scholarly journals Endovascular transvenous cure for ruptured brain arteriovenous malformations in complex cases with high Spetzler-Martin grades

2015 ◽  
Vol 122 (5) ◽  
pp. 1229-1238 ◽  
Author(s):  
Christina Iosif ◽  
Georges A. C. Mendes ◽  
Suzana Saleme ◽  
Sanita Ponomarjova ◽  
Eduardo Pedrolo Silveira ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Clinical Status ◽  
Surgical Techniques ◽  
Venous Drainage ◽  
Endovascular Embolization ◽  
Modified Rankin Scale ◽  
Transvenous Embolization ◽  
Scale Scores ◽  
Therapeutic Decision Making ◽  
Brain Avms

OBJECT Ruptured cerebral arteriovenous malformations (AVMs) with deep localization and high Spetzler-Martin grades are associated with considerable challenges regarding nidus eradication treatment. The authors report their experience with curative endovascular transvenous embolization in a series of patients harboring “untreatable” lesions. METHODS Between January 2008 and June 2013, a transvenous endovascular embolization protocol was implemented at the authors' institution for consecutive patients with ruptured brain AVMs that were considered incurable by classic endovascular and surgical techniques. Therapeutic decision making was based on Spetzler-Martin grades, AVM location, type of venous drainage, and angioarchitectural evaluation. Complete exclusion of the nidus was the objective of treatment. RESULTS Twenty patients (10 male and 10 female, mean age 36.7 ± 17.7 years) were included. Initial Spetzler-Martin grades were III–V for 90.0% of the patients. The lesions were deeply seated in 80% and in eloquent locations in 90% of cases. The preprocedural modified Rankin Scale score was 0–2 for 12 of the 20 patients (60.0%), 3 for 2 patients (10.0%), and 4 for 6 patients (30.0%). The postprocedural clinical status was unchanged for all patients. The procedure was technically feasible in all cases. Procedure-related mortality was 0%. Ninety percent of the patients were independent in their everyday lives (modified Rankin Scale Scores 0–2) at the 6-month follow-up. In all cases but one (95%) the embolization was curative, confirmed by selective DSA at 6 months and 18 months postintervention. CONCLUSIONS Single-session endovascular transvenous embolization seems to be a safe and effective curative treatment for patients harboring complex brain AVMs with high Spetzler-Martin grade.

Overview of the current concepts in the management of arteriovenous malformations of the brain

2020 ◽  
Vol 96 (1134) ◽  
pp. 212-220 ◽  
Author(s):  
AKA Unnithan
Keyword(s):  
Arteriovenous Malformations ◽  
Treatment Options ◽  
Descriptive Analysis ◽  
Randomised Trial ◽  
Surgical Techniques ◽  
Venous Drainage ◽  
Interventional Therapy ◽  
Brain Avms ◽  
Endothelial Growth Factor ◽  
The Brain

BackgroundThere is a lack of consensus in the management of arteriovenous malformations (AVMs) of the brain since ARUBA (A Randomised trial of Unruptured Brain Arteriovenous malformations) trial showed that medical management is superior to interventional therapy in patients with unruptured brain AVMs. The treatment of brain AVM is associated with significant morbidity.Objectives and methodsA review was done to determine the behaviour of brain AVMs and analyse the risks and benefits of the available treatment options. A search was done in the literature for studies on brain AVMs. Descriptive analysis was also done.ResultsThe angiogenic factors such as vascular endothelial growth factor and inflammatory cytokines are involved in the growth of AVMs. Proteinases such as matrix metalloproteinase-9 contribute to the weakening and rupture of the nidus. The risk factors for haemorrhage are prior haemorrhage, deep and infratentorial AVM location, exclusive deep venous drainage and associated aneurysms. The advancements in operating microscope and surgical techniques have facilitated microsurgery. Stereotactic radiosurgery causes progressive vessel obliteration over 2–3 years. Endovascular embolisation can be done prior to microsurgery or radiosurgery and for palliation.ConclusionsSpetzler-Martin grades I and II have low surgical risks. The AVMs located in the cerebellum, subarachnoid cisterns and pial surfaces of the brainstem can be treated surgically. Radiosurgery is preferable for deep-seated AVMs. A combination of microsurgery, embolisation and radiosurgery is recommended for deep-seated and Spetzler-Martin grade III AVMs. Observation is recommended for grades IV and V.

