scholarly journals Surgical treatment of a complex Grade III Spetzler-Martin posterior temporal arteriovenous malformation

2017 ◽  
Vol 43 (videosuppl1) ◽  
pp. V9 ◽  
Author(s):  
Amrit Chiluwal ◽  
Amir R. Dehdashti
Keyword(s):  
Video Clip ◽  
Venous Drainage ◽  
External Carotid Artery ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Distinct Subgroup ◽  
Heterogenous Group ◽  
Risk Of Hemorrhage ◽  
Brain Avms ◽  
Grade Iii

Grade III Spetzler-Martin arteriovenous malformations (AVMs) are a distinct subgroup of brain AVMs. Their variety in terms of location, type of venous drainage, and size makes them the most heterogenous group in the AVM classification. The surgical risk of treatment is also variable depending on the specifics of a given Grade III AVM. In this video illustration, the authors describe the technical nuances of surgical resection of a very complex Grade III left posterior temporal AVM. According to supplementary grading, the unruptured aspect and patient age give this lesion a Grade III; therefore, the combined grading gives the patient a score of 6, which puts him at moderate risk of morbidity for surgery. The indication for surgery was based on the patient’s young age, lifetime risk of hemorrhage, and the location of the AVM in the left inferior/posterior temporal gyrus.The patient underwent 2 sessions of preoperative embolization of the posterior cerebral artery and the external carotid artery feeders prior to craniotomy. The day after the second embolization, the patient was operated on via a posterior temporobasal craniotomy. The dural supply attached to the draining vein was left intact during the dural exposure. The detail of the AVM resection is described in the video clip. A total resection was achieved, and the patient’s neurological examination was intact after the procedure.The video can be found here: https://youtu.be/fj5Cxw3kpXQ.

scholarly journals Multimodal management of pediatric carotid body tumors: a systematic review and case illustrations

2019 ◽  
Vol 23 (3) ◽  
pp. 325-332
Author(s):  
Manish Kuchakulla ◽  
Ashish H. Shah ◽  
Valerie Armstrong ◽  
Sarah Jernigan ◽  
Sanjiv Bhatia ◽  
...  
Keyword(s):  
Systematic Review ◽  
Carotid Artery ◽  
Cranial Nerve ◽  
External Carotid Artery ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Surgical Morbidity ◽  
Balloon Test Occlusion ◽  
Cranial Nerve Palsies ◽  
Carotid Body Tumors

OBJECTIVECarotid body tumors (CBTs), extraadrenal paragangliomas, are extremely rare neoplasms in children that often require multimodal surgical treatment, including preoperative anesthesia workup, embolization, and resection. With only a few cases reported in the pediatric literature, treatment paradigms and surgical morbidity are loosely defined, especially when carotid artery infiltration is noted. Here, the authors report two cases of pediatric CBT and provide the results of a systematic review of the literature.METHODSThe study was divided into two sections. First, the authors conducted a retrospective review of our series of pediatric CBT patients and screened for patients with evidence of a CBT over the last 10 years (2007–2017) at a single tertiary referral pediatric hospital. Second, they conducted a systematic review, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, of all reported cases of pediatric CBTs to determine the characteristics (tumor size, vascularity, symptomatology), treatment paradigms, and complications.RESULTSIn the systematic review (n = 21 patients [includes 19 cases found in the literature and 2 from the authors’ series]), the mean age at diagnosis was 11.8 years. The most common presenting symptoms were palpable neck mass (62%), cranial nerve palsies (33%), cough or dysphagia (14%), and neck pain (19%). Metastasis occurred only in 5% of patients, and 19% of cases were recurrent lesions. Only 10% of patients presented with elevated catecholamines and associated sympathetic involvement. Preoperative embolization was utilized in 24% of patients (external carotid artery in 4 and external carotid artery and vertebral artery in 1). Cranial nerve palsies (cranial nerve VII [n = 1], IX [n = 1], X [n = 4], XI [n = 1], and XII [n = 3]) were the most common cause of surgical morbidity (33% of cases). The patients in the authors’ illustrative cases underwent preoperative embolization and balloon test occlusion followed by resection, and both patients suffered from transient Horner’s syndrome after embolization.CONCLUSIONSSurgical management of CBTs requires an extensive preoperative workup, anesthesia, and multimodal surgical management. Due to a potentially high rate of surgical morbidity and vascularity, balloon test occlusion with embolization may be necessary in select patients prior to resection. Careful thorough preoperative counseling is vital to preparing families for the intensive management of these children.

