Obliteration of a metameric spinal arteriovenous malformation (Cobb syndrome) using combined endovascular embolization and surgical excision

2012 ◽  
Vol 10 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Clemens M. Schirmer ◽  
Steven W. Hwang ◽  
Ron I. Riesenburger ◽  
In Sup Choi ◽  
Carlos A. David
Keyword(s):  
Arteriovenous Malformation ◽  
Vascular Malformation ◽  
Surgical Excision ◽  
Endovascular Embolization ◽  
Neurological Function ◽  
High Morbidity ◽  
Partial Recovery ◽  
Spinal Vascular Malformation ◽  
Spinal Arteriovenous Malformation

Cobb syndrome represents the concurrent findings of a metameric spinal vascular malformation and a cutaneous vascular malformation within several dermatomes of each other. This rare entity engenders many difficult decisions with respect to appropriate therapeutic management. Historically, surgical excision carried a high morbidity, and conservative management without intervention was preferred. More recently, several cases of endovascular embolization have been reported with good success. The authors describe the case of a 17-year-old boy who presented with a right gluteal angioma and was found to have a spinal arteriovenous malformation. Multiple embolizations failed to prevent neurological deterioration, and the patient eventually became wheelchair dependent. Surgical excision of the malformation led to partial recovery of neurological function, and at the latest follow-up, 52 months postoperatively, the patient was able to ambulate independently. This case demonstrates the successful treatment of a patient with Cobb syndrome with surgical excision after multiple refractory embolizations. A multidisciplinary approach, which balances the patient's current neurological function against the risks and potential gains from any interventional and surgical procedure, is recommended.

scholarly journals Pulmonary arteriovenous malformation (PAVM) embolization: prediction of angiographically-confirmed recanalization according to PAVM Diameter changes on CT

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Jihoon Hong ◽  
Sang Yub Lee ◽  
Jung Guen Cha ◽  
Jae-Kwang Lim ◽  
Jongmin Park ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Case Series ◽  
Pulmonary Angiography ◽  
Endovascular Embolization ◽  
Pulmonary Arteriovenous Malformation ◽  
Conventional Angiography ◽  
Receiver Operating Characteristic Curves ◽  
Vein Diameter ◽  
Diameter Reduction

Abstract Background To assess pulmonary arteriovenous malformation (PAVM) recanalization after embolization based on PAVM diameter changes on computed tomography (CT), with pulmonary angiography used as a gold standard. Methods A retrospective review was done of patients from 2008 to 2019 with a PAVM treated with endovascular embolization. The treatment outcome was determined by conventional angiography. Follow-up pulmonary angiography was performed when recanalization was suspected on CT, or embolization of all lesions in multiple PAVM patients could not be completed in a single session. Patients who had no preprocedural or follow-up CT were excluded. Draining vein, feeding artery, and venous sac diameter were measured on CT, and diameter reduction rates were compared with the widely-used, binary 70 % criteria. Results Forty-one patients with 114 PAVMs were treated during the study period. Eight patients with 50 PAVMs met the inclusion criteria. Mean vein, artery, and venous sac diameter reduction rates were as follows: 59.2 ± 9.3 %, 47.5 ± 10.6 %, and 62.6 ± 13.2 %, respectively, in the occluded group and 5.4 ± 19.5 %, 11.3 ± 17.7 %, and 26.8 ± 14.2 %, respectively, in the recanalized group. The area under the receiver operating characteristic curves for PAVM recanalization for the draining vein was 1.00, showing a better result than the artery (0.97) and sac (0.99). Patients showed > 42 % draining vein diameter reduction in the occluded group and < 32 % in the recanalized group. The widely-used 70 % criteria showed low specificity for predicting recanalization (draining vein, 7.3 %; venous sac, 41.7 %) but 100 % sensitivity for both the draining vein and venous sac. Conclusions The widely-used 70 % binary criteria showed limited performance in predicting outcomes in this angiographically-confirmed case series. Further investigations are warranted to establish a strategy for detecting recanalization after PAVM embolization.