scholarly journals Complication Analysis of 469 Brain Arteriovenous Malformations Treated with N-Butyl Cyanoacrylate

2005 ◽  
Vol 11 (2) ◽  
pp. 141-148 ◽  
Author(s):  
T. L. Li ◽  
B. Fang ◽  
X. Y. He ◽  
C. Z. Duan ◽  
Q. J. Wang ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Endovascular Procedures ◽  
Endovascular Embolization ◽  
Neurological Deficits ◽  
Embolization Therapy ◽  
Brain Arteriovenous Malformations ◽  
Ischemic Complications ◽  
Brain Avms ◽  
Special Strategy ◽  
Low Rate

We independently assessed the frequency, severity and determinants of neurological deficits after endovascular embolization with NBCA of brain arteriovenous malformations (BAVMs) to have a better basis for making treatment decisions. All the charts of 469 BAVMs patients who underwent embolization with NBCA were reviewed. We analyzed the complications and their relation to angiographic features. The 469 patients were treated with 1108 endovascular procedures. Each met one to eight times, average 2.3 times. Eleven patients showed treatment-related complications, including four haemorrhagic and seven ischemic complications. Of these 11 cases, two died, two had persistent disabling deficits, and another seven suffered transient neurological deficits. Our finding suggests a low rate of disabling treatment complications for embolization of brain AVMs with NBCA in this center. The management of AVM patients who have high risk of embolization therapy should be treated by special strategy.

Double Arterial Catheterization Technique for Embolization of Brain Arteriovenous Malformations With Onyx

Neurosurgery ◽  
2012 ◽  
Vol 72 (1) ◽  
pp. 92-98 ◽  
Author(s):  
Leonardo Renieri ◽  
Arturo Consoli ◽  
Giulia Scarpini ◽  
Giulia Grazzini ◽  
Sergio Nappini ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Medium Size ◽  
Endovascular Techniques ◽  
Complete Occlusion ◽  
Arterial Catheterization ◽  
Catheterization Technique ◽  
Occlusion Rate ◽  
Brain Avms ◽  
Lower Morbidity

Abstract BACKGROUND: Arteriovenous malformation (AVM) treatment is multidisciplinary, and the patient may undergo embolization, neurosurgery, or radiosurgery combined. Great improvement in endovascular techniques was provided by the introduction of Onyx with different kinds of approach. OBJECTIVE: To evaluate the efficacy and the safety of Onyx embolization of brain AVMs with the double arterial catheterization technique (DACT). METHODS: This was a retrospective study. From January 2006 until June 2011, 61 AVMs eligible for the DACT were treated. Forty-one of the 61 AVMs were treated with single arterial catheterization technique and 20 of 61 with DACT; patient age and Spetzler-Martin AVM grade were similar in the 2 groups. RESULTS: In the DACT group, we obtained complete occlusion of the nidus in all small AVMs, whereas in the single arterial catheterization technique group, we obtained complete occlusion in only 1 of the 36% of the cases. Among the medium-size AVMs, there were no significant differences in the 2 groups, but we performed fewer procedures per patient when we used the DACT (1.4 vs 2.2). In the DACT group, we observed fewer hemorrhagic complications (3.4% vs 12.5% per procedure) and lower morbidity (5% vs 7% per patient) and mortality (0% vs 2.4%) rates. CONCLUSION: The DACT in multifeeder AVMs may lead to a higher occlusion rate of the nidus for small AVMs and reduce the number of procedures, ensuring a higher standard of safety because of the possibility of managing the progression of Onyx into venous drainage.

