Balloon-assisted Onyx embolization of cerebral single-channel pial arteriovenous fistulas

2011 ◽  
Vol 7 (6) ◽  
pp. 637-642 ◽  
Author(s):  
C. Benjamin Newman ◽  
Yin C. Hu ◽  
Cameron G. McDougall ◽  
Felipe C. Albuquerque
Keyword(s):  
Treatment Strategy ◽  
Pediatric Patients ◽  
Single Channel ◽  
Vascular Malformations ◽  
High Flow ◽  
Flow Dynamics ◽  
Arteriovenous Fistulas ◽  
Male Patients ◽  
The Brain

Object Pial arteriovenous fistulas (AVFs) of the brain are rare vascular malformations associated with significant risks of hemorrhage and neurological deficit. Depending on their location and high-flow dynamics, these lesions can present treatment challenges for both endovascular and open cerebrovascular surgeons. The authors describe a novel endovascular treatment strategy that was used successfully to treat 2 pediatric patients with a pial AVF, and they discuss the technical nuances specific to their treatment strategy. Methods A single-channel high-flow pial AVF was diagnosed in 2 male patients (6 and 17 years of age). Both patients were treated with endovascular flow arrest using a highly conformable balloon followed by Onyx infusion for definitive closure of the fistula. Results Neither patient suffered a complication as a result of the procedure. At the 6-month follow-up in both cases, the simple discontinuation of blood flow had resulted in durable obliteration of the fistula and stable or improved neurological function. Conclusions Onyx can be delivered successfully into high-flow lesions after flow arrest to allow a minimally invasive and durable treatment for pial AVFs.

Matas test revisited: carotid compression for embolization of high-flow pediatric pial arteriovenous fistulas

2020 ◽  
pp. 1-4
Author(s):  
Zeferino Demartini ◽  
Gelson Luis Koppe ◽  
Bernardo Corrêa de Almeida Teixeira ◽  
Adriano Keijiro ◽  
Alexandre Novicki Francisco ◽  
...  
Keyword(s):  
Single Channel ◽  
High Flow ◽  
Local Circulation ◽  
Distal Embolization ◽  
Embolic Material ◽  
Arteriovenous Fistulas ◽  
Pial Arteriovenous Fistula ◽  
Endovascular Approach ◽  
Matas Test

OBJECTIVECerebral pial arteriovenous fistula (AVF) is a rare vascular malformation and may cause hemorrhage and neurological deficit. The presence of high-flow shunts constitutes a challenge when performing the endovascular technique, due to risk of distal embolization. The authors report a simple maneuver, adapted from the Matas test, that was successfully applied to treat a child with two pial AVFs.METHODSAn 8-year-old boy presented with headache and vomiting due to two single-channel high-flow intracerebral pial AVFs. He was treated with an endovascular approach using brief, gentle compression of the ipsilateral cervical carotid artery. The temporary flow arrest ensured proper placement of the first coil, allowing definitive obliteration of the shunt.RESULTSThere were no complications with the procedure, and the patient recovered uneventfully. Throughout the 9-month follow-up, the patient experienced a stable neurological condition, with both fistulas occluded and improvement of local circulation.CONCLUSIONSThis easy-to-perform maneuver allows precise positioning of embolic material into high-flow shunts to facilitate treatment of pial AVF.

Endovascular embolization of high-grade cerebral dural arteriovenous fistulas - assessment of long-term recurrences

2021 ◽  
pp. 159101992110382
Author(s):  
Alan Mendez-Ruiz ◽  
Waldo R Guerrero ◽  
Viktor Szeder ◽  
Mudassir Farooqui ◽  
Cynthia B Zevallos ◽  
...  
Keyword(s):  
Endovascular Therapy ◽  
Dural Arteriovenous Fistula ◽  
High Flow ◽  
High Grade ◽  
Complete Occlusion ◽  
Arteriovenous Fistulas ◽  
Dural Arteriovenous Fistulas ◽  
Mean Time

