Development of a de novo arteriovenous malformation after bilateral revascularization surgery in a child with moyamoya disease

2014 ◽  
Vol 13 (6) ◽  
pp. 647-649 ◽  
Author(s):  
Miki Fujimura ◽  
Naoto Kimura ◽  
Masayuki Ezura ◽  
Kuniyasu Niizuma ◽  
Hiroshi Uenohara ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Moyamoya Disease ◽  
Mr Angiography ◽  
De Novo ◽  
Occipital Lobe ◽  
Initial Examination ◽  
Anterior Circulation ◽  
Hemodynamic Compromise ◽  
The Right

The development of a de novo arteriovenous malformation (AVM) in patients with moyamoya disease is extremely rare. A 14-year-old girl developed an AVM in the right occipital lobe during the 4-year postoperative period following successful bilateral revascularization surgeries. She suffered a transient ischemic attack with hemodynamic compromise of the bilateral hemispheres at the age of 10 years. Results of an initial examination by 1.5-T MRI and MR angiography satisfied the diagnostic criteria of moyamoya disease but failed to detect any vascular malformation. Bilateral direct and indirect revascularization surgeries in the anterior circulation relieved her symptoms, and she underwent MRI and MR angiography follow-up every year after surgery. Serial T2-weighted MRI revealed the gradual appearance of flow voids in the right occipital lobe during the follow-up period. Magnetic resonance angiography ultimately indicated the development of an AVM 4 years after these surgeries when catheter angiography confirmed the diagnosis of an AVM in the right occipital lobe. The AVM remained asymptomatic, and the patient remained free of cerebrovascular events during the time she was observed by the authors. Acquired AVM in moyamoya disease is extremely rare, with only 3 pediatric cases including the present case being reported in the literature. The development of a de novo AVM in a postoperative patient with moyamoya disease appears to be unique, and this case may provide insight into the dynamic pathology of AVMs.

scholarly journals Contralateral De Novo Intraosseous Arteriovenous Malformation in a Child with Arteriovenous Malformation of Mandible Treated by Endovascular Embolotherapy

2012 ◽  
Vol 18 (4) ◽  
pp. 484-489 ◽  
Author(s):  
C-H Yeh ◽  
Y-M Wu ◽  
Y-L Chen ◽  
H-F Wong
Keyword(s):  
Arteriovenous Malformation ◽  
De Novo ◽  
Transarterial Embolization ◽  
Subsequent Development ◽  
Cyanoacrylate Glue ◽  
Direct Puncture ◽  
Life Threatening ◽  
Detachable Coils ◽  
The Right

We describe our experience of the development of contralateral de novo intraosseous AVMs in a ten-year-old girl with AVMs of the mandible who underwent endovascular embolotherapy. She initially presented with intermittent oral bleeding. Computed tomography and digital subtraction angiography demonstrated intraosseous AVMs within the right mandible. The AVMs were treated by transosseous direct-puncture and transarterial embolization with Guglielmi detachable coils and n-butyl cyanoacrylate glue. However, de novo intraosseous AVMs developed within the previously healthy contralateral mandible and resulted in dangerous oral bleeding. Therefore, we suggest regular follow-up and prompt retreatment of any residual mandibular AVMs in patients undergoing endovascular or surgical treatment to prevent subsequent development of “secondary” AVMs and life-threatening oral bleeding.

scholarly journals Case of de novo cerebral microbleeds in ischemic-type pediatric moyamoya disease

2021 ◽  
Vol 12 ◽  
pp. 284
Author(s):  
Kohei Inoue ◽  
Akihiko Momozaki ◽  
Takashi Furukawa ◽  
Fumitaka Yoshioka ◽  
Atsushi Ogata ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Pediatric Patients ◽  
De Novo ◽  
Cerebral Microbleeds ◽  
Left Middle Cerebral Artery ◽  
Current Case ◽  
Motor Weakness ◽  
The Right ◽  
Revascularization Surgery