Management of perisylvian arteriovenous malformations: a retrospective institutional case series and review of the literature

2014 ◽  
Vol 37 (3) ◽  
pp. E13
Author(s):  
Aqueel H. Pabaney ◽  
Kevin A. Reinard ◽  
Lara W. Massie ◽  
Padmaja K. Naidu ◽  
Yedathore S. Mohan ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Multidisciplinary Treatment ◽  
Case Series ◽  
Therapeutic Modality ◽  
Institutional Review ◽  
Scale Scores ◽  
Henry Ford ◽  
Grade Ii ◽  
Martin Grade ◽  
Brain Avms

Object Sylvian arteriovenous malformations (sAVMs) are challenging lesions of the central nervous system. The natural history of these unique lesions as well as clinical outcomes following treatment of sAVMs has been limited to case series owing to the rarity of these lesions. The authors present their experience with sAVMs and review the literature. Methods In accordance with the Henry Ford Institutional Review Board, medical records of patients with sAVMs treated from 2000 to 2012 were reviewed. Clinical data were retrospectively collected to calculate pre- and posttreatment modified Rankin Scale scores for all patients. Results The authors identified 15 patients with sAVMs who received treatment. Of these, 12 were female and 3 were male, and the average age at presentation was 39.6 ± 12.94 years (± SD). Two patients (13.3%) had Spetzler-Martin Grade I lesions, 6 patients (40%) had Grade II lesions, 5 patients (33.3%) had Grade III lesions, and another 2 (13.3%) harbored Grade IV arteriovenous malformations (AVMs). According to the Sugita classification, 6 patients (40%) had medial lesions, 6 (40%) had lateral lesions, 2 (13.3%) had deep lesions, and 1 patient (6.67%) had a pure sAVM. Eight patients (53.3%) underwent stereotactic radiosurgery while 7 patients (46.7%) had microsurgical resection; 1 patient underwent surgical extirpation after incomplete response following radiosurgery. After treatment, 9 patients were unchanged from pretreatment (60%), 3 patients worsened, and 2 patients had improved functional outcome (20% and 13.3%, respectively). The authors’ literature search yielded 348 patients with sAVMs, most of them harboring Spetzler-Martin Grade II and III lesions. Approximately 98% of the patients underwent resection with excellent outcomes. Conclusions While the ideal choice of therapeutic modality for cerebral AVMs remains controversial in light of the recent publication of the ARUBA (A Randomized trial of Unruptured Brain AVMs) trial, a multidisciplinary treatment approach for the management of sAVMs can lead to acceptable neurological outcome.

Transvenous embolization: a report of 4 pediatric cases

2015 ◽  
Vol 15 (4) ◽  
pp. 445-450 ◽  
Author(s):  
Leonardo Renieri ◽  
Nicola Limbucci ◽  
Arturo Consoli ◽  
Andrea Rosi ◽  
Sergio Nappini ◽  
...  
Keyword(s):  
Side Effects ◽  
Arteriovenous Malformations ◽  
Therapeutic Option ◽  
Endovascular Embolization ◽  
Transvenous Embolization ◽  
Promising Alternative ◽  
Complete Occlusion ◽  
Arterial Access ◽  
Drainage Vein ◽  
Transvenous Approach

The treatment of brain arteriovenous malformations (AVMs) in children has always been a challenge for interventionalists, neurosurgeons, and radiosurgeons. Endovascular embolization is usually performed through transarterial access, but in selected cases the transvenous approach can be considered. The authors of this report aimed to evaluate the efficacy of transvenous embolization in very selected pediatric cases. They describe 4 children treated using transvenous embolization for AVMs that were small, had a single drainage vein, and were deeply located or had a difficult arterial access. The 6-month angiographic and clinical follow-ups are reported as well. In all cases, complete occlusion of the AVM was achieved with no side effects for the patient. Transvenous embolization may represent a promising alternative therapeutic option in very selected cases.

