics, most notably Onyx and n-butyl cyanoacrylate. However, of near-equal impact has been the innovations seen in the catheters that help deliver the liquid embolics to the AVMs. These developments include flow-directed catheters, balloon-tipped catheters, detachable-tipped catheters, and distal access catheters. This article aims to review some of the more substantial advancements in the endovascular treatment of brain AVMs and to discuss the literature surrounding the expanding indications for endovascular treatment of these lesions.

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Surgical Management Of Posterior Fossa Arteriovenous Malformations

Operative Neurosurgery ◽

10.1227/01.neu.0000204641.38419.2d ◽

2006 ◽

Vol 58 (suppl_4) ◽

pp. ONS-189-ONS-201 ◽

Cited By ~ 6

Author(s):

John Sinclair ◽

Michael E. Kelly ◽

Gary K. Steinberg

Keyword(s):

Stereotactic Radiosurgery ◽

Surgical Resection ◽

Posterior Fossa ◽

Arteriovenous Malformations ◽

Cranial Nerves ◽

Venous Drainage ◽

Cerebellar Nuclei ◽

Preoperative Embolization ◽

Frameless Stereotaxy ◽

Microsurgical Resection

Abstract Objective: Arteriovenous malformations (AVMs) involving the cerebellum and brainstem are relatively rare lesions that most often present clinically as a result of a hemorrhagic episode. Although these AVMs were once thought to have a more aggressive clinical course in comparison with supratentorial AVMs, recent autopsy data suggests that there may be little difference in hemorrhage rates between the two locations. Although current management of these lesions often involves preoperative embolization and stereotactic radiosurgery, surgical resection remains the treatment of choice, conferring immediate protection to the patient from the risk of future hemorrhage. Methods: Most symptomatic AVMs that involve the cerebellum and the pial or ependymal surfaces of the brainstem are candidates for surgical resection. Preoperative angiography and magnetic resonance imaging studies are critical to determine suitability for resection and choice of operative exposure. In addition to considering the location of the nidus, arterial supply, and predominant venous drainage, the surgical approach must also be selected with consideration of the small confines of the posterior fossa and eloquence of the brainstem, cranial nerves, and deep cerebellar nuclei. Results: Since the 1980s, progressive advances in preoperative embolization, frameless stereotaxy, and intraoperative electrophysiologic monitoring have significantly improved the number of posterior fossa AVMs amenable to microsurgical resection with minimal morbidity and mortality. Conclusion: Future improvements in endovascular technology and stereotactic radiosurgery will likely continue to increase the number of posterior fossa AVMs that can safely be removed and further improve the clinical outcomes associated with microsurgical resection.

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Posterior Fossa Dural Arteriovenous Fistulas with Subarachnoid Venous Drainage: Outcomes of Endovascular Treatment

American Journal of Neuroradiology ◽

10.3174/ajnr.a6140 ◽

2019 ◽

Vol 40 (8) ◽

pp. 1363-1368 ◽

Cited By ~ 1

Author(s):

L. Détraz ◽

K. Orlov ◽

V. Berestov ◽

V. Borodetsky ◽

A. Rouchaud ◽

...

Keyword(s):

Endovascular Treatment ◽

Posterior Fossa ◽

Venous Drainage ◽

Arteriovenous Fistulas ◽

Dural Arteriovenous Fistulas

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The Endovascular Treatment of Brain Arteriovenous Malformations

Advances and Technical Standards in Neurosurgery ◽

10.1007/978-3-7091-6504-1_4 ◽

1998 ◽

pp. 131-214 ◽

Cited By ~ 163

Author(s):

A. Valavanis ◽

M. G. Yasargil

Keyword(s):

Endovascular Treatment ◽

Arteriovenous Malformations ◽

Brain Arteriovenous Malformations

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Posterior fossa brain arteriovenous malformations

Clinical Neuroradiology ◽

10.1007/s00062-016-0514-3 ◽

2016 ◽

Vol 28 (1) ◽

pp. 17-24 ◽

Cited By ~ 4

Author(s):

Ling-Feng Lai ◽

Jia-Xiang Chen ◽

Kuang Zheng ◽

Xu-Ying He ◽

Xi-Feng Li ◽

...