Background: Studies on pediatric patients with moyamoya disease who presented with de novo cerebral microbleeds (CMBs) are extremely rare. Case Description: Herein, we report a 7-year-old boy with moyamoya disease who had de novo CMBs during treatment. He presented with transient left-side motor weakness and was diagnosed with moyamoya disease. He underwent revascularization surgery on the right cerebral hemisphere. Six months after the surgery, he presented with transient right-side motor weakness and MRA revealed progression of stenosis in the left middle cerebral artery. After another 3 months, three de novo CMBs were identified. He underwent revascularization surgery on the left side. The symptom disappeared completely after surgery and no additional de novo CMBs were identified 1 year after surgery. Conclusion: This is the first report on de novo CMBs in pediatric patients. Although the significance of de novo CMBs in pediatric patients is completely unknown, attention should be paid to not only ischemic stroke but also hemorrhagic stroke. Although the short-term course is good in the current case, follow-up period is too short to assess for rebleeding and long-term follow-up is still important. Further, more cases should be collected.

scholarly journals Arteriovenous malformation in association with moyamoya disease

1998 ◽  
Vol 5 (5) ◽  
pp. E8 ◽  
Author(s):  
Toshihiko Nakashima ◽  
Noriyuki Nakayama ◽  
Masahiro Furuichi ◽  
Jouji Kokuzawa ◽  
Takatsugu Murakawa ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Moyamoya Disease ◽  
Cerebral Arteries ◽  
Posterior Part ◽  
Occipital Lobe ◽  
External Carotid ◽  
Cerebral Veins ◽  
Left Frontal Lobe ◽  
Arteriovenous Shunts ◽  
The Right

The authors report two rare cases of arteriovenous malformation (AVM) associated with moyamoya disease. An AVM, supplied by transdural communicating arteries, was located in the right occipital lobe in one patient who presented with ischemia. The second AVM, which was supplied by basal moyamoya vessels, was located in the posterior part of the left frontal lobe in a patient who developed intracerebral hemorrhage that occupied the left basal ganglion. A review of the literature revealed a total of 12 AVMs in 11 patients with moyamoya disease including our cases. All AVMs were cerebral and two were supplied by normal cerebral arteries, whereas six AVMs were supplied by basal moyamoya vessels at the base of the brain and four AVMs were supplied by external carotid arteries through the transdural communicating arteries. Every AVM drained into deep or cortical cerebral veins. These findings suggest that the hyperangiogenic character of moyamoya disease occasionally induces the development of acquired arteriovenous shunts that mimic AVM.

scholarly journals Treatment of aneurysms in patients with moyamoya disease: a 10-year single-center experience

2018 ◽  
Vol 128 (6) ◽  
pp. 1813-1822 ◽  
Author(s):  
Wei Ni ◽  
Hanqiang Jiang ◽  
Bin Xu ◽  
Yu Lei ◽  
Heng Yang ◽  
...  
Keyword(s):  
Moyamoya Disease ◽  
Posterior Circulation ◽  
Cerebral Revascularization ◽  
Endovascular Coiling ◽  
Single Center ◽  
Anterior Circulation ◽  
Main Trunk ◽  
Aneurysm Embolization ◽  
Peripheral Aneurysms

OBJECTIVEMoyamoya disease (MMD) is occasionally accompanied by intracranial aneurysms. The purpose of this study was to delineate the efficacy of the authors’ current surgical strategy in the management of MMD-associated aneurysms of different types.METHODSBetween January 2007 and March 2016, a consecutive cohort of 34 patients with 36 MMD-associated aneurysms was enrolled in this prospective single-center cohort study. The lesions were classified as peripheral (17 aneurysms) or main trunk aneurysms (13 in the anterior circulation and 6 in the posterior circulation). For the peripheral aneurysms, revascularization with or without endovascular treatment was suggested. For the main trunk aneurysms, revascularization alone, revascularization with aneurysm clipping, or revascularization with aneurysm embolization were used, depending on the location of the aneurysms.RESULTSOf the peripheral aneurysms, 4 were treated endovascularly with staged revascularization, and 13 were treated solely with cerebral revascularization. Of the 13 main trunk aneurysms in the anterior circulation, 10 were clipped followed by revascularization, and 3 were coiled followed by staged cerebral revascularization. Of the 6 main trunk aneurysms in the posterior circulation, 4 underwent endovascular coiling and 2 were treated solely with revascularization. One patient died of contralateral intracerebral hemorrhage 6 months after the operation. No other patients suffered recurrent intracranial hemorrhage, cerebral ischemia, or aneurysm rupture. An angiographic follow-up study showed that all the bypass grafts were patent. Complete occlusion was achieved in all 21 aneurysms that were clipped or embolized. Of the remaining 15 aneurysms that were not directly treated, 12 of 13 peripheral aneurysms were obliterated during the follow-up, whereas 1 remained stable; 1 of 2 posterior main trunk aneurysms remained stable, and the other became smaller.CONCLUSIONSThe authors’ current treatment strategy may benefit patients with MMD-associated aneurysms.

