Pros, cons, and current indications of open craniotomyversusgamma knife in the treatment of arteriovenous malformations and the role of endovascular embolization

2002 ◽  
Vol 24 (4) ◽  
pp. 347-353 ◽  
Author(s):  
Daniel L. Surdell ◽  
Sumon Bhattacharjee ◽  
Christopher M. Loftus
Keyword(s):  
Arteriovenous Malformations ◽  
Endovascular Embolization

Curing arteriovenous malformations using embolization

2014 ◽  
Vol 37 (3) ◽  
pp. E19 ◽  
Author(s):  
Matthew B. Potts ◽  
Daniel W. Zumofen ◽  
Eytan Raz ◽  
Peter K. Nelson ◽  
Howard A. Riina
Keyword(s):  
Arteriovenous Malformations ◽  
Endovascular Embolization ◽  
Cerebral Arteriovenous Malformations ◽  
Curative Intent ◽  
The Past ◽  
Embolic Agents ◽  
Liquid Embolic ◽  
Diagnostic Angiography ◽  
Endovascular Technology

Endovascular embolization is typically reserved as an adjuvant therapy in the management of cerebral arteriovenous malformations (AVMs), either for preoperative devascularization or preradiosurgical volume reduction. Curative embolization plays a limited role in AVM treatment but several studies have shown that it is possible, especially with later-generation liquid embolic agents. Given the complexity of AVM anatomy and the recent controversies over the role of any intervention in AVM management, it is critical that the cerebrovascular community better define the indications of each treatment modality to provide quality AVM management. In this review, the authors evaluate the role of curative AVM embolization. Important considerations in the feasibility of curative AVM embolization include whether it can be performed reliably and safely, and whether it is a durable cure. Studies over the past 20 years have begun to define the anatomical factors that are amenable to complete endovascular occlusion, including size, feeding artery anatomy, AVM morphology, and endovascular accessibility. More recent studies have shown that highly selected patients with AVMs can be treated with curative intent, leading to occlusion rates as high as 100% of such prospectively identified lesions with minimal morbidity. Advances in endovascular technology and techniques that support the efficacy and safety of curative embolization are discussed, as is the importance of superselective diagnostic angiography. Finally, the durability of curative embolization is analyzed. Overall, while still unproven, endovascular embolization has the potential to be a safe, effective, and durable curative treatment for select AVMs, broadening the armamentarium with which one can treat this disease.

scholarly journals Microsurgical treatment for cerebellomesencephalic fissure arteriovenous malformations after multiple sessions of endovascular treatment

2021 ◽  
Vol 12 ◽  
pp. 214
Author(s):  
Silvio Sarmento Lessa ◽  
Juan Alberto Paz-Archilla ◽  
Bruno Loof Amorim ◽  
Jose Maria Campos Filho ◽  
Christiane Monteiro de Siqueira Campos ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Therapeutic Strategy ◽  
Endovascular Embolization ◽  
Female Adolescent ◽  
Neurological Deficits ◽  
High Incidence ◽  
Microsurgical Resection

Background: Arteriovenous malformations (AVMs) are relatively uncommon congenital vascular anomalies, and only 7–15% of AVMs occur in the posterior fossa. Most posterior fossa AVMs clinically present with hemorrhage and are associated with a high risk of neurological deficits and mortality. These malformations are associated with a high incidence of flow-related aneurysms. Endovascular treatment of infratentorial AVMs is challenging in pediatric patients. Case Description: We describe an 11-year-old female adolescent with cerebellar syndrome [Video 1], who was diagnosed with a cerebellomesencephalic fissure AVM. We observed a sequential increase in the size of the AVM after multiple sessions of endovascular treatment and performed successful microsurgical resection of the lesion. Conclusion: This illustrative video highlights the role of microsurgery as a feasible therapeutic strategy for complete resection of cerebellar AVMs after endovascular embolization.