Preoperative Embolization for Meningioma Using Lipiodol

1998 ◽  
Vol 4 (1_suppl) ◽  
pp. 63-66 ◽  
Author(s):  
K. Yasui ◽  
Y. Shoda ◽  
T. Suyama ◽  
Y. Numa ◽  
Y.Y. Amanouchi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
External Carotid Artery ◽  
The Other ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Embolic Material ◽  
Operative Complications ◽  
Perifocal Oedema ◽  
Slow Infusion ◽  
Proximal Occlusion

Four patient (3 males, 1 female) with meningioma treated by preoperative embolization using lipiodol since January 1997 were included in this study. Almost the same procedure was performed on them; superselective catheterization into feeders from the external carotid artery, slow infusion of lipiodol, and proximal occlusion with liquid coils. Duration between embolization and direct surgery varied (5–13 days). Three meningiomas resected 5 days after the embolization were successful but one resected after 13 days needed transfusion. Post operative complications were seen in two patients, one is lockjaw due to ischaemia of the temporal muscles, and the other is transient dilatation of perifocal oedema. The ischaemic effect and safety of lipiodol as embolic material are discussed.

scholarly journals Safety and Efficacy of Preoperative Embolization in Patients with Meningioma

2018 ◽  
Vol 79 (S 04) ◽  
pp. S328-S333 ◽  
Author(s):  
Hiroshi Manaka ◽  
Junya Tatezuki ◽  
Tadao Shinohara ◽  
Wataru Shimohigoshi ◽  
Tetsuya Yamamoto ◽  
...  
Keyword(s):  
Operating Time ◽  
External Carotid Artery ◽  
External Carotid ◽  
Intracranial Meningioma ◽  
Preoperative Embolization ◽  
Tumor Removal ◽  
Embolic Material ◽  
Allogenic Blood ◽  
Ischemic Complication ◽  
Tumor Consistency

Preoperative embolization for intracranial meningioma has remained controversial for several decades. In this study, we retrospectively reviewed our experience of embolization using particulate embolic material and coil to clarify the therapeutic efficacy, safety, and risk of complication. Methods We reviewed 69 patients who underwent embolization with particulate embolic material followed by surgical resection. An additional 6 procedures were included for patients in whom recurrence was treated, for a total of 75 procedures of preoperative embolization. We analyzed the following clinical data: age, sex, tumor size pathology, complications related to embolization, and surgeon's opinion on the intraoperative ease of debulking and blood transfusion. Embolization was performed mainly from the branches of the external carotid artery. Results No allogenic blood transfusions were needed for any patients. The surgeon had the opinion that whitening and softening of the tumor allowed for easy debulking during decompression of the tumor in most of the patients. Hemorrhagic complications were seen in two patients after embolization. Emergency tumor removal was performed in both of those patients, and they were recovered well after surgery. Transient cranial nerve palsy was seen in one patient. One ischemic complication and one allergic complication occurred. Conclusion Preoperative embolization could give us an advantage in surgery for meningioma. The procedure reduces intraoperative blood loss and operating time by softening the tumor consistency. However, we must pay attention to the possibility of embolic complications and keep the preparation of emergency craniotomy, particularly in patients with large meningiomas.