Treatment of brain arteriovenous malformations with high-flow arteriovenous fistulas: risk and complications associated with endovascular embolization in multimodality treatment

2010 ◽  
Vol 113 (4) ◽  
pp. 715-722 ◽  
Author(s):  
Ichiro Yuki ◽  
Robert H. Kim ◽  
Gary Duckwiler ◽  
Reza Jahan ◽  
Satoshi Tateshima ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Multimodality Treatment ◽  
Endovascular Embolization ◽  
High Flow ◽  
Special Focus ◽  
Arteriovenous Fistulas ◽  
Brain Arteriovenous Malformations ◽  
Superselective Angiography ◽  
Fistula Treatment ◽  
Brain Avms

Object High-flow fistulas associated with brain arteriovenous malformations (AVMs) pose a significant challenge to both stereotactic radiosurgery (SRS) and surgical treatment. The purpose of this study was to examine the outcomes of multimodality treatment of AVMs in association with a large arteriovenous fistula (AVF), with a special focus on endovascular embolization and its associated complications. Methods One hundred ninety-two patients harboring cerebral AVMs underwent endovascular treatment in the authors' department between 1997 and 2003. Of these, the authors selected 74 patients presenting with an AVM associated with high-flow AVF(s) for a retrospective analysis based on the findings of superselective angiography. After endovascular embolization, 32 patients underwent resection, 33 underwent either SRS or hypofractionated stereotactic radiotherapy (HSRT), and 3 underwent both surgery and SRS. Six patients underwent embolization only. Immediate and midterm treatment outcomes were analyzed. Results Fifty-seven (77%) of the 74 patients had AVMs that were Spetzler-Martin Grade III or higher. A complete resection was achieved in all 32 patients. Of patients who underwent SRS/HSRT, 13 patients (39.3%) had either complete or > 90% obliteration of the AVM, and 2 patients (6.1%) had incomplete obliteration. Fourteen patients (42.4%) with residual AVM underwent repeated radiotherapy (and remain under observation). Of the 3 patients who underwent both SRS and resection, resection was complete in 2 and incomplete in one. No follow-up was obtained in 6 patients (8.1%). An endovascular complication was observed in 4 patients (5.4%). Fistula embolization was safely performed in every patient, whereas every endovascular complication was associated with other procedures such as nidus embolization. Conclusions Endovascular occlusion of the fistulous component was successfully achieved in every patient; every endovascular complication in this series was related to other procedures such as nidus embolization. The importance of the fistula treatment should be emphasized to minimize the endovascular complications and to maximize the treatment effect when a multimodality therapy is used to treat brain AVMs with large AVF.

Abstract 1122‐000061: Initial Experience Using the Transvenous Embolization for Intracranial Arteriovenous Malformations in a Reference Endovascular Center

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Giancarlo Saal Zapata ◽  
Giancarlo Saal‐Zapata ◽  
Aaron Rodriguez‐Calienes ◽  
Rodolfo Rodriguez‐Varela
Keyword(s):  
Decompressive Craniectomy ◽  
Clinical Condition ◽  
Arteriovenous Malformations ◽  
Arterial Embolization ◽  
Venous Drainage ◽  
External Ventricular Drainage ◽  
Initial Experience ◽  
Transvenous Embolization ◽  
Complete Obliteration ◽  
The Mean