scholarly journals The Role Of Decompressive Hemnicraniectomies As Damage Control For Ruptured Intracranial Arteriovenous Malformations

2021 ◽  
pp. 101270
Author(s):  
Raphael Bertani ◽  
Stefan W. Koester ◽  
Karl R. Abi-Aad ◽  
Anna R. Kimata ◽  
Kevin L. Ma ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Damage Control ◽  
Intracranial Arteriovenous Malformations

Vascular Reconstruction of a Brachial Artery Aneurysm Proximally to an Arteriovenous Malformation

2019 ◽  
Vol 54 (1) ◽  
pp. 75-79
Author(s):  
Curtis Woodford ◽  
Elizabeth Tai ◽  
Sebastian Mafeld ◽  
Husain A. Al-Mubarak ◽  
Arash Jaberi ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Radial Artery ◽  
Brachial Artery ◽  
Arteriovenous Malformations ◽  
Femoral Vein ◽  
Artery Aneurysm ◽  
Vascular Reconstruction ◽  
Endovascular Embolization ◽  
Antecubital Fossa ◽  
Interposition Graft

Brachial artery aneurysms and arteriovenous malformations (AVM) are limb-threatening vascular anomalies. This patient presented with a bilobed brachial artery aneurysm in the antecubital fossa proximally to an AVM arising from the dorsal interosseous and ulnar arteries that had been treated with endovascular embolization, leaving the hand solely supplied by the radial artery. The aneurysm continued to increase in size and imaging revealed concomitant thrombus. A femoral vein interposition graft was used to repair the aneurysm, and postoperatively, the patient retained full left arm function.

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.

Management of spinal dural arteriovenous malformations

1989 ◽  
Vol 70 (6) ◽  
pp. 832-836 ◽  
Author(s):  
Michael K. Morgan ◽  
W. Richard Marsh
Keyword(s):  
Arteriovenous Malformations ◽  
Primary Treatment ◽  
Endovascular Embolization ◽  
Content Type ◽  
Early Improvement ◽  
Time To Treatment Failure ◽  
Spinal Arteriovenous Malformations ◽  
Progressive Paraparesis ◽  
Dural Avm

✓ Dura-based spinal arteriovenous malformations (AVM's) are being diagnosed with increasing frequency. The optimal management of such lesions remains a topic of discussion. In an effort to guide this discussion, the authors review their experience with 17 cases of spinal dural AVM treated between January, 1984, and July, 1987. All patients presented with a slowly progressive paraparesis. The abnormalities were initially identified on myelography and confirmed by selective spinal angiography. Fourteen patients underwent endovascular embolization as a primary treatment, and a total of 18 embolization procedures were performed. After all but two of these, obliteration was confirmed at angiography. Patients' symptoms improved following 15 or these procedures but early improvement was not sustained in 10 instances; patients were unchanged after two procedures and worse after one. Follow-up angiography was performed at varying intervals after 15 of the 18 procedures, and recanalization of the previously obliterated spinal dural AVM was demonstrated in 13 instances. Eight patients ultimately underwent surgical treatment of their dura-based spinal AVM. No patient suffered deterioration of symptoms following operation. While embolization may allow angiographic obliteration of a spinal dural AVM and early clinical improvement, for the majority of patients these are not sustained. The average time to treatment failure was 5 months. Newer embolization materials will be necessary to effect permanent treatment in many of these patients.