Successful excision of a juvenile-type spinal arteriovenous malformation following intraoperative embolization

1991 ◽  
Vol 75 (4) ◽  
pp. 647-651 ◽  
Author(s):  
Hajime Touho ◽  
Jun Karasawa ◽  
Hisashi Shishido ◽  
Keisuke Yamada ◽  
Keiji Shibamoto
Keyword(s):  
Arteriovenous Malformation ◽  
Surgical Excision ◽  
Cervicothoracic Junction ◽  
Content Type ◽  
Spinal Arteriovenous Malformation ◽  
Large Size ◽  
Juvenile Type ◽  
Rapid Flow ◽  
History Of ◽  
Progressive Paraparesis

✓ The case of a 57-year-old woman with a 14-year history of progressive paraparesis is presented. Selective spinal angiography revealed a juvenile-type spinal arteriovenous malformation (AVM) with a typical large size and rapid flow. The AVM was located primarily in the retromedullary space at the cervicothoracic junction. The AVM was successfully obliterated by intraoperative embolization using isobutyl-2-cyanoacrylate and surgical excision.

scholarly journals Early description of synchronous double spinal vascular malformations by Łucja Frey in 1928

2016 ◽  
Vol 25 (2) ◽  
pp. 271-278 ◽  
Author(s):  
Philippe Gailloud
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformation ◽  
Vascular Malformation ◽  
Vascular Malformations ◽  
Current Understanding ◽  
Complex Case ◽  
Spinal Arteriovenous Malformation ◽  
Spinal Vascular Malformations ◽  
Early Description ◽  
Auriculotemporal Nerve

The Polish neurologist Łucja Frey (1889–1942) is principally remembered for her description of the auriculotemporal nerve (or Frey's) syndrome. She also reported a complex case of spinal cord vascular malformation in 1928, which included one of the earliest accurate anatomopathological depictions of a spinal arteriovenous malformation as well as the first known observation of double synchronous spinal cord vascular malformation. An abbreviated translation of Frey's report is followed by a discussion of the place occupied by her contribution in the development of our current understanding of spinovascular disorders.

scholarly journals Surgical feed ligation performed in 22 year old female with scalp arteriovenous malformation

2019 ◽  
Vol 7 (7) ◽  
pp. 2829
Author(s):  
Nyoman Gde Trizka Santhiadi ◽  
I. Nyoman Semadi
Keyword(s):  
Arteriovenous Malformation ◽  
Superficial Temporal Artery ◽  
Vascular Anatomy ◽  
Major Complication ◽  
Surgical Excision ◽  
Temporal Artery ◽  
Endovascular Embolization ◽  
Pulsatile Mass ◽  
History Of ◽  
Feeding Vessel

Scalp arteriovenous malformation (AVM) are rare conditions that usually need surgical treatment. Its management is difficult because of its high shunt flow, complex vascular anatomy, and possible cosmetic complication. The etiology of scalp AVM may be spontaneous or traumatic. This vascular lesion present as scalp lump or a mass, grotesque, pulsatile mass with a propensity to massive haemorrhage. Various treatment option that have been adopted to treat these lesions include surgical excision, ligation of feeding vessel, trans arterial and transvenous embolization, injection of sclerosant into the nidus and electro thrombosis. A 22-years-old-female referred to cardiothoracic division with a 10 years history of a large fronto-parietal pulsatile reddish soft mass, progressively increasing in size, measuring about 15x6x2 cm, ulcerated area; without any symptoms and history of trauma. Three-dimensional CT angiography demonstrated a mass that was completely within the scalp and prominent vascular that was completely within the scalp and was not associated with bone or periosteum. The feeding arteries were originated from angular artery, supratrochlear artery, left and right superficial temporal artery. Surgical excision and ligation of feeding vessel was performed without complication. With pre-operative appropriate surgical planning, scalp AVM can be excised safely without any major complication. Though some cases may be treated with percutaneous or endovascular embolization, surgery remains the treatment of choice. In the event of scalp ulceration and haemorrhage, total excision is the only option.

