scholarly journals Spontaneous regression of a thrombosed cerebral arteriovenous malformation in a patient with a prothrombotic state associated with multiple myeloma: A case report and literature review

2021 ◽  
Vol 12 ◽  
pp. 521
Author(s):  
José A. Arenas-Ruiz ◽  
Nickjail Hernández-Álvarez ◽  
Juan P. Navarro-Garcia de Llano ◽  
Aurelio Ponce-Ayala ◽  
Edgar Nathal
Keyword(s):  
Multiple Myeloma ◽  
Arteriovenous Malformations ◽  
Spontaneous Regression ◽  
Cerebral Arteriovenous Malformation ◽  
Hypercoagulable State ◽  
Prothrombotic State ◽  
Cerebral Arteriovenous Malformations ◽  
Brain Vasculature ◽  
The Relationship ◽  
The Brain

Background: Cerebral arteriovenous malformations (AVMs) are pathologic communications between veins and arteries of the brain vasculature. Its spontaneous regression is rare, and many factors have been described in the effort to explain this phenomenon, including a hypercoagulable state. Case Description: We present the case of a spontaneous unruptured AVM regression in a patient where thrombosis of the malformation was found, probably due to a prothrombotic state associated with multiple myeloma (MM). Conclusion: We aim to contribute to the study of this rare phenomenon, presenting the relationship between a hypercoagulable state caused by MM and the spontaneous AVM regression that has not been previously reported.

Acute Effect of the Nd:YAG Laser on the Cerebral Arteriovenous Malformation: A Histological Study

Neurosurgery ◽  
1989 ◽  
Vol 24 (3) ◽  
pp. 328-333 ◽  
Author(s):  
Mario Zuccarello ◽  
Thaddeus I. Mandybur ◽  
John M. Tew ◽  
William D. Tobler
Keyword(s):  
Nd:Yag Laser ◽  
Arteriovenous Malformations ◽  
Histological Study ◽  
Acute Effect ◽  
Cerebral Arteriovenous Malformation ◽  
Neurological Deficits ◽  
Cerebral Arteriovenous Malformations ◽  
Laser Technique ◽  
Histological Evidence ◽  
The Brain

Abstract The acute effect of Nd:YAG laser beam on cerebral arteriovenous malformations (AVMs) was examined. Histological examination of the specimens after treatment with the Nd:YAG laser revealed that the most prominent effect of the laser was shrinkage of the collagen of the vessels of the AVM, which led to laser-induced narrowing of blood vessels. The brain tissue confined to the resected AVM did not contain any histological evidence of acute damage. The resection of 10 cases of AVMs was safely accomplished with no morbidity or increased neurological deficits attributable to the laser technique.

Advances in Radiosurgery for Arteriovenous Malformations of the Brain

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S50-S59 ◽  
Author(s):  
Benjamin A. Rubin ◽  
Andrew Brunswick ◽  
Howard Riina ◽  
Douglas Kondziolka
Keyword(s):  
Natural History ◽  
Stereotactic Radiosurgery ◽  
Endovascular Therapy ◽  
Arteriovenous Malformations ◽  
Morbidity And Mortality ◽  
Cerebral Arteriovenous Malformations ◽  
History Of ◽  
The Brain ◽  
Management Algorithms

Abstract Arteriovenous malformations of the brain are a considerable source of morbidity and mortality for patients who harbor them. Although our understanding of this disease has improved, it remains in evolution. Advances in our ability to treat these malformations and the modes by which we address them have also improved substantially. However, the variety of patient clinical and disease scenarios often leads us into challenging and complex management algorithms as we balance the risks of treatment against the natural history of the disease. The goal of this article is to provide a focused review of the natural history of cerebral arteriovenous malformations, to examine the role of stereotactic radiosurgery, to discuss the role of endovascular therapy as it relates to stereotactic radiosurgery, and to look toward future advances.

Retrograde flow in the distal aortic arch and proximal descending aorta—a clue to presence of a major cerebral arteriovenous malformation

1993 ◽  
Vol 3 (2) ◽  
pp. 161-163 ◽  
Author(s):  
Andrew M. Davis ◽  
Samuel Menahem
Keyword(s):  
Early Diagnosis ◽  
Arteriovenous Malformation ◽  
Cardiac Failure ◽  
Arteriovenous Malformations ◽  
Cerebral Arteriovenous Malformation ◽  
Cranial Ultrasound ◽  
Retrograde Flow ◽  
Cerebral Arteriovenous Malformations ◽  
Descending Aorta ◽  
Satisfactory Outcome

SummaryTwo neonates are described presenting in severe cardiac failure within a few hours of birth. Echocardiography and the demonstration by color-coded Doppler of retrograde diastolic flow in the proximal descending aorta suggested the presence of large cerebral arteriovenous malformations. Such lesions were demonstrated by cranial ultrasound. The early diagnosis permitted early intervention, albeit with less than satisfactory outcome.