Concurrent decompression and resection versus decompression with delayed resection of acutely ruptured brain arteriovenous malformations

2021 ◽  
pp. 1-8
Author(s):  
Rajeev D. Sen ◽  
Isaac Josh Abecassis ◽  
Jason Barber ◽  
Michael R. Levitt ◽  
Louis J. Kim ◽  
...  
Keyword(s):  
Intracranial Hypertension ◽  
Scale Score ◽  
Arteriovenous Malformations ◽  
Endovascular Embolization ◽  
Surgical Decompression ◽  
Low Grade ◽  
Brain Arteriovenous Malformations ◽  
Significant Difference ◽  
Delayed Group

OBJECTIVE Brain arteriovenous malformations (bAVMs) most commonly present with rupture and intraparenchymal hemorrhage. In rare cases, the hemorrhage is large enough to cause clinical herniation or intractable intracranial hypertension. Patients in these cases require emergent surgical decompression as a life-saving measure. The surgeon must decide whether to perform concurrent or delayed resection of the bAVM. Theoretical benefits to concurrent resection include a favorable operative corridor created by the hematoma, avoiding a second surgery, and more rapid recovery and rehabilitation. The objective of this study was to compare the clinical and surgical outcomes of patients who had undergone concurrent emergent decompression and bAVM resection with those of patients who had undergone delayed bAVM resection. METHODS The authors conducted a 15-year retrospective review of consecutive patients who had undergone microsurgical resection of a ruptured bAVM at their institution. Patients presenting in clinical herniation or with intractable intracranial hypertension were included and grouped according to the timing of bAVM resection: concurrent with decompression (hyperacute group) or separate resection surgery after decompression (delayed group). Demographic and clinical characteristics were recorded. Groups were compared in terms of the primary outcomes of hospital and intensive care unit (ICU) lengths of stay (LOSs). Secondary outcomes included complete obliteration (CO), Glasgow Coma Scale score, and modified Rankin Scale score at discharge and at the most recent follow-up. RESULTS A total of 35/269 reviewed patients met study inclusion criteria; 18 underwent concurrent decompression and resection (hyperacute group) and 17 patients underwent emergent decompression only with later resection of the bAVM (delayed group). Hyperacute and delayed groups differed only in the proportion that underwent preresection endovascular embolization (16.7% vs 76.5%, respectively; p < 0.05). There was no significant difference between the hyperacute and delayed groups in hospital LOS (26.1 vs 33.2 days, respectively; p = 0.93) or ICU LOS (10.6 vs 16.1 days, respectively; p = 0.69). Rates of CO were also comparable (78% vs 88%, respectively; p > 0.99). Medical complications were similar in the two groups (33% hyperacute vs 41% delayed, p > 0.99). Short-term clinical outcomes were better for the delayed group based on mRS score at discharge (4.2 vs 3.2, p < 0.05); however, long-term outcomes were similar between the groups. CONCLUSIONS Ruptured bAVM rarely presents in clinical herniation requiring surgical decompression and hematoma evacuation. Concurrent surgical decompression and resection of a ruptured bAVM can be performed on low-grade lesions without compromising LOS or long-term functional outcome; however, the surgeon may encounter a more challenging surgical environment.

scholarly journals Embolization of Bleeding Pinna Arteriovenous Malformation after Ligation of the External Carotid Artery: A Therapeutic Challenge

2017 ◽  
Vol 01 (03) ◽  
pp. 184-189
Author(s):  
Rahul Kumar ◽  
Ankur Goyal ◽  
Ashu Bhalla ◽  
Sonia Sandip ◽  
Kapil Sikka
Keyword(s):  
Carotid Artery ◽  
Arteriovenous Malformation ◽  
Percutaneous Treatment ◽  
Endovascular Embolization ◽  
External Carotid Artery ◽  
External Carotid ◽  
Resonance Imaging ◽  
Percutaneous Embolization ◽  
History Of

AbstractA 25-year-old patient presented with bleeding of right pinna arteriovenous malformation (AVM). There was history of ipsilateral external carotid artery (ECA) ligation 10 years back. Subsequent investigations (ultrasound, magnetic resonance imaging, digital subtraction angiography) showed recruitment of complex collaterals from the ipsilateral subclavian artery and vertebral artery feeding the recurrent nidus. The patient underwent two sessions of endovascular embolization and one session of percutaneous embolization. We wish to highlight the feasibility of antegrade embolization in such cases via collaterals and role of direct percutaneous treatment.

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