Contralateral Transfalcial Approach for Arteriovenous Malformations Located Adjacent to the Interhemispheric Fissure.

2001 ◽  
Vol 29 (5) ◽  
pp. 321-327
Author(s):  
Yutaka KONNO ◽  
Masahiro OINUMA ◽  
Sonomi SATO ◽  
Mitsuo SATO ◽  
Kyouichi SUZUKI ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Interhemispheric Fissure

Parafalcine and midline arteriovenous malformations: surgical strategy, techniques, and outcomes

2011 ◽  
Vol 114 (4) ◽  
pp. 984-993 ◽  
Author(s):  
Yong Bae Kim ◽  
William L. Young ◽  
Michael T. Lawton
Keyword(s):  
Arteriovenous Malformations ◽  
Cerebral Arteries ◽  
Middle Zone ◽  
Surgical Strategies ◽  
Neurological Condition ◽  
Sagittal Sinus ◽  
Feeding Vessels ◽  
Interhemispheric Fissure ◽  
Regional Factors

Object Parafalcine arteriovenous malformations (AVMs) have a midline plane in common, but differ in their location (anterior, middle, or posterior) and depth (superficial or deep). Surgical management varies with AVM location and depth in terms of patient position, head position, craniotomy, and surgical approach. This study examined surgical strategies, patient outcomes, and regional factors influencing results. Methods Patients with AVMs located on the medial surface of the cerebral hemisphere were identified retrospectively from a consecutive, single-neurosurgeon series that is registered prospectively as part of the UCSF Brain Arteriovenous Malformation Study Project. During a 12-year period, 443 patients with AVMs were treated surgically. Of these 443 patients, 132 (30%) had parafalcine AVMs, which were distributed in zones as follows: superficial-anterior, 25 (18.9%); superficial-middle, 26 (19.7%); superficial-posterior, 39 (29.5%); deep-anterior, 25 (18.9%); deep-posterior, 17 (12.9%). Five different surgical strategies were used depending on AVM zone. Results Complete AVM resection was achieved in 123 (93.2%) of 132 patients. Overall, neurological condition improved in 74 patients (56.1%) and remained unchanged in 41 patients (31.1%). Neurological condition deteriorated in 12 patients (9.1%), and 5 patients (3.8%) died. Patients with AVMs in the superficial-middle zone had the highest rate of neurological deterioration (26.9%). Conclusions Parafalcine AVMs lie on a midline surface that, when exposed with a bilateral craniotomy across the superior sagittal sinus and a wide opening of the interhemispheric fissure, makes them superficial. However, unlike convexity AVMs, which are approached perpendicularly, parafalcine AVMs are approached tangentially. Gravity retraction is useful with deeply located AVMs (those in the deep-anterior and deep-posterior zones), because it widens the interhemispheric fissure and accesses deep arterial feeding vessels from the anterior and posterior cerebral arteries. Surgical risks were increased in the superficial-middle zone, which is likely explained by the proximity of sensorimotor cortex. The authors' regional classification of parafalcine AVMs may serve as a guide to surgical planning.

Contralateral Anterior Interhemispheric Approach to Medial Frontal Arteriovenous Malformations: Surgical Technique and Results

2017 ◽  
Vol 13 (4) ◽  
pp. 413-420 ◽  
Author(s):  
Ahmad Hafez ◽  
Kunal P. Raygor ◽  
Michael T. Lawton
Keyword(s):  
Arteriovenous Malformations ◽  
Angle Of Attack ◽  
Lateral Margin ◽  
Safe Alternative ◽  
Neurological Outcomes ◽  
Interhemispheric Approach ◽  
Anterior Interhemispheric Approach ◽  
Interhemispheric Fissure ◽  
Radiographic Data