Introduction : Transvenous embolization (TVE) is used in cases of arteriovenous malformations (AVMs) with specific characteristics such as small size (<3 cm), deep location, single draining vein and the absence of adequate feeders. High complete obliteration rates have been reported. Therefore, our study aimed to analyze our initial experience using the TVE for treatment of AVMs. Methods : Between May 2018 and January 2021, consecutive patients who underwent TVE of AVMs were selected. Demographics, radiological and clinical variables were collected. The modified Rankin Scale (mRS) was used to determine clinical outcomes and was dichotomized (good clinical condition: mRS £2; poor clinical condition: mRS >2). Complete obliteration was defined as the total absence of the nidus and vein, subtotal obliteration was defined as the embolization of >95% of nidus and partial obliteration was defined as the embolization of <95% of nidus. Procedure‐related complications were defined as those that occurred during the procedure and were divided as intraoperative rupture and thrombosis. Results : Twenty‐one patients harboring 21 AVMs were evaluated. Fourteen patients (67%) were women. The mean age was 24.5 ± 14.1 years (7 – 48 years). A good preoperative clinical condition was present in 20 patients. Twenty AVMs were ruptured (95.2%). The most frequent locations were thalamus/basal ganglia in 6 patients (29%), followed by temporal/insular in 5 patients (24%). Spetzler‐Martin grades III, II and I were present in 11, 9 and 1 patients, respectively. The mean number of feeders was 2.1 per AVM. The feeders arised from the MCA in 9 cases, followed by PCA in 5 cases, ACA and AChoA in 3 cases, AICA in 2 cases, and ECA and PCom in 1 case, respectively. The mean number of veins was 1.3 per AVM. Deep venous drainage was present in 12 cases (57%). The mean size of the AVM nidus was 15.7 ± 7.8 mm (3.7 – 34 mm). Previous trans‐arterial embolization was done in 10 patients (47.6%). Pre‐embolization hematoma evacuation was done in 4 patients (19%). An immediate complete obliteration was achieved in 18 patients (85.7%), whereas a subtotal and partial obliteration were achieved in 2 and 1 patients, respectively. A poor post‐operative clinical condition occurred in 4 patients (20%). Procedure‐related complications occurred in 4 patients (20%): 3 cases with intra‐operative rupture of the AVM nidus and 1 case of a thrombus in the M1 treated with stent retriever. Mortality occurred in 3 patients (14.2%) of which two presented intra‐operative rupture with intracerebral hematomas that required decompressive craniectomy. One patient presented a post‐operative bleeding of the AVM nidus that required external ventricular drainage and decompressive craniectomy. Follow‐up angiography was done in 4 cases with total obliteration of all the cases (100%). Conclusions : The transvenous approach has emerged as an alternative to trans‐arterial approach with high grades of immediate total obliteration rates, but with potential procedure‐related complications. Thus, this technique should be used in selected cases in order to achieve complete cure rates.

Evolution of the Management of Tentorial Dural Arteriovenous Malformations

Neurosurgery ◽  
2003 ◽  
Vol 52 (4) ◽  
pp. 750-762 ◽  
Author(s):  
Patrick R. Tomak ◽  
Harry J. Cloft ◽  
Akihiko Kaga ◽  
C. Michael Cawley ◽  
Jacques Dion ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Therapeutic Strategy ◽  
Transarterial Embolization ◽  
Treatment Strategies ◽  
Venous Drainage ◽  
Neurological Deficits ◽  
Transvenous Embolization ◽  
Single Institution ◽  
Clinical Presentations

Abstract OBJECTIVE Tentorial dural arteriovenous malformations (DAVMs) are uncommon lesions associated with an aggressive natural history. Controversy exists regarding their optimal treatment. We present a single-institution series of tentorial DAVMs treated during a 12-year period, address the current controversies, and present the rationale for our current therapeutic strategy. METHODS Twenty-two patients with tentorial DAVMs were treated between 1988 and 2000. Treatment consisted of transarterial or transvenous embolization, surgical resection, disconnection of venous drainage, or a combination of these therapies. The clinical presentations, radiological features, treatment strategies, and results were studied. RESULTS Eighteen patients (82%) presented with intracranial hemorrhage or progressive neurological deficits. Retrograde leptomeningeal venous drainage was documented in 22 cases (100%), classifying the lesions as Borden Type III. Angiographic follow-up monitoring was performed for 0 to 120 months and clinical follow-up monitoring for 1 to 120 months. Posttreatment angiography demonstrated obliteration in 22 cases (100%). Two patients experienced neurological decline after endovascular treatment and died. All of the 20 surviving patients exhibited clinical improvement; there were no episodes of rehemorrhage or new neurological deficits. Outcomes were excellent in 17 cases (77%), good in 2 cases (9%), and fair in 1 case (5%), and there were 2 deaths (9%). CONCLUSION Tentorial DAVMs are aggressive lesions that require prompt total angiographic obliteration. Disconnection of the venous drainage from the fistula may be accomplished with transarterial embolization to the venous side, transvenous embolization, or surgical disconnection of the fistula. We think that extensive nidal resections carry more risk and are unnecessary. We do not think there is a role for stereotactic radiosurgery in the treatment of these lesions.