Preoperative Embolization of Intracranial Meningiomas

Neurosurgery ◽  
1983 ◽  
Vol 13 (3) ◽  
pp. 261-268 ◽  
Author(s):  
Hans-Peter Richter ◽  
Walter Schachenmayr
Keyword(s):  
Carotid Artery ◽  
Histopathological Examination ◽  
External Carotid Artery ◽  
External Carotid ◽  
Intracranial Meningioma ◽  
Preoperative Embolization ◽  
Computed Tomographic ◽  
Intracranial Meningiomas ◽  
Feeding Vessels ◽  
Lyophilized Dura Mater

Abstract The operative and histopathological findings in 31 cases of intracranial meningioma after preoperative embolization with Gelfoam and/or lyophilized dura mater are reported. Removal of the tumor after embolization was facilitated in those meningiomas fed exclusively or mainly by branches of the external carotid artery (29 of 31). Large areas of tumor necrosis were never seen on histopathological examination, even when suggested by large regions of decreased density on the postembolization computed tomographic scan. Preoperative embolization of the feeding vessels arising from the external carotid artery system has proven to be a useful adjunct before the resection of intracranial meningiomas.

Pitfalls during the Embolization and Evaluation after the Embolization for the Skull Base Meningiomas

1995 ◽  
Vol 8 (6) ◽  
pp. 252-257
Author(s):  
A. Nishio ◽  
K. Ohata ◽  
N. Tsuyuguchi ◽  
T. Gotoh ◽  
T. Ishiguro ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Skull Base ◽  
Internal Carotid ◽  
Serum Levels ◽  
External Carotid Artery ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Mri Findings ◽  
Skull Base Meningiomas

Pitfall during the embolization and evaluation after the embolization for skull base meningiomas supplied by meningeal arteries of internal carotid artery (ICA) are reported. This study includes 15 cases of skull base meningiomas (two males and 13 females) that supplied by meningeal branches of internal carotid artery. The preoperative embolization was performed by these feeders. MRI findings and serum levels of C-reactive protein (CRP) after the embolization were examined. In ten patients among 15 patients the meningeal branches of ICA were dominant feeders. In ten patients out of 15 patients, the embolization from the meningeal branches of ICA was possible. Eight patients out of these ten patients were suffered from high fever and increase of serum level of CRP after the embolization. During the embolization for skull base meningiomas, the existence of collateral pathways between the ICA system and external carotid artery system were identified. The increase of serum levels of CRP might be recognized in the patients that effective embolization were performed.

Subselective preoperative embolization for meningiomas

1984 ◽  
Vol 60 (3) ◽  
pp. 506-511 ◽  
Author(s):  
Evelyn Teasdale ◽  
James Patterson ◽  
Douglas McLellan ◽  
Peter Macpherson
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Computerized Tomography ◽  
Tumor Necrosis ◽  
External Carotid Artery ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Content Type ◽  
Tumor Specimen ◽  
Fine Print

✓ Over a 2-year period the authors have studied the effects of preoperative subselective embolization of meningiomas. Thirty-six consecutive patients shown by computerized tomography (CT) to have a meningioma underwent selective internal and external carotid artery angiography, and any significant external carotid artery feeders were embolized (27 cases). It was found that CT and dynamic radioisotope scan findings were unable to predict the degree of vascularity of the tumor or its suitability for embolization. Furthermore, these tests, repeated after embolization, were unreliable in detecting either the extent of necrosis or reduction in blood flow. The effects of embolization upon surgery were recorded, and the excised tumor specimen examined for evidence of thrombosis and infarction. Subselective embolization was determined to be a simple, safe, and effective method of producing tumor necrosis and intraoperative hemostasis in selected patients.

Concomitant Embolization and Microsurgical Resection of a Giant, Hypervascular Skull Base Meningioma: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Michael A Mooney ◽  
Walid Ibn Essayed ◽  
Mohammad Ali Aziz-Sultan ◽  
Ossama Al-Mefty
Keyword(s):  
Skull Base ◽  
Hybrid Approach ◽  
Vascular Tumor ◽  
External Carotid Artery ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Skull Base Tumors ◽  
Selective Embolization ◽  
Skull Base Meningioma ◽  
Microsurgical Resection