Keyword(s):

Posterior Fossa ◽

Arteriovenous Malformations ◽

Brain Arteriovenous Malformations

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Endovascular treatment modality of aneurysms coexisting with brain arteriovenous malformations

Turkish Neurosurgery ◽

10.5137/1019-5149.jtn.8230-13.1 ◽

2013 ◽

Author(s):

Yong Sun ◽

Tian Renfu

Keyword(s):

Endovascular Treatment ◽

Treatment Modality ◽

Arteriovenous Malformations ◽

Brain Arteriovenous Malformations

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A supplementary grading scale combining lesion-to-eloquence distance for predicting surgical outcomes of patients with brain arteriovenous malformations

Journal of Neurosurgery ◽

10.3171/2016.10.jns161415 ◽

2018 ◽

Vol 128 (2) ◽

pp. 530-540 ◽

Cited By ~ 9

Author(s):

Yuming Jiao ◽

Fuxin Lin ◽

Jun Wu ◽

Hao Li ◽

Lijun Wang ◽

...

Keyword(s):

Arteriovenous Malformations ◽

Predictive Accuracy ◽

Diffusion Tensor ◽

Preoperative Evaluation ◽

Roc Curves ◽

Venous Drainage ◽

Grading System ◽

Neurological Outcomes ◽

Brain Arteriovenous Malformations ◽

Fiber Tracts

OBJECTIVECase selection for the surgical treatment of brain arteriovenous malformations (BAVMs) remains challenging. This study aimed to construct a predictive grading system combining lesion-to-eloquence distance (LED) for selecting patients with BAVMs for surgery.METHODSBetween September 2012 and September 2015, the authors retrospectively studied 201 consecutive patients with BAVMs. All patients had undergone preoperative functional MRI and diffusion tensor imaging (DTI), followed by resection. Both angioarchitectural factors and LED were analyzed with respect to the change between preoperative and final postoperative modified Rankin Scale (mRS) scores. LED refers to the distance between the lesion and the nearest eloquent area (eloquent cortex or eloquent fiber tracts) measured on preoperative fMRI and DTI. Based on logistic regression analysis, the authors constructed 3 new grading systems. The HDVL grading system includes the independent predictors of mRS change (hemorrhagic presentation, diffuseness, deep venous drainage, and LED). Full Score combines the variables in the Spetzler-Martin (S-M) grading system (nidus size, eloquence of adjacent brain, and venous drainage) and the HDVL. For the third grading system, the fS-M grading system, the authors added information regarding eloquent fiber tracts to the S-M grading system. The area under the receiver operating characteristic (ROC) curves was compared with those of the S-M grading system and the supplementary S-M grading system of Lawton et al.RESULTSLED was significantly correlated with a change in mRS score (p < 0.001). An LED of 4.95 mm was the cutoff point for the worsened mRS score. Hemorrhagic presentation, diffuseness, deep venous drainage, and LED were independent predictors of a change in mRS score. Predictive accuracy was highest for the HDVL grading system (area under the ROC curve 0.82), followed by the Full Score grading system (0.80), the fS-M grading system (0.79), the supplementary S-M grading system (0.76), and least for the S-M grading system (0.71). Predictive accuracy of the HDVL grading system was significantly better than that of the Spetzler-Martin grade (p = 0.040).CONCLUSIONSLED was a significant predictor for the preoperative risk evaluation for surgery. The HDVL system was a good predictor of neurological outcomes after BAVM surgery. Adding the consideration of the involvement of eloquent fiber tracts to preoperative evaluation can effectively improve its predictive accuracy.

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