Successful Transvenous Embolization of Brain Arteriovenous Malformations Using Onyx in Five Consecutive Patients

Neurosurgery ◽  
2011 ◽  
Vol 69 (1) ◽  
pp. 184-193 ◽  
Author(s):  
Iruena Kessler ◽  
Roberto Riva ◽  
Maria Ruggiero ◽  
Monica Manisor ◽  
Maher Al-Khawaldeh ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Interventional Neuroradiology ◽  
Endovascular Embolization ◽  
Term Treatment ◽  
University Hospital ◽  
Modified Rankin Scale ◽  
Safe Alternative ◽  
Ethylene Vinyl Alcohol ◽  
Brain Arteriovenous Malformations ◽  
Transvenous Approach

Abstract BACKGROUND: There is an increasing application of endovascular treatment for brain arteriovenous malformations (BAVMs) using ethylene vinyl alcohol copolymer (Onyx). Historically, this treatment has been performed using a transarterial approach. OBJECTIVE: To report our experience with transvenous endovascular embolization with Onyx (TVEO). METHODS: Five consecutive patients with BAVMs underwent endovascular TVEO between June 2007 and March 2009 at the Interventional Neuroradiology Department of the University Hospital of Limoges. There were 3 men and 2 women with a mean age of 41.8 years (range, 19-57 years). The clinical presentation included symptoms caused by intracerebral hemorrhage (n = 4) and seizures (n = 1). According to the Spetzler-Martin classification scheme, 3 BAVMs (60%) were grade III, and 2 BAVMs (40%) were grade IV. Four BAVMs (80%) were supratentorial and 1 BAVM (20%) was infratentorial. Immediate and mid-term treatment (6 months) outcomes were angiographically and clinically analyzed according to the modified Rankin Scale. RESULTS: The transvenous approach was used in all patients (100%). The success rate of complete obliteration of the arteriovenous malformation nidus was 80% (4 of 5), confirmed by follow-up angiography performed immediately and at 6 months after TVEO. No procedure-related complications occurred during or after embolization. All patients remained unchanged (modified Rankin Scale score = 0–2) and clinically stable 6 months after TVEO. CONCLUSION: The transvenous approach using Onyx for the management of BAVMs is shown to be an efficient and safe alternative treatment in cases with no other conventional therapeutic choice and when some anatomic considerations are respected.

scholarly journals Bilateral Petrous Ridge Dural Arteriovenous Malformations Treated by a Combination of Endovascular Embolization and Surgical Excision

2006 ◽  
Vol 12 (3) ◽  
pp. 269-275 ◽  
Author(s):  
S.O. Seong ◽  
C. David ◽  
In Sup Choi
Keyword(s):  
Arteriovenous Malformations ◽  
Transarterial Embolization ◽  
Surgical Excision ◽  
Endovascular Embolization ◽  
Transvenous Embolization ◽  
First Case ◽  
The Right

We report the first case of bilateral complex petrosal arteriovenous malformations (AVM). The patient was treated by a combination of transarterial embolization and surgical excision on the right-sided AVM, and by transarterial and transvenous embolization on left-sided lesion.

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