Hyperbaric oxygen therapy in the treatment of malign edema complication after arteriovenous malformation radiosurgery

2019 ◽  
pp. 713-717
Keyword(s):  
Arteriovenous Malformation ◽  
Hyperbaric Oxygen ◽  
Vasogenic Edema ◽  
Mass Effect ◽  
Radiological Examination ◽  
Temporal Region ◽  
Left Frontal Lobe ◽  
Steroid Resistant ◽  
Alternative Treatment Option ◽  
Martin Grade

A 16-year-old female patient with headache was admitted to our hospital. Radiological examination showed a Spetzler- Martin Grade III arteriovenous malformation (AVM) located at the left frontal lobe. Volume-staged stereotactic radiosurgery (SRS) treatment performed in two fractions at three-month intervals and post-procedural period were uneventful. Eight months later the patient was admitted to our hospital with headache, vomiting, right-sided facial palsy and right upper extremity paresthesia. Radiological examination demonstrated severe vasogenic edema in the left centrum semiovale and temporal region. Due to severe and steroid-resistant malign edema, hyperbaric oxygen (HBO2) therapy was performed as an alternative treatment option. Neurological symptoms resolved completely after HBO2. Radiological examination demonstrated serious improvement of brain edema and mass effect.

scholarly journals Navigation-guided transsylvian approach and microsurgical resection of a deep left temporal low-grade arteriovenous malformation

2017 ◽  
Vol 43 (videosuppl1) ◽  
pp. V6
Author(s):  
William T. Couldwell
Keyword(s):  
Arteriovenous Malformation ◽  
Superior Temporal Gyrus ◽  
Adolescent Male ◽  
Low Grade ◽  
Link Type ◽  
Transsylvian Approach ◽  
Grade Ii ◽  
Microsurgical Resection ◽  
Martin Grade

This video demonstrates stereotactic-guided resection of a ruptured diffuse left temporal arteriovenous malformation (AVM) in an adolescent male who presented with headache and speech difficulties. The diffuse nidus of the AVM, 25 mm in size, was located in the posterior superior temporal gyrus, with drainage into the sylvian veins (Spetzler-Martin Grade II). The AVM was located stereotactically, and resection was performed through a small corticectomy. The clot cavity was evacuated. Feeding branches to the AVM were identified during careful dissection, and parent M1 and M2 branches were preserved. The patient recovered well, with no residual speech deficit. Postoperative angiogram demonstrated complete AVM removal.The video can be found here: https://youtu.be/Sttc86H8jCw.

Acute Subdural Hematoma

Neurotrauma ◽  
2019 ◽  
pp. 17-26
Author(s):  
Benjamin McGahan ◽  
Nathaniel Toop ◽  
Varun Shah ◽  
John McGregor
Keyword(s):  
Brain Injury ◽  
Arteriovenous Malformation ◽  
Conservative Management ◽  
Epidural Hematoma ◽  
Mass Effect ◽  
Acute Subdural Hematoma ◽  
Subdural Space ◽  
Cortical Injury ◽  
Subdural Hematomas ◽  
Hemorrhagic Lesion

Acute subdural hematomas are collections of acute blood in the subdural space. They usually present as a result of significant head trauma. They can occur spontaneously in relationship to an underlying hemorrhagic lesion such as tumor, arteriovenous malformation, or aneurysm. They are more likely to be associated with cortical injury than the epidural hematoma. Neurological symptoms on presentation are related to the underlying brain injury and/or mass effect. Acute subdural blood on CT scan is hyperdense, in a crescent shape, along the inner dural surface. Emergent surgical intervention via craniotomy is indicated in patients with at least 10 mm in thickness or at least 5 mm shift, or elevated ICP, or pupillary dilatations suggesting herniation, or progression of deficit based on the Glasgow Coma Score. Conservative management of small acute subdural hematomas may be done in select situations that include proper ICU monitoring for ICP elevations and neurological deteriorations.