Endovascular embolization of a muscular symptomatic arteriovenous malformation with Glubran 2 acrylic glue

Vascular ◽  
2014 ◽  
Vol 23 (4) ◽  
pp. 432-435
Author(s):  
Enrique M San Norberto ◽  
José A Brizuela ◽  
Álvaro Revilla ◽  
James H Taylor ◽  
Carlos Vaquero
Keyword(s):  
Arteriovenous Malformation ◽  
Vastus Lateralis ◽  
Transcatheter Embolization ◽  
Endovascular Embolization ◽  
Deep Fascia ◽  
Vastus Lateralis Muscle ◽  
Clinical Complications ◽  
Glubran 2 ◽  
Acrylic Glue

Objective Few cases of muscle arteriovenous malformations have been reported in literature to date. Case report We report the case of a 32-year-old man presenting a muscle arteriovenous malformation involving the vastus lateralis muscle with recurrent episodes of pain. The patient was treated by transcatheter embolization with Glubran 2 acrylic glue. There were no periprocedural or subsequent clinical complications, the glue resulted in successful selective occlusion and the patient showed resolution of symptoms at the six-months follow-up. Conclusions Endovascular therapy has been shown to be beneficial in patients with high surgical risks and is the treatment of choice for arteriovenous malformation lesions that extend beyond the deep fascia and involve muscle, tendon, and bone. Glubran 2 constitutes a useful tool to attempt embolization of the muscle arteriovenous malformation nidus, with easier handling and promising results.

Sinus skeletonization: a treatment for dural arteriovenous malformation of the tentorial apex

1996 ◽  
Vol 84 (3) ◽  
pp. 514-517 ◽  
Author(s):  
César P. Lucas ◽  
Evandro de Oliveira ◽  
Helder Tedeschi ◽  
Mario Siqueira ◽  
Mario Lourenzi ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Arteriovenous Malformation ◽  
Endovascular Embolization ◽  
Dural Arteriovenous Malformation ◽  
Content Type ◽  
Suboccipital Craniotomy ◽  
First Case ◽  
Transverse Sinuses ◽  
Fine Print

✓ Two cases of dural arteriovenous malformation of the tentorial apex are presented. Both were treated surgically by means of a sinus skeletonization technique. The operative technique included a combined bioccipital and median suboccipital craniotomy in which the posterior third of the superior sagittal and the straight and bilateral transverse sinuses were skeletonized by incising the falx and the tentorium along the sinuses. Endovascular embolization was used prior to the surgical approach in one case. Clinical and angiographic cure was achieved in both patients, with a follow up of 4 years in the first case and 1 year in the second one. The surgical technique is described in detail.

Surgical and Endovascular Management of Arteriovenous Malformation: Case Series from a Single Center

Vascular ◽  
2007 ◽  
Vol 15 (3) ◽  
pp. 134-140 ◽  
Author(s):  
Mohamed A. Elsharawy ◽  
Khaled M. Moghazy
Keyword(s):  
Arteriovenous Malformation ◽  
Case Series ◽  
Surgical Excision ◽  
Preoperative Embolization ◽  
Conventional Angiography ◽  
Ethanol Sclerotherapy ◽  
Superselective Embolization ◽  
Endovascular Approach ◽  
A Prospective Study

Management of arteriovenous malformation (AVM) remains a major challenge to vascular surgeons. A multidisciplinary approach was introduced in our hospital to manage these cases from October 2003 to date. This is a report of our experience in their management. A prospective study was done on all patients with symptomatic AVM admitted to our unit between October 2003 and May 2006. All patients had preoperative duplex scanning and magnetic resonance imaging with or without conventional angiography. A multidisciplinary team assessed and treated these cases according to the type of malformation. Thirty-two cases were included in this study, with a mean follow-up of 18.3 months. Of these, 20 cases were predominantly venous and treated with surgical excision ( n = 14) or ethanol sclerotherapy ( n = 6). Twelve cases were predominantly arterial or arteriovenous shunting; 10 were treated with preoperative embolization followed by surgical excision and the remaining 2 with superselective embolization alone. The overall complication rate was high (31%). However, all were minor and settled down conservatively. No recurrence was observed in the early follow-up period. Management of AVM by a surgical and endovascular approach can deliver excellent results, with acceptable morbidity and no recurrence in the early follow-up period.