Introduction Endovascular therapy has shown to be safe and effective for the treatment of cerebral dural arteriovenous fistulas; however, recurrence after complete occlusion is not uncommon, and the timing of recurrence remains unknown. Methods A retrospective single-center cohort study was conducted from January 2005 to December 2020. Patients with high-grade (≥Borden II–Cognard IIB) dural arteriovenous fistulas treated with endovascular therapy were included in this study. Clinical and angiographic characteristics were collected for hospitalization and at follow-up. Results A total of 51 patients with a median age of 61 years were studied; 57% were female. High-flow symptoms related to the high-flow fistula were the most common presentation (67%), and 24% presented with intracranial hemorrhage. Transverse-sigmoid (26%) and cavernous (26%) sinuses were the most common dural arteriovenous fistula locations. A total of 40 patients (70%) had middle meningeal arterial feeders and 4 (7%) had deep cerebral venous drainage. The mean number of embolization procedures per patient was 1.4. Transarterial access was the most frequent approach (61%). Onyx alone was the most common embolic agent (26%). Complete occlusion rate was achieved in 46 patients (80.1%). Last mean radiographic follow-up time was 26.7 months for all 57 dural arteriovenous fistulas. Dural arteriovenous fistula recurrence after radiographic resolution at last treatment was seen in six cases (6/46, 13.1%). Mean time for recurrence was 15.8 months. Mean time of last clinical follow-up was 46.1 months for the 51 patients (100%). A total of 10 (20%) experienced any procedural complications, among which two (4%) became major thromboembolic events. Conclusion Endovascular therapy is safe and effective for the treatment of high-grade dural arteriovenous fistulas. Given the significant recurrence rate of embolized dural arteriovenous fistulas even after 2 years, long-term angiographic follow-up might be needed.

Time-Resolved Magnetic Resonance Angiography for Follow-Up of Treated Dural and Epidural Spinal Arteriovenous Fistula

2021 ◽  
Author(s):  
Giovanni Giulio Vercelli ◽  
Fabrizio Venturi ◽  
Massimiliano Minardi ◽  
Fabio Cofano ◽  
Francesco Zenga ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Vascular Malformations ◽  
High Sensitivity ◽  
Recurrence Time ◽  
Venous Plexus ◽  
Time Resolved ◽  
Arteriovenous Fistulas ◽  
Spinal Arteriovenous Fistula

Abstract Background Spinal arteriovenous fistulas (AVFs) are uncommon vascular malformations of spinal dural and epidural vessels. Actually digital subtraction angiography (DSA) is the gold standard for diagnosis and follow-up. The aim of this study is to demonstrate the validity of the multiphasic magnetic resonance angiography (MRA) to identify recurrent/residual AVFs or their correct surgical and/or endovascular closure. Methods A retrospective cases series with perimedullary venous plexus congestion due to spinal dural or epidural AVF was performed at our center from April 2014 to September 2019. After 1 month from treatment, the patients were subjected to time-resolved MRA and DSA to demonstrate recurrence or correct closure of AVFs. Results We collected a series of 26 matched time-resolved MRA and DSA in 20 patients who underwent an endovascular and/or surgical procedure. In our series, we reported five cases of recurrence. Time-resolved MRA detected six cases of recurrence, with 100% sensitivity and 95% specificity (p < 0.001). We used DSA as the standard reference. Conclusion Time-resolved MRA is a valid tool in posttreatment follow-up to detect recurrent or residual AVFs. It has high sensitivity and specificity and may replace DSA.