Localization and Microsurgical Resection of Left Postcentral Gyrus Spetzler-Martin Grade 3 Arteriovenous Malformation by Intraoperative Neuronavigation and Tracing of Subcortical Draining Vein: 3-Dimensional Operative Video

2019 ◽  
Vol 19 (2) ◽  
pp. E185-E186
Author(s):  
Qazi Zeeshan ◽  
Juan P Carrasco Hernandez ◽  
Laligam N Sekhar
Keyword(s):  
Arteriovenous Malformation ◽  
Blood Clot ◽  
Preoperative Embolization ◽  
Facial Weakness ◽  
Cortical Vein ◽  
3 Dimensional ◽  
Postcentral Gyrus ◽  
Microsurgical Resection ◽  
Martin Grade ◽  
Grade 3

Abstract This 42-yr-old man presented with a history of sudden right-sided facial and right arm weakness and dysarthria. Head computed tomography showed a left frontal-parietal blood clot. An intra-arterial digital subtraction angiography demonstrated a left subcortical postcentral, Spetzler-Martin Grade 3 arteriovenous malformation (AVM) with a diffuse nidus, measuring 2.1 × 1.5 cm, supplied by branches of the left MCA, and draining into a cortical vein and a deep vein, which was going toward the ventricle. Preoperative embolization was not possible.  The patient underwent left frontal-parietal craniotomy with intraoperative motor and sensory mapping. No arterialized veins were visible on the cortical surface. Neuronavigation localized the AVM in the subcortical postcentral gyrus. Through an incision in the postcentral sulcus, microdissection led to a yellowish gliotic plane. The large cortical vein was in the gliotic area and traced to the AVM. Circumferential microdissection was performed around the AVM. It had a very diffuse nidus; the arterial feeders were cauterized and divided, and the superior superficial and inferior deep draining veins were finally occluded, and AVM was removed.  Postoperative angiogram showed total removal of the AVM. At discharge, his right arm weakness had improved (power 5/5), and facial weakness and dysarthria were improving (modified Rankin Scale (mRS) 2). At 1-yr follow-up, facial weakness and dysarthria had improved considerably, and patient returned to work (mRS 1).  This video shows microsurgical resection of an AVM by neuronavigation and tracing of the subcortical draining vein. The technique of cauterizing the perforating arteries after temporary clipping with flow arrest is shown in the video. Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

Clip reconstruction of an 8 cm giant internal carotid artery bifurcation aneurysm: microsurgical technique

2015 ◽  
Vol 38 (videosuppl1) ◽  
pp. Video20
Author(s):  
Ulas Cikla ◽  
Kutluay Uluc ◽  
Mustafa K. Baskaya
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Vasogenic Edema ◽  
Treatment Options ◽  
Superficial Temporal Artery ◽  
Temporal Artery ◽  
Mass Effect ◽  
Carotid Artery Bifurcation ◽  
Bifurcation Aneurysm

Thrombosed giant intracranial aneurysms usually present with symptoms and signs from their mass effect. Although multiple treatment options are available, direct clip reconstruction with thromboendarterectomy remains the gold standard. Here we present a 66-year-old man with seizure, aphasia and hemiparesis. Work-up revealed a giant partially thrombosed aneurysm of the internal carotid artery bifurcation with surrounding vasogenic edema. He underwent clip reconstruction of the aneurysm via a cranio-orbital approach. Although we prepared for bypass with the radial artery and/or the superficial temporal artery, we were able to clip-reconstruct the aneurysm without bypass. The patient improved upon his pre-morbid state after surgery and made an excellent recovery.The video can be found here: http://youtu.be/P_10hRQFuPo.

scholarly journals Cerebral arteriovenous malformation radiosurgery after intracranial hemorrhage: A case report and literature review

2017 ◽  
Vol 70 (7-8) ◽  
pp. 241-244
Author(s):  
Bojan Jelaca ◽  
Tomislav Cigic ◽  
Vladimir Papic ◽  
Mladen Karan ◽  
Jagos Golubovic ◽  
...  
Keyword(s):  
Case Report ◽  
Arteriovenous Malformation ◽  
Gamma Knife ◽  
Intracranial Hemorrhage ◽  
Good Condition ◽  
Gamma Knife Radiosurgery ◽  
Treatment Modalities ◽  
Temporal Region ◽  
Surgical Morbidity

Introduction. Treatment of cerebral arteriovenous malformations is very challenging and controversial in spite of current recommendations. Surgery is recommended in patients with hemorrhagic stroke, but in patients with good neurological status, when symptoms improve rapidly, the risk of surgical morbidity may be much higher than the risk of rebleeding. Case report. We report a case of a patient with an intracranial hemorrhage due to a ruptured arteriovenous malformation located in the right temporal region of the brain. Because of angiographic and anatomical features of the arteriovenous malformation (deep location and deep venous drainage, but also small arteriovenous malformation nidus size), radiosurgery was the preferred treatment modality. The patient was treated conservatively in the acute stage, and the arteriovenous malformation was subsequently completely eradicated with gamma knife radiosurgery. During the 3-year imaging follow-up, no sings of rebleeding were found. Also, angiography demonstrated that the arteriovenous malformation was completely excluded from the cerebral circulation. The patient was in a good condition and presented without neurological deficits or seizures during the follow-up period. Conclusion. All treatment modalities carry a risk of neurological compromise, but gamma knife radiosurgery may be a good option, even in cases with hemorrhagic presentation. It needs to be mentioned that complete obliteration takes approximately 1 to 3 years after the treatment, and in some cases it cannot be obtained.