Unruptured Cerebral Arteriovenous Malformations Presenting with Intracranial Hypertension

Neurosurgery ◽  
1988 ◽  
Vol 23 (4) ◽  
pp. 484-490 ◽  
Author(s):  
Daniel L. Barrow
Keyword(s):  
Intracranial Hypertension ◽  
Arteriovenous Malformations ◽  
Perfusion Pressure ◽  
Pseudotumor Cerebri ◽  
Surgical Removal ◽  
Cerebral Arteriovenous Malformations ◽  
Normal Perfusion Pressure Breakthrough ◽  
The Relationship

Abstract Two cases of unruptured pial arteriovenous malformations (AVMs) presenting with intracranial hypertension and papilledema are reported. In the absence of previous hemorrhage or associated hydrocephalus, such a manifestation of pial AVMs is quite unusual. Both patients experienced prompt and sustained resolution of papilledema after surgical removal of the malformation. One case was complicated by the normal perfusion pressure breakthrough phenomenon postoperatively. The pathophysiology of intracranial hypertension associated with unruptured pial AVMs and the relationship to pseudotumor cerebri are discussed.

scholarly journals Anaesthesia for Closed Embolisation of Cerebral Arteriovenous Malformations

1988 ◽  
Vol 16 (3) ◽  
pp. 318-323 ◽  
Author(s):  
B. J. O'Mahony ◽  
S. N. C. Bolsin
Keyword(s):  
Arteriovenous Malformation ◽  
Glyceryl Trinitrate ◽  
Sodium Nitroprusside ◽  
Arteriovenous Malformations ◽  
Anaesthetic Management ◽  
Cerebral Arteriovenous Malformation ◽  
Vascular Network ◽  
Arterial Hypotension ◽  
Cerebral Arteriovenous Malformations ◽  
Neurological Assessment

Cerebral arteriovenous malformation embolisation is a therapeutic, neuroradiological procedure involving injection of bucrylate glue into the nidus of the A V malformation to obliterate the abnormal vascular network. These procedures may involve significant risks, are often long and thereby necessitate the need for some form of sedation and for adequate monitoring of the cerebral, cardiovascular and respiratory systems. The anaesthetic management of a series of twenty patients undergoing embolisation of a cerebral arteriovenous malformation is outlined, seven general and nineteen neurolept anaesthetics being administered. Neurolept anaesthesia is the preferred technique as neurological assessment during the procedure is possible and complications may be diagnosed immediately. Systemic arterial hypotension may facilitate the embolisation process and various agents, including glyceryl trinitrate and sodium nitroprusside, have been employed for this purpose.

Effectiveness and Pitfall of Embolization of Cerebral Arteriovenous Malformations

1999 ◽  
Vol 5 (1_suppl) ◽  
pp. 151-156 ◽  
Author(s):  
S. Miyachi ◽  
M. Negoro ◽  
T. Okamoto ◽  
O. Suzuki ◽  
J. Yoshida
Keyword(s):  
High Risk ◽  
Functional Imaging ◽  
Brain Function ◽  
Arteriovenous Malformations ◽  
High Flow ◽  
Surgical Removal ◽  
Cerebral Arteriovenous Malformations ◽  
Total Occlusion ◽  
Embolic Materials ◽  
The Relationship

We studied the course of perisurgical complications of 66 AVMs and discussed the approapriate precautions. Of 66 patients with AVMs, 14 underwent postembolization surgical removal, and 43 underwent radiosurgery. Four patients were cured with total occlusion of their AVM by embolization alone. 48 patients achieved a more than 70% occlusion of the nidus. We observed 12 complications including 3 permanent and 9 temporary. Four complications occurred immediately after the embolization due to overembolization or thromboembolism, and 7 were observed several hours later which might have been caused by retrograde thrombosis or a chemical reaction to the glue. While presurgical embolization deep-seated feeders must be embolized along with fistulous or high-flow feeders, 4 cases of 2nd embolization following radiosurgery showed that meningeal feeders developed or recanalized in cases embolized with absorbable particles. Thus, preradiosurgically, fistulous and meningeal feeders should be treated, and the nidus must be packed with embolic materials with no risk of recanalization. Successful nidus packing performed in 10 AVMs yielded a further nidus reduction before radiosurgery. The intranidal aneurysms which pose a high risk of rebleeding were also embolized. In order to avoid complications in the embolization of AVM, the angioarchitecture, hemodynamics and the relationship to brain function should be well recognized by preoperative functional imaging and superselective angiograms, and adequate embolic materials should be properly injected. As an embolization strategy, the priority of the target feeders should depend on the treatment to follow, and aggressive embolization of risky feeders or causing abrupt hemodynamic change should be avoided.