Stereotactic Radiosurgery of Angiographically Occult Vascular Malformations: Indications and Preliminary Experience

Neurosurgery ◽  
1990 ◽  
Vol 27 (6) ◽  
pp. 892-900 ◽  
Author(s):  
Douglas Kondziolka ◽  
L. Dade Lunsford ◽  
Robert J. Coffey ◽  
David J. Bissonette ◽  
John C. Flickinger
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Stereotactic Radiosurgery ◽  
Vascular Malformations ◽  
Neurological Deficits ◽  
Resonance Imaging ◽  
University Of Pittsburgh ◽  
History Of ◽  
The Brain

Abstract Stereotactic radiosurgery has been shown to treat successfully angiographically demonstrated arteriovenous malformations of the brain. Angiographic obliteration has represented cure and eliminated the risk of future hemorrhage. The role of radiosurgery in the treatment of angiographically occult vascular malformations (AOVMs) has been less well defined. In the initial 32 months of operation of the 201-source cobalt-60 gamma knife at the University of Pittsburgh, 24 patients meeting strict criteria for high-risk AOVMs were treated. Radiosurgery was used conservatively; each patient had sustained two or more hemorrhages and had a magnetic resonance imaging-defined AOVM located in a region of the brain where microsurgical removal was judged to pose an excessive risk. Venous angiomas were excluded by performance of high-resolution subtraction angiography in each patient. Fifteen malformations were in the medulla, pons, and/or mesencephalon, and 5 were located in the thalamus or basal ganglia. Follow-up ranged from 4 to 24 months. Nineteen patients either improved or remained clinically stable and did not hemorrhage again during the follow-up interval. One patient suffered another hemorrhage 7 months after radiosurgery. Five patients experienced temporary worsening of pre-existing neurological deficits that suggested delayed radiation injury. Magnetic resonance imaging demonstrated signal changes and edema surrounding the radiosurgical target. Dose-volume guidelines for avoiding complications were constructed. Our initial experience indicates that stereotactic radiosurgery can be performed safely in patients with small, well-circumscribed AOVMs located in deep, critical, or relatively inaccessible cerebral locations. Because cerebral angiography is not useful in following patients with AOVMs, long-term magnetic resonance imaging and clinical studies will be necessary to determine whether the natural history of such lesions is changed by radiosurgery.

The cerebrofacial metameric syndromes: An embryological review and proposal of a novel classification scheme

2021 ◽  
pp. 159101992110449
Author(s):  
Anthony S. Larson ◽  
Waleed Brinjikji ◽  
Timo Krings ◽  
Julie B. Guerin
Keyword(s):  
Cell Migration ◽  
Classification System ◽  
Classification Scheme ◽  
Vascular Malformations ◽  
High Flow ◽  
Low Flow ◽  
Pharyngeal Arches ◽  
Detailed Classification ◽  
Vascular Syndromes ◽  
The Brain

The cerebrofacial metameric syndromes are a group of congenital syndromes that result in vascular malformations throughout specific anatomical distributions of the brain, cranium and face. Multiple reports of patients with high-flow or low-flow vascular malformations following a metameric distribution have supported this idea. There has been much advancement in understanding of segmental organization and cell migration since the concept of metameric vascular syndromes was first proposed. We aim to give an updated review of these embryological considerations and then propose a more detailed classification system for these syndromes, predominately incorporating the contribution of neural crest cells and somitomeres to the pharyngeal arches.

scholarly journals Non increased neuron-specific enolase concentration in cerebrospinal fluid during first febrile seizures and a year follow-up in pediatric patients

1998 ◽  
Vol 56 (3B) ◽  
pp. 540-544 ◽  
Author(s):  
ALBERTO J. DORTA-CONTRERAS ◽  
EDITH TABÍO-VALDÉS ◽  
ALINA TABÍO-VALDÉS ◽  
CARIDAD DELGADO-FERNÁNDEZ ◽  
HANSOTTO REIBER
Keyword(s):  
Cerebrospinal Fluid ◽  
Early Childhood ◽  
Enzyme Assay ◽  
Pediatric Patients ◽  
Neuron Specific Enolase ◽  
Febrile Seizures ◽  
Childhood Studies ◽  
Neurological Problem ◽  
The Brain

Febrile seizures are the commonest acute neurological disorder of early childhood. Studies suggested that febrile seizures are previous acute events from a more serious neurological problem. Due to neuron-specific enolase is generally accepted as a marker for neuropathological processes in the brain, 16 pediatric patients were studied during their first seizures and a year after it. Neuron-specific enolase in cerebrospinal fluid and blood were analysed by an immune enzyme assay. Non pathological neuron-specific enolase values were obtained in both periods in the group of patients. There were no significative differences when paired series statistics test was performed with 95% of confidence. Neuron-specific enolase appears not to be a marker for febrile seizures because its concentration not be increased in cerebrospinal fluid in this group of patients.