scholarly journals Microsurgical resection of previously embolized recurrent cerebellopontine angle AVM

2021 ◽  
Vol 4 (1) ◽  
pp. V2
Author(s):  
Ehsan Dowlati ◽  
Kelsi Chesney ◽  
Vikram V. Nayar
Keyword(s):  
Arteriovenous Malformation ◽  
Indocyanine Green ◽  
Endovascular Treatment ◽  
Cerebellopontine Angle ◽  
Indocyanine Green Angiography ◽  
Transverse Sinus ◽  
Grade Ii ◽  
Microsurgical Resection ◽  
Martin Grade

This is the case of a ruptured Spetzler-Martin grade II arteriovenous malformation (AVM) located in the cerebellopontine angle and draining into the transverse sinus. The AVM was initially treated with staged embolization using Onyx (ev3 Neurovascular). However, recurrence was noted and treatment with microsurgical resection was undertaken. The authors present technical nuances of the approach and strategies for microsurgical resection of a previously embolized recurrent AVM with the aid of intraoperative indocyanine green angiography. Follow-up after endovascular treatment is critical, and curative treatment with microsurgical resection can be achieved with low morbidity in such AVMs as demonstrated by this case.The video can be found here: https://youtu.be/LMpz_YTFC0g

scholarly journals Giant Prolactinoma Causing Proptosis and Stroke

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A584-A584
Author(s):  
Joy Wortham ◽  
Brenda Sandoval ◽  
Maureen Koops ◽  
Ramona Granda-Rodriguez ◽  
Jan M Bruder
Keyword(s):  
Prolactin Level ◽  
Vasogenic Edema ◽  
Hormone Replacement ◽  
Proliferation Index ◽  
Left Middle Cerebral Artery ◽  
Left Frontal Lobe ◽  
Cavernous Sinus Invasion ◽  
Giant Prolactinoma ◽  
Clin Neurol ◽  
Giant Prolactinomas

Abstract Background: Although suprasellar and cavernous sinus invasion are common in giant prolactinomas, intra-orbital extension is extremely uncommon [1]. Even less reported are cases of giant prolactinomas causing cerebral ischemia or death. Clinical Case: A 51-year old woman presented to the ED with confusion, right-sided weakness and severe left eye proptosis with loss of vision. Five years prior, she underwent a partial transphenoidal resection for a macroprolactinoma due to acute vision changes with compression of the optic chiasm. Prior to surgery, prolactin level was elevated to 2,106 ng/mL (n 2.4-24.0 ng/mL). Post-operative MRI showed residual 2.7 x 3.1 x 2.6 cm mass. Thereafter she was prescribed cabergoline which she self-discontinued three years later. MRI of the brain at time of presentation demonstrated a 10.1 x 6.4 x 4.3 cm sellar/suprasellar mass extending into the left orbit causing severe proptosis and mass effect on the left frontal lobe, temporal lobe, midbrain, and basilar artery with encasement of the left cavernous internal carotid artery. A recent left striatocapsular infarct due to compression of the left middle cerebral artery was present. Prolactin level was elevated to 16,487 ng/mL. Neurosurgery was consulted and recommended medical management. Free thyroxine level was low and thyroid hormone replacement was started. Although the cosyntropin stimulation test showed an appropriate cortisol level peak of 21.5 mcg/dL, she was given stress dose glucocorticoids. Bromocriptine was initially started and titrated and later changed to cabergoline. Six weeks after discharge, she was readmitted with worsening confusion and seizure activity. On day 2 of admission, she decompensated. New hemorrhage inside the mass with increased vasogenic edema and a midline shift was discovered on a head CT. She underwent emergent craniotomy with surgical debulking of the tumor. Unfortunately, her mental status did not improve post-operatively. She was transitioned to hospice care and died 7 days after surgery. Surgical pathology showed a lactotroph adenoma with markedly elevated Ki67 proliferation index of 20-30%. Conclusion: This case demonstrates an unusually aggressive macroprolactinoma causing severe proptosis, ischemic stroke and death and adds to the very few cases previously reported [2]. References: 1. Karcioglu ZA, Aden LB, Cruz AA, Zaslow L, Saloom RJ. Orbital invasion with prolactinoma: a clinical review of four patients. Ophthalmic Plast Reconstr Surg. 2002 Jan;18(1):64-71. 2. Navarro-Bonnet J, Martínez-Anda JJ, Balderrama-Soto A, Pérez-Reyes SP, Pérez-Neri I, Portocarrero-Ortiz L. Stroke associated with pituitary apoplexy in a giant prolactinoma: a case report. Clin Neurol Neurosurg. 2014 Jan;116:101-3.