Surgical Dissection of a Perimedullary Fistula of Conus Medullaris With Long-Term Follow-Up: 2-Dimensional Operative Video

2018 ◽  
Vol 17 (2) ◽  
pp. E59-E59 ◽  
Author(s):  
Thomas J Sorenson ◽  
Giuseppe Lanzino
Keyword(s):  
Surgical Excision ◽  
Vascular Supply ◽  
Conus Medullaris ◽  
Endovascular Embolization ◽  
Neurological Deficits ◽  
Vascular Lesions ◽  
Complete Obliteration ◽  
Long Term Follow Up ◽  
Clinical And Radiological Outcome

Abstract Perimedullary fistulae of the spinal cord are rare vascular lesions that can present with different clinical patterns: hemorrhage, progressive myelopathy due to arterial steal and/or venous congestion, or symptoms due to compression of neural structures by engorged vessels. Treatment consists of surgical excision, endovascular embolization, or a combination of the two. If complete obliteration of the nidus exposes the patient to undue risk of permanent neurological deficits, incomplete obliteration with reduction of the vascular supply is a reasonable compromise to improve clinical symptomatology. Partial devascularization may also alter the natural history by decreasing the risk of further growth and bleeding. In this video we illustrate the case of a patient with a perimedullary fistula of the conus treated with surgical disconnection of the main fistulous component. Partial devascularization resulted in resolution of MRI signal changes and symptoms with documented good clinical and radiological outcome and progressive regression of the residual nidus over six years of follow-up.

Surgical Excision of Cerebral Arteriovenous Malformations: Late Results

Neurosurgery ◽  
1990 ◽  
Vol 26 (4) ◽  
pp. 570-578 ◽  
Author(s):  
Roberto C. Heros ◽  
Kazuyoshi Korosue ◽  
Paula M. Diebold
Keyword(s):  
Arteriovenous Malformation ◽  
Arteriovenous Malformations ◽  
Surgical Excision ◽  
Late Results ◽  
Neurological Deficits ◽  
Clinical Event ◽  
Complete Excision ◽  
Late Morbidity ◽  
History Of

Abstract A follow-up study of 153 consecutive patients who underwent complete excision of an angiographically visualized intracerebral arteriovenous malformation was conducted. The follow-up period ranged from 0.5 to 10.6 years, with a mean of 3.8 years. The presenting clinical event was hemorrhage in about one-half of the patients and seizure in about one-third. There was a marked tendency for postoperative neurological deficits to improve with time, so that whereas the immediate postoperative rate of serious morbidity was 24.2%, only 7.8% of the patients were found to have serious morbidity at follow-up. An additional 3 patients had died. one of an unrelated carcinoma, making the mortality related to arteriovenous malformation 1.3%. The classification of Spetzler and Martin (43) was used retrospectively; the percentages of Grade I (easiest) through Grade V (most difficult) lesions were 7.8%, 22.9%, 28.8%, 26.8%, and 13.8%, respectively. The early result was well correlated to grade, with good or excellent results in 100%, 94.3%, 88.6%, 61%, and 28.6% of the patients in Grades I through V, respectively. At follow-up, 98.7% of the patients with arteriovenous malformations of Grades I, II, and III were in good or excellent condition. The late morbidity and mortality rates for the patients in Grades IV and V were 12.2% and 38.4%, respectively. Of the patients who did not have seizures before surgery, 8.2% had only one or two seizures during the immediate postoperative period, and 7.1% had late seizures that were well controlled with medication in all. Of the patients who had seizures before surgery, over half were either cured or greatly improved with respect to the seizures. In 32.7% there was no change in the frequency of the seizures, and in 12.7% the seizures were more frequent after surgery. There was no history of either proven or suspected intracranial hemorrhage in any of the patients during the entire follow-up period, which in the aggregate totalled 556.3 years.

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