The Case Against Staged Operative Resection of Cerebral Arteriovenous Malformations

Neurosurgery ◽  
1989 ◽  
Vol 25 (3) ◽  
pp. 429-436 ◽  
Author(s):  
Michael K. Morgan ◽  
Thoralf M. Sundt
Keyword(s):  
Arteriovenous Malformations ◽  
Time Course ◽  
Cerebral Arteriovenous Malformation ◽  
Subtotal Resection ◽  
Brain Swelling ◽  
Cerebral Arteriovenous Malformations ◽  
Surgical Ablation ◽  
Collateral Vessels ◽  
Risk Of Hemorrhage ◽  
Theoretical Considerations

Abstract Three cases of large cerebral arteriovenous fistulae are presented in which surgical ablation was complicated by brain swelling from hyperperfusion breakthrough believed to be caused by acute intraoperative hypoperfusion superimposed on chronic preoperative hypoperfusion. On the basis of these cases, experimental data, and theoretical considerations, we seriously question the wisdom of using staged surgical resection of cerebral arteriovenous malformation to prevent complications related to alterations in cerebral hemodynamics. The reasons for this concern are: the repeated occurrence of acute-on-chronic hypoperfusion during staged resection; a lack of understanding of the time course for the correction of a disordered autoregulation; risk of hemorrhage between the initial and final resection; difficulty in assessing and substantiating flow reduction after subtotal resection; the rapidity of collateralization; the divergence of flow from large, readily accessible feeding arteries to deep penetrating vessels; and attenuation of the wall thickness in collateral vessels as a consequence of increased flow.

Cerebral arteriovenous malformations

1984 ◽  
Vol 60 (1) ◽  
pp. 14-22 ◽  
Author(s):  
Alfred J. Luessenhop ◽  
Louis Rosa
Keyword(s):  
Arteriovenous Malformations ◽  
Neurological Dysfunction ◽  
Cerebral Arteriovenous Malformations ◽  
Natural Risk ◽  
Surgical Risk ◽  
Content Type ◽  
Mortality And Morbidity ◽  
The Brain ◽  
Fine Print

✓ To address the problems of surgical risk versus natural risk associated with cerebral arteriovenous malformations (AVM's), and the role of the intravascular operative approach, the authors have assessed a 20-year experience with 450 patients. Results of direct surgery in 90 patients indicate that for the smaller AVM's (Grades I and II), mortality and morbidity rates are lower than a reasonably projected natural risk. Hence, these patients are candidates for surgery in most instances. However, for more extensive AVM's (Grades III and IV), consideration of anticipated future years of exposure to natural risk and the location of the AVM in the brain are necessary for determining operability. In general, neither seizures nor incipient focal neurological dysfunction alone are indications for surgery, and the risks of disability or death from hemorrhage after the fifth decade of life are probably less than the surgical risks by present operative techniques. Considering the usual age of patients at the time of diagnosis, it is estimated that surgical risk is currently less than the natural risk for about 65% to 70% of all AVM patients. The categories of AVM's in which the angiographic effectiveness of the intravascular approach is the greatest correspond to the same categories of AVM's that can be surgically removed with low risk. The intravascular approach is most useful for management of large AVM's causing progressive neurological dysfunction or as a preliminary step to surgery in selected cases in which access to major feeding arteries is difficult. The authors believe that the future of the intravascular approach should be directed toward transforming large inoperable AVM's into operable ones, but that the overall capability for this with acceptable risk is uncertain at present.

Angioarchitecture Predicting Hemorrhage in Cerebral Arteriovenous Malformations

1999 ◽  
Vol 5 (1_suppl) ◽  
pp. 157-160 ◽  
Author(s):  
S. Hirai ◽  
S. Mine ◽  
E. Kobayashi ◽  
I. Yamakami ◽  
A. Yamaura
Keyword(s):  
Retrospective Study ◽  
Subarachnoid Hemorrhage ◽  
Conservative Treatment ◽  
Arteriovenous Malformations ◽  
Spontaneous Regression ◽  
Venous Drainage ◽  
Cerebral Arteriovenous Malformations ◽  
Aneurysmal Dilatation ◽  
Treatment Comparison ◽  
Hemorrhagic Events

To find out lesions responsible for hemorrhage in arteriovenous malformations (AVMs), a retrospective study of angioarchitecture around the nidus was conducted in 27 patients who underwent conservative treatment. Comparison of angiograms revealed disappearance of an intranidal aneurysmal dilatation after the hemorrhagic events in two cases. The hematomas were adjacent to the dilatation, and no subarachnoid hemorrhage was evident. Obstruction of venous drainage, noticed in a case of spontaneous regression of AVM, was not demonstrated in the cases of hemorrhage. The intranidal aneurysmal dilatation is likely to have caused the hemorrhage in our cases. Careful endavascular embolization using proper materials should be indicated for an intranidal aneurysmal dilatation to prevent subsequent hemorrhage.

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