Interventional management of high-flow craniofacial vascular malformations: a database analysis and review of the literature

2016 ◽  
Vol 9 (1) ◽  
pp. 92-96 ◽  
Author(s):  
Guilherme Dabus ◽  
Italo Linfante ◽  
James Benenati ◽  
Chad A Perlyn ◽  
Mario Martínez-Galdámez
Keyword(s):  
Vascular Malformations ◽  
Treatment Session ◽  
High Flow ◽  
Institutional Review ◽  
Procedural Complication ◽  
Procedural Complications ◽  
Location Type ◽  
Scalp Lesions ◽  
Symptomatic Control

BackgroundHigh-flow craniofacial vascular malformations are uncommon, locally aggressive lesions that pose a therapeutic challenge.ObjectiveTo report our experience with the treatment of high-flow craniofacial vascular malformations.MethodsAfter institutional review board approval was obtained, the neurointerventional databases of two institutions were retrospectively reviewed for vascular malformations from October 2010 to June 2015. All patients who had been treated for a high-flow craniofacial vascular malformation were included in the analysis. Clinical presentation, location, type, agent and techniques used, procedural complications, and clinical and imaging follow-up were included in the analysis.ResultsEighteen patients (12 female and 6 male) harboring 21 high-flow vascular malformations met the inclusion criteria in our study. All patients were symptomatic. One patient had two separated arteriovenous malformations (AVMs) (one nasal and the other forehead/scalp), and one patient had three separated scalp lesions. One patient with a nasal AVM had capillary malformation-AVM syndrome. Overall, 13 AVM and 8 arteriovenous fistuli were treated in 31 targeted embolization procedures (ranging from 1 procedure to 4 procedures, mean 1.7 procedures). Onyx was the predominant agent used in 25 procedures. In 31 procedures, 1 procedural complication (skin ulceration) occurred. At the end of the last treatment session 14 of the 21 lesions were cured. Symptomatic control was achieved in all cases, with resolution or significant improvement of the symptoms (mean follow-up of 10 months).ConclusionsHigh-flow craniofacial vascular malformations can be successfully managed with interventional techniques.

scholarly journals Classification of Spinal Vascular Malformations

2009 ◽  
Vol 22 (1_suppl) ◽  
pp. 97-106
Author(s):  
T. Krings ◽  
P.L. Lasjaunias ◽  
S. Geibprasert ◽  
F.J. Hans ◽  
A.K. Thron ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Rare Diseases ◽  
Vascular Malformations ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Choice Of Treatment ◽  
Meningeal Arteries ◽  
Brain Avms ◽  
The Brain

Spinal vascular malformations are rare diseases with a wide variety of neurological presentations. Their classification depends on the differentiation of shunting versus non-shunting lesions, the latter being the spinal cord cavernomas. In the shunting lesions, the next step in the proposed classification scheme is related to the feeding artery which can subdivide the dural vascular shunts from the pial vascular malformations: while those shunts that are fed by radiculomeningeal arteries (i.e. the counterparts of meningeal arteries in the brain) constitute the dural arteriovenous fistulas, the shunts that are fed by arteries that would normally supply the spinal cord (i.e. the radiculomedullary and radiculopial arteries) are the pial cord arteriovenous malformations (whose cranial counterparts are the brain AVMs). Depending on the type of transition between artery and vein the latter pial AVMs can be further subdivided into glomerular (plexiforme or nidus-type) AVMs with a network of intervening vessels in between the artery and vein and the fistulous pial AVMs. The last step in the classification then describes whether the type of fistula has a high or a low shunting volume which will differentiate the “Macro-” from the “Micro-”fistulae. The proposed classification is therefore based on a stepwise analysis of the shunt including its arterial anatomy, its nidus-architecture and its flow-volume evaluation. The major advantage of this approach is that it leads to a subclassification with direct implications on the choice of treatment, thereby constituting a simple and practical approach to evaluate these rare diseases.