scholarly journals Intraarterial Thrombolysis with r-tPA for Treatment of Anterior Circulation Acute Ischemic Stroke

2003 ◽  
Vol 9 (3) ◽  
pp. 273-282
Author(s):  
F. Baltacioğlu ◽  
N. Afşar ◽  
G. Ekinci ◽  
N. Tuncer-Elmaci ◽  
N Çagatay Çimşit ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Recombinant Tissue Plasminogen Activator ◽  
Neurological Status ◽  
Treatment Modalities ◽  
Anterior Circulation ◽  
Main Trunk ◽  
History Of ◽  
The Right

To investigate factors effecting the safety and recanalization efficacy of local intraarterial (IA) recombinant tissue plasminogen activator (r-tPA) delivery in patients with acute ischemic stroke. Eleven patients with anterior circulation acute ischemic stroke were treated. The neurological status of the patients were graded with the Glasgow Coma Scale (GCS) and National Institute of Health Stroke Scale (NIHSS). All patients underwent a computed tomography (CT) examination at admission. In addition four patients had diffusion-weighted and one patient had a perfusion magnetic resonance (MR) examinations. Patients were treated within six hours from stroke onset. Immediate, six hours, and 24 hours follow-up CT examinations were performed in order to evaluate the haemorrhagic complications and the extent of the ischemic area. The Rankin Scale (RS) was used as an outcome measure. Two of the 11 patients had carotid “T” occlusion (CTO), nine had middle cerebral artery (MCA) main trunk occlusion. Four patients had symptomatic haemorrhage with a large haematoma rupturing into the ventricles and subarachnoid space. Of these, three patients died within 24 hours. The remaining seven patients had asymptomatic haematomas that were smaller compared to symptomatic ones, and showed regression in size and density on follow-up CTs. At third month five patients had a good outcome and three patients had a poor outcome. In acute ischemic stroke, local IA thrombolysis is a feasible treatment when you select the right patient. Haemorrhage rate does not seem to exceed that occuring in the natural history of the disease and in other treatment modalities.

Long-term follow-up study after extracranial-intracranial bypass surgery for anterior circulation ischemia in childhood moyamoya disease

1992 ◽  
Vol 77 (1) ◽  
pp. 84-89 ◽  
Author(s):  
Jun Karasawa ◽  
Hajime Touho ◽  
Hideyuki Ohnishi ◽  
Susumu Miyamoto ◽  
Haruhiko Kikuchi
Keyword(s):  
Moyamoya Disease ◽  
Visual Disturbance ◽  
Minor Stroke ◽  
Anterior Circulation ◽  
Content Type ◽  
Long Term Follow Up ◽  
Poor Outcomes ◽  
Borderline Iq ◽  
Major Stroke

✓ Between May, 1974, and March, 1991, 104 patients with moyamoya disease, all under 16 years old at the time of first surgery, underwent superficial temporal-to-middle cerebral artery anastomosis and/or encephalomyosynangiosis. The mean follow-up period was 9.6 years (range 4.8 to 16.0 years). Hemiplegia was the most frequent symptom before the first operation. Transient ischemic attacks (TIA's) were noted in 57 patients and minor stroke with hemiplegia in 44. The most frequent type of cortical dysfunction was aphasia (21 cases). Postoperatively, the incidence of TIA's and/or completed stroke with motor weakness of the extremities was markedly decreased, but visual disturbance progressed and major or minor stroke with visual disturbance was found in two cases. In patients under the age of 3 years, a major stroke prior to surgery resulted in a poor outcome in 36% of cases. Preoperative major stroke in patients between the ages of 3 and 7 years was less frequent, and poor outcomes were seen in 17% of this group. There were no major preoperative strokes in patients with surgery after the age of 7 years, and no poor outcomes were recorded in this group. A major preoperative stroke prior to surgery had adverse impact on the ultimate patient intelligence quotient (IQ) following surgery. All patients operated on after the age of 7 years had a normal or borderline IQ at follow-up examination.