Abstract BACKGROUND: Medial frontal arteriovenous malformations (AVMs) require opening the interhemispheric fissure and are traditionally accessed through an ipsilateral anterior interhemispheric approach (IAIA). The contralateral anterior interhemispheric approach (CAIA) flips the positioning with the midline still positioned horizontally for gravity retraction, but with the AVM on the upside and the approach from the contralateral, dependent side. OBJECTIVE: To determine whether the perpendicular angle of attack associated with the IAIA converts to a more favorable parallel angle of attack with the CAIA. METHODS: The CAIA was used in 6 patients with medial frontal AVMs. Patients and AVM characteristics, as well as pre- and postoperative clinical and radiographic data, were reviewed retrospectively. RESULTS: Four patients presented with unruptured AVMs, with 5 AVMs in the dominant, left hemisphere. The lateral margin was off-midline in all cases, and average nidus size was 2.3 cm. All AVMs were resected completely, as confirmed by postoperative catheter angiography. All patients had good neurological outcomes, with either stable or improved modified Rankin Scores at last follow-up. CONCLUSIONS: This study demonstrates that the CAIA is a safe alternative to the IAIA for medial frontal AVMs that extend 2 cm or more off-midline into the deep frontal white matter. The CAIA aligns the axis of the AVM nidus parallel to the exposure trajectory, brings its margins in view for circumferential dissection, allows gravity to deliver the nidus into the interhemispheric fissure, and facilitates exposure of the lateral margin for the final dissection, all without resecting or retracting adjacent normal cortex.

Transarterial embolization of peripheral arteriovenous malformations with ethylenevinyl alcohol copolymer - feasibility, technical outcomes, and clinical outcomes

VASA ◽  
2016 ◽  
Vol 45 (6) ◽  
pp. 497-504 ◽  
Author(s):  
Tom De Beule ◽  
Jan Vranckx ◽  
Peter Verhamme ◽  
Veerle Labarque ◽  
Marie-Anne Morren ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Arteriovenous Malformations ◽  
Clinical Success ◽  
Transarterial Embolization ◽  
Recurrent Bleeding ◽  
Complete Disappearance ◽  
Ethylene Vinyl Alcohol ◽  
Initial Symptoms

Abstract. Background: The technical and clinical outcomes of catheter-directed embolization for peripheral arteriovenous malformations (AVM) using Onyx® (ethylene-vinyl alcohol copolymer) are not well documented. The purpose of this study was to retrospectively assess the safety, technical outcomes and clinical outcomes of catheter-directed Onyx® embolisation for the treatment of symptomatic peripheral AVMs. Patients and methods: Demographics, (pre-)interventional clinical and radiological data were assessed. Follow-up was based on hospital medical records and telephone calls to the patients’ general practitioners. Radiological success was defined as complete angiographic eradication of the peripheral AVM nidus. Clinical success was defined as major clinical improvement or complete disappearance of the initial symptoms. Results: 25 procedures were performed in 22 patients. The principal indications for treatment were pain (n = 10), limb swelling (n = 6), recurrent bleeding (n = 2), tinnitus (n = 3), and exertional dyspnoea (n = 1). Complete radiological success was obtained in eight patients (36 %); near-complete eradication of the nidus was achieved in the remaining 14 patients. Adjunctive embolic agents were used in nine patients (41 %). Clinical success was observed in 18 patients (82%). Major complications were reported in two patients (9 %). During follow-up, seven patients (32 %) presented with symptom recurrence, which required additional therapy in three patients. Conclusions: Catheter-directed embolisation of peripheral AVMs with Onyx® resulted in major clinical improvement or complete disappearance of symptoms in the vast majority of patients, although complete angiographic exclusion of the AVMs occurred in only a minority of patients.

Bevacizumab efficacy in treatment of brain radiation necrosis

2019 ◽  
Vol 1 (10) ◽  
pp. 15-21
Author(s):  
O. V. Absalyamova ◽  
G. L. Kobiakov ◽  
S. L. Gutorov ◽  
E. R. Vetlova ◽  
S. V. Zolotova ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Vascular Endothelial Growth Factor ◽  
Arteriovenous Malformations ◽  
Radiation Necrosis ◽  
Critical Role ◽  
Common Adverse Effect ◽  
Vascular Endothelial ◽  
Brain Radiation Necrosis ◽  
Endothelial Growth Factor ◽  
Brain Radiation

Radiation therapy (RT) plays an important role in treatment of primary and metastatic CNS tumors and some non-neopiastic conditions (arteriovenous malformations, trigeminal neuralgia). Radiation necrosis (RN) is a common adverse effect of RT. Until recently steroid therapy was used as a main treatment regimen for RN. Mechanisms of RN development are not clear; however, it was shown that vascular endothelial growth factor (VEGF) plays a critical role in its formation. A number of surveys showed efficacy of bevacizumab as an anti-VEGF agent in treatment of RN. Radiation necrosis pathogenesis, diagnostics and treatment are summarized in this review.

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