scholarly journals ABORDAGEM TERAPEUTICA DE ABSCESSOS CEREBRAIS MÚLTIPLOS DE CAUSA IDIOPÁTICA EM PACIENTE IMUNOCOMPETENTE: RELATO DE CASO.

2018 ◽  
Vol 5 (4) ◽  
pp. 23-27
Author(s):  
Ermilton Barreira Parente Júnior ◽  
Marlon Daniel Gomes Coelho ◽  
Thais Mahassem Cavalcante de Macedo Parente ◽  
Olivia Maria Veloso Coutinho ◽  
Oscar Nunes Alves
Keyword(s):  
Antibiotic Therapy ◽  
Rare Case ◽  
Mass Effect ◽  
Immunocompetent Patient ◽  
Etiologic Agent ◽  
Evolutionary Stage ◽  
Temporal Region ◽  
Empirical Antibiotic Therapy ◽  
Brain Abscesses ◽  
The Right

Introdução: Abscessos cerebrais múltiplos são focos de infecções piogênicas do parênquima cerebral que requerem uma atenção imediata e eficaz para reducão de morbimortalidade. A identificação do agente etiológico e do foco infeccioso normalmente é de grande valia na programação terapêutica. Esse trabalho busca relatar um raro caso de abscessos cerebrais múltiplos em paciente imunocompetente e sem fatores de risco evidentes, e o papel fundamental da antibioticoterapia empírica na resolução do caso. Relato do caso: Paciente, 75 anos, sem evidência de imunossupressão e doenças prévias iniciou quadro de alterações das atividades básicas da vida diária, confusão de tempo e espaço, hipersonia, lentificação da marcha, disartria e dor em pontada na região temporal direita que não cessava ao uso de analgésicos. Em Ressôncia magnética evidenciou-se múltiplos abscessos em região temporal gerando efeito de massa e hipertensão intracraniana. Realizado craniotomias com drenagens de secreções purulentas e culturas do material que não identificaram o agente etiológico. Discussão: A abordagem terapêutica dos abscessos cerebrais ainda não se encontra definida. Em virtude disso, cada caso tem sido conduzido de forma individualizada de acordo com a localização das lesões, seu estágio evolutivo e as condições clínicas do paciente. No caso em questão não indentificou-se a origem dos abscessos e a resolução do quadro foi obtida através das drenagens cirúrgicas em associação a antibioticoterapia empírica. Com os avanços da neuroimagem e da farmacologia, a redução da mortalidade por abscessos cerebrais reduziu para menos de 10%. Porém, a não identificação de um agente etiológico e diversas abordagens neurocirúrgicas podem acarretar em mais comorbidades para o paciente. Apresentamos um raro caso de abcessos cerebrais em paciente imunocompetente sem identificação de organismo agressor e o papel da antibioticoterapia empírica na resolução do caso.   Palavras-chave: abscesso encefálico; imunocompetência; diagnóstico;  terapêutica; antimicrobianos. ABSTRACT Introduction: Multiple brain abscesses are centers of pyogenic cerebral parenchymal infections that require immediate and effective attention to reduce morbidity and mortality. The identification of the etiologic agent and the infectious focus are usually of great value in terms of therapeutic planning. This paper seeks to report a rare case of multiple brain abscesses in an immunocompetent patient with no evident risk factors and the fundamental role that empirical antibiotic therapy plays in the resolution of the case. Case report: A 75-year-old patient with no evidence of immunosuppression and previous illnesses began to experience changes in her basic daily live activities, confusion in time and space, hypersomnia, gait slowing, dysarthria and stabbing pain in the right temporal region of the brain that would not cease even with use of analgesics. Magnetic Resonance revealed multiple abscesses in the temporal region generating mass effect and intracranial hypertension. It was performed craniotomies with drainage of purulent secretions and it was prepared cultures out of the material which resulted in no identification of the etiological agent. Discussion: The therapeutic approach of brain abscesses has not yet been defined. As a result, each case has been conducted in an individualized manner according to the location of the lesions, their evolutionary stage and the patient's clinical conditions. In the case of this report, the abscess’ origin was not identified and the resolution of the condition was obtained through surgical drainage in association with empirical antibiotic therapy. With advances in neuroimaging and pharmacology, reduction in mortality from brain abscesses reduced to less than 10%. However, failure to identify an etiologic agent and several neurosurgical approaches may lead to more comorbidities for the patient. We present a rare case of cerebral abscesses in an immunocompetent patient without identification of an aggressor organism and the importance of empirical antibiotic therapy in the resolution of the case. Keywords: brain abscess; immunocompetence; diagnosis; therapeutics; anti-infective agents.