scholarly journals Descriptive Study of Pediatric Patients with Ileum Stoma at Inpatient Installation of Dr. Soetomo General Hospital Surabaya

2021 ◽  
Vol 12 (1) ◽  
pp. 1
Author(s):  
Farihazqa Hafez Mikala ◽  
Alpha Fardah Athiyyah ◽  
I Gusti Bagus Adria Hariastawa ◽  
I Gusti Made Reza Gunadi Ranuh
Keyword(s):  
Body Weight ◽  
General Hospital ◽  
Medical Records ◽  
Pediatric Patients ◽  
Intestinal Atresia ◽  
Descriptive Study ◽  
Average Weight ◽  
Normal Body Mass Index ◽  
Male Patients

Introduction: Ileostomy is needed as an important part of the management of several congenital disorders of the intestine. One of the indication of ileostomy in children is short bowel syndrome, which is caused by intestinal atresia such as ileal atresia and intussusception. Ileostomy is a surgery procedure which consists of creating holes on abdominal walls to release stool. The objective of this study was to determine the description of pediatric patients who underwent ileostomy in Dr. Soetomo General Hospital Surabaya. Methods: This was a retrospective descriptive study on medical records in the Central Medical Record Department of Pediatrics and General Surgery Dr. Soetomo General Hospital Surabaya from January 2017 to December 2018. Results: There were 26 pediatric patients who underwent ileostomy in Dr. Soetomo General Hospital Surabaya. Samples from male patients consisted of 57.7%, while female patients consisted of 42.3% with the most common age group was neonates with 57.7%, infants 30.8%, and toddlers 11.5%. There were 30.7% patients with 2.0-2.9 kg body weight, 27% with 3.0-3.9 kg body weight, and 42.3% with more than 4 kg body weight. The outcome showed that repair was needed, or the patient was discharged with periodic follow-up after ileostomy. Conclusion: Ileostomy was performed mostly in neonates with average weight within normal body mass index (BMI) and the highest incidence of pediatric patient with ileum stoma was in pediatric patients.

scholarly journals Congenital intrahepatic aorto-portal fistula presenting with cardiac failure

2020 ◽  
Vol 6 (4) ◽  
pp. 20200006
Author(s):  
Adithya Pathanki ◽  
Khalid Sharif ◽  
Ian McCafferty ◽  
Jane Hartley ◽  
Simon McGuirk
Keyword(s):  
Cardiac Failure ◽  
Congenital Heart ◽  
Unusual Case ◽  
Vascular Malformations ◽  
High Flow ◽  
Ductus Venosus ◽  
First Case ◽  
Left And Right ◽  
Portal Veins

Congenital intrahepatic arterio-portal fistulae (cIAPF) are rare, high-flow vascular malformations that usually present with portal hypertension. They almost never cause heart failure, unless there is associated congenital heart disease or the ductus venosus in patent. We present an unusual case of IAPF in an 11-day-old boy, who presented with features of cardiac failure associated with increased N-terminal pro-brain natriuretic peptide (NT pro-BNP). The IAPF arose directly from the aorta, separated from the hepatic artery and divided to separately supply both left and right portal veins. The ductus venosus was occluded. The IAPF was treated with embolization of the aorto-portal fistula, accessed through a direct percutaneous puncture of the fistula. Embolization was associated with an immediate clinical improvement and a rapid and sustained normalization of the NT pro-BNP level. A similar re-presentation was noted and treated with repeat embolization. The child is well on follow-up. To our knowledge, this is the first case of cIAPF, which was presented with cardiac failure when the ductus venosus has closed and has been treated successfully with direct, percutaneous transhepatic embolization of the fistula, twice. Serial clinical follow-up and ultrasonographical examinations have proven to be an effective strategy to detect recurrent fistulae.

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