Abstract Some skull base tumors can be extremely hypervascular, incorporating multiple vascular territories and demonstrating arteriovenous shunting. Devascularization is a critical step undertaken early in meningioma surgery, necessary before the debulking that is required in skull base tumors. While devascularization can often be achieved with appropriate approach selection, bony drilling, and microsurgical cautery, preoperative embolization of meningiomas has an invaluable role in selected cases.1,2  Embolization, however, does have added risk, magnified in large tumors by the potential infarction with subsequent edema that can potentially lead to acute deterioration and neurosurgical emergency. Hence, to achieve devascularization of an extremely vascular tumor, embolization and surgical resection should be performed concomitantly, as one operation, in which embolization might be the first stage, or might be performed after the craniotomy flap is raised, if necessary.3 Naturally, this requires the multifaceted neurosurgical expertise of embolization and microsurgical resection, and the facility to perform such.  We present a case of a giant, hypervascular, radiation-induced, skull base meningioma with internal and external carotid artery supply in a young patient with deteriorating vision in his only eye. Selective embolization of the internal maxillary, middle meningeal, and middle cerebral artery blood supplies was performed. Microsurgical interruption of the ethmoidal artery blood supply was then performed. This hybrid approach safely and effectively devascularized the tumor and allowed for a complete resection of this high-risk tumor4 while minimizing risk to the ophthalmic artery and optic nerve.  The patient was consented for surgery.

Dual cerebral and meningeal supply to giant arteriovenous malformations of the posterior cerebral hemisphere

1980 ◽  
Vol 52 (2) ◽  
pp. 153-161 ◽  
Author(s):  
Miguel A. Faria ◽  
Alan S. Fleischer
Keyword(s):  
Cerebral Hemisphere ◽  
Arteriovenous Malformations ◽  
Internal Carotid ◽  
External Carotid Artery ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Content Type ◽  
Vertebral Arteries ◽  
Feeding Vessels ◽  
Carotid And Vertebral Arteries

✓ Seven cases of giant posterior hemisphere arteriovenous malformations are described. The significance of meningeal feeding vessels from the external carotid artery in addition to the primary cerebral supply through the internal carotid and vertebral arteries to these malformations is discussed. The necessity of bilateral selective external carotid arteriography is stressed, and the value of preoperative embolization is questioned.

scholarly journals Twenty Years of Experience in Juvenile Nasopharyngeal Angiofibroma (JNA) Preoperative Endovascular Embolization: An Effective Procedure with a Low Complications Rate

2021 ◽  
Vol 10 (17) ◽  
pp. 3926
Author(s):  
Andrea Giorgianni ◽  
Stefano Molinaro ◽  
Edoardo Agosti ◽  
Alberto Vito Terrana ◽  
Francesco Alberto Vizzari ◽  
...  
Keyword(s):  
Blood Loss ◽  
Arterial Embolization ◽  
Endovascular Embolization ◽  
External Carotid Artery ◽  
Juvenile Nasopharyngeal Angiofibroma ◽  
External Carotid ◽  
Preoperative Embolization ◽  
Surgical Removal ◽  
Intraoperative Blood Loss ◽  
Nasopharyngeal Angiofibroma

Juvenile nasopharyngeal angiofibroma (JNA) is a benign tumor of the nasal cavity that predominantly affects young boys. Surgical removal remains the gold standard for the management of this disease. Preoperative intra-arterial embolization (PIAE) is useful for reductions in intraoperative blood loss and surgical complications. In our series of 79 patients who underwent preoperative embolization from 1999 to 2020, demographics, procedural aspects, surgical management and follow-up outcome were analyzed. Embolization was performed in a similar fashion for all patients, with a superselective microcatheterization of external carotid artery (ECA) feeders and an injection of polyvinyl alcohol (PVA) particles, followed, in some cases, by the deployment of coils . Procedural success was reached in 100% of cases, with no complications such as bleeding or thromboembolic occlusion, and surgical intraoperative blood loss was significantly decreased. In conclusion, PIAE is a safe and effective technique in JNA treatment, minimizing intraoperative bleeding.

Sign in / Sign up

Export Citation Format

Share Document