scholarly journals Value of 4D MR Angiography at 3T Compared with DSA for the Follow-Up of Treated Brain Arteriovenous Malformation

2014 ◽  
Vol 35 (10) ◽  
pp. 1903-1909 ◽  
Author(s):  
S. Soize ◽  
F. Bouquigny ◽  
K. Kadziolka ◽  
C. Portefaix ◽  
L. Pierot
Keyword(s):  
Arteriovenous Malformation ◽  
Mr Angiography ◽  
Brain Arteriovenous Malformation

Venous ischemia caused by dural arteriovenous malformation

1994 ◽  
Vol 80 (3) ◽  
pp. 552-555 ◽  
Author(s):  
Akira Kurata ◽  
Yoshio Miyasaka ◽  
Takatomo Yoshida ◽  
Masatake Kunh ◽  
Kenzoh Yada ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Single Photon ◽  
Photon Emission ◽  
Occipital Lobe ◽  
Ct Scans ◽  
Dural Arteriovenous Malformation ◽  
Content Type ◽  
Ischemic Region ◽  
Ischemic Change ◽  
The Right

✓ A case is presented of tentorial dural arteriovenous malformation (AVM) associated with visual hallucinations and quadrant hemianopsia. Computerized tomography (CT) and magnetic resonance imaging showed an ischemic region, mainly affecting the white matter of the right occipital lobe, that was defined as an area of increased blood volume on dynamic CT scans and as a decrease in cerebral blood flow on N-isopropylp-123I-iodoamphetamine single-photon emission CT scans. Angiography demonstrated venous congestion, probably because the retrograde arterial inflow from the dural AVM into the corticomedullary vein was direct and not via the sinuses. The symptoms and radiological findings improved immediately after endovascular treatment. The origin of these symptoms was fully evaluated and confirmed to be a reversible ischemic change caused by disturbance of the volume of venous return over an extensive area.

scholarly journals Case Series on Perforator Aneurysm: Endovascular Stenting—A Safe Strategy

2017 ◽  
Vol 01 (03) ◽  
pp. 179-183 ◽  
Author(s):  
Chandra Sahu ◽  
Ashish Ashpilaya
Keyword(s):  
Case Series ◽  
Treated Group ◽  
Vascular Lesions ◽  
World Federation ◽  
Imaging Data ◽  
Anterior Circulation ◽  
Fisher Grade ◽  
Complete Thrombosis ◽  
The Right

AbstractPerforator aneurysms are rare vascular lesions that are infrequently reported in literature, and because of difficult anatomic approach, their treatment and management pose challenges. Given the rarity of these aneurysms, the natural history and ideal approach to treatment has not been established. The authors retrospectively analyzed six patients, age ranging from 16 to 75 years with ruptured perforator aneurysm, four of posterior circulation and two of anterior circulation including clinical characteristics, imaging data, treatment regimen, and outcome. All but two patients presented with the World Federation of Neurosurgical Societies grades I to III and Fisher grade 2 or 3 subarachnoid hemorrhage, and the other two presented with intracerebral bleed in the right gangliocapsular region. Four patients were managed conservatively whereas two basilar perforator aneurysms were treated with endovascular stent. At the last follow-up, the endovascularly treated group of patients demonstrated complete thrombosis of aneurysm with preservation of perforators, and the conservatively managed group showed spontaneous occlusion in one patient, whereas three were lost to follow-up and ultimate outcome remains unknown. The authors report single-center hospital-based experience in six patients, which adds to the scarce published literature that addresses the limited understanding of the natural course and consolidating safe endovascular management of this entity.

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