scholarly journals Disappearance of a Cerebral Arteriovenous Malformation after Partial Endovascular Embolisation

2001 ◽  
Vol 7 (1) ◽  
pp. 41-46
Author(s):  
S. Mangiafico ◽  
M. Cellerini ◽  
G. Villa ◽  
M. Nistri ◽  
F. Ammannati ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Cerebral Arteriovenous Malformation ◽  
Endovascular Embolisation ◽  
Martin Grade ◽  
Grade 3 ◽  
Development And Evolution ◽  
Over Time

The authors report the observation of a patient with a Spetzler-Martin grade 3, symptomatic, sulcal cerebral arteriovenous malformation (cAVM) of the left precuneus that after partial, uncomplicated, endovascular embolisation disappeared at 4, 6 and 12 months follow-up. Discussion focuses on the angioarchitectural remodelling of the cAVM over time according to the latest concepts on AVM development and evolution.

scholarly journals Management of a decompensated acute-on-chronic intracranial venous sinus thrombosis

2019 ◽  
Vol 12 ◽  
pp. 175628641989515 ◽  
Author(s):  
Carmen Serna Candel ◽  
Victoria Hellstern ◽  
Tania Beitlich ◽  
Marta Aguilar Pérez ◽  
Hansjörg Bäzner ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Endovascular Treatment ◽  
Sinus Thrombosis ◽  
Vasogenic Edema ◽  
Factor V Leiden ◽  
Venous Sinus ◽  
Venous Stasis ◽  
Left Frontal Lobe ◽  
Factor V Leiden Mutation ◽  
Venous Sinus Thrombosis

A 34-year-old female patient presented during the 10th week of her second gravidity with headache, nausea and vomiting 2 weeks before admission. Her medical history was remarkable for a heterozygous factor V Leiden mutation, elevated lipoprotein A, and a cerebral venous thrombosis (CVT) after oral contraceptive intake 15 years before. Magnetic resonance imaging (MRI) suggested acute and massive intracranial sinus thrombosis. Despite full-dose anticoagulation, the patient deteriorated clinically and eventually became comatose. Now, MRI/magnetic resonance angiography revealed vasogenic edema of both thalami, of the left frontal lobe, and of the head of the caudate nucleus, with venous stasis and frontal petechial hemorrhage. She was referred for endovascular treatment. Diagnostic angiography confirmed a complete superficial and deep venous sinus occlusion. Endovascular access to the straight and superior sagittal sinus was possible, but neither rheolysis nor balloon angioplasty resulted in recanalization of the venous sinuses. Monitored heparinization was continued and antiaggregation was initiated. The patient remained comatose for another 5 days and MRI showed progress of the cytotoxic edema. On day 6, infusion of eptifibatide at body-weight-adapted dosage was started. The following day, the patient improved and slowly regained consciousness. MRI confirmed regression of the edema. The eptifibatide infusion was continued for a total of 14 days. Thereafter two doses of 180 mg ticagrelor per os (PO) daily were started. The patient remained on acetylsalicylic acid (ASA), ticagrelor, and enoxaparin on an unchanged dosage regimen. She was discharged home 26 days after the endovascular treatment without serious neurological deficit, with the pregnancy intact. At the 30th week of pregnancy the dosage of ASA was reduced to 300 mg once PO daily. Cesarian delivery was carried out at the 38th week of pregnancy. The newborn was completely healthy. Ultima ratio therapeutic options for severe intracranial venous sinus thrombosis refractory to anticoagulation are discussed, with an emphasis on platelet-function inhibition.

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