Arteriovenous malformation presenting with epilepsy: a multimodal approach to diagnosis and treatment

Arteriovenous malformation (AVM) presenting with epilepsy significantly impacts patient quality of life, and it should be considered very much a seizure disorder. Although hemorrhage prevention is the primary treatment aim of AVM surgery, seizure control should also be at the forefront of therapeutic management. Several hemodynamic and morphological characteristics of AVM have been identified to be associated with seizure presentation. This includes increased AVM flow, presence of long pial draining vein, venous outflow obstruction, and frontotemporal location, among other aspects. With the advent of high-throughput image processing and quantification methods, new radiographic attributes of AVM-related epilepsy have been identified. With respect to therapy, several treatment approaches are available, including conservative management or interventional modalities; this includes microsurgery, radiosurgery, and embolization or a combination thereof. Many studies, especially in the domain of microsurgery and radiosurgery, evaluate both techniques with respect to seizure outcomes. The advantage of microsurgery lies in superior AVM obliteration rates and swift seizure response. In addition, by incorporating electrophysiological monitoring during AVM resection, adjacent or even remote epileptogenic foci can be identified, leading to extended lesionectomy and improved seizure control. Radiosurgery, despite resulting in reduced AVM obliteration and prolonged time to seizure freedom, avoids the risks of surgery altogether and may provide seizure control through various antiepileptic mechanisms. Embolization continues to be used as an adjuvant for both microsurgery and radiosurgery. In this study, the authors review the latest imaging techniques in characterizing AVM-related epilepsy, in addition to reviewing each treatment modality.

Download Full-text

Impact of venous thromboembolism, venous stasis syndrome, venous outflow obstruction and venous valvular incompetence on quality of life and activities of daily living: A nested case-control study

Vascular Medicine ◽

10.1177/1358863x10379672 ◽

2010 ◽

Vol 15 (5) ◽

pp. 387-397 ◽

Cited By ~ 18

Author(s):

Aneel A Ashrani ◽

Marc D Silverstein ◽

Thom W Rooke ◽

Brian D Lahr ◽

Tanya M Petterson ◽

...

Keyword(s):

Daily Living ◽

Case Control Study ◽

Case Control ◽

Venous Stasis ◽

Outflow Obstruction ◽

Venous Outflow ◽

Venous Outflow Obstruction ◽

Nested Case Control ◽

Control Study

Download Full-text

Pediatric Epilepsy Surgery in Focal and Generalized Epilepsy: Current Trends and Recent Advancements

Journal of Pediatric Epilepsy ◽

10.1055/s-0040-1722298 ◽

2021 ◽

Author(s):

William B. Harris ◽

H. Westley Phillips ◽

Aria Fallah ◽

Gary W. Mathern

Keyword(s):

Epilepsy Surgery ◽

Intractable Epilepsy ◽

Pediatric Epilepsy ◽

Seizure Freedom ◽

Surgical Interventions ◽

Current Trends ◽

Pediatric Epilepsy Surgery ◽

Generalized Epilepsy ◽

Epileptogenic Foci

AbstractFor a subset of children with medically intractable epilepsy, surgery may provide the best chances of seizure freedom. Whereas the indications for epilepsy surgery are commonly thought to be limited to patients with focal epileptogenic foci, modern imaging and surgical interventions frequently permit successful surgical treatment of generalized epilepsy. Resection continues to be the only potentially curative intervention; however, the advent of various neuromodulation interventions provides an effective palliative strategy for generalized or persistent seizures. Although the risks and benefits vary greatly by type and extent of intervention, the seizure outcomes appear to be uniformly favorable. Advances in both resective and nonresective surgical interventions provide promise for improved seizure freedom, function, and quality of life. This review summarizes the current trends and recent advancements in pediatric epilepsy surgery from diagnostic workup and indications through surgical interventions and postoperative outcomes.

Download Full-text

Unruptured arteriovenous malformation in a patient presenting with obstructive hydrocephalus

Neurosurgical FOCUS ◽

10.3171/foc.2007.22.4.13 ◽

2007 ◽

Vol 22 (4) ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

Stefan A. Mindea ◽

Benson P. Yang ◽

H. Hunt Batjer

Keyword(s):

Arteriovenous Malformation ◽

Obstructive Hydrocephalus ◽

Cerebral Aqueduct ◽

Outflow Obstruction ◽

Venous Outflow ◽

Venous Outflow Obstruction ◽

Venous Varix

✓The authors report on a patient harboring an unruptured cortical arteriovenous malformation (AVM), who had presented with obstructive hydrocephalus due to compression of the cerebral aqueduct by a large venous varix. Although patients with ruptured AVMs are known to either present with or later suffer from obstructive hydrocephalus, those with unruptured AVMs who present in this manner are quite rare. Moreover, hydrocephalus caused by a venous varix draining an AVM, to our knowledge, has never been previously reported in the literature. This report serves to illustrate two primary points, namely, that tortuous venous varices draining AVMs can result in obstructive hydrocephalus and that this unusual circumstance can be fostered in the setting of venous outflow obstruction.

Download Full-text

Outcome of Intracerebral Cavernoma Treated by Gamma Knife Radiosurgery Based on a Double-blind Assessment of Treatment Indication

10.21203/rs.3.rs-550603/v2 ◽

2021 ◽

Author(s):

Chiung-Chyi Shen ◽

Ming-Hsi Sun ◽

Men-Yin Yang ◽

Weir Chiang You ◽

Meei-Ling Sheu ◽

...

Keyword(s):

Quality Of Life ◽

Gamma Knife ◽

Seizure Control ◽

Gamma Knife Radiosurgery ◽

Neurological Deficits ◽

Seizure Freedom ◽

Double Blind ◽

Highly Correlated

Abstract Background: The benefit and the risk profile of Gamma Knife radiosurgery for intracerebral cavernoma remains incompletely defined in part due to the natural history of low incidence of bleeding and spontaneous regression of this vascular malformation. In this study, we retrieved cases from a prospectively collected database to assess the outcome of intracerebral cavernoma treated with Gamma Knife using a double blinded review process for treatment.Methods: From 2003 to 2018, there were 94 cases of cavernoma treated by Gamma Knife radiosurgery doubly blinded assessed by two experienced neurological and approved for Gamma Knife treatment. All the patients received Gamma Knife radiosurgery with margin dose of 11-12 Gy and afterwards were assessed for neurological outcome, radiologic response, and quality of life.Results: The median age of the patients was 48(15-85) years with median follow up of 77(26-180) months post SRS. The mean treated volume was 1.93±3.45cc. In those who has pre-SRS epilepsy, 7 of 16(43.7%) achieved seizure freedom (Engel I/II) and 9 of 16 (56.3%) achieved decreased seizures (Engel III) after SRS. Rebleeding occurred in 2 cases (2.1%) at 13 and 52 months post SRS. The radiologic assessment demonstrated 20 (21.3%) cases of decreased cavernoma volume, 69(73.4%) were stable, and 5 (7.3%) increased size. Eight-seven of 94 (92.5%) cases at the last follow up achieve improvement in their quality of life, but 7 cases (7.4%) showed a deterioration. In statistical analysis, the effective seizure control class (Engel I/II) was highly correlated with patient harboring a single lesion (p<0.05) and deep seated location of the cavernoma (p<0.01). New neurological deficits were highly correlated with decreased mental (p<0.001) and physical (p<0.05) components of quality of life testing, KPS (p<0.001), deep seated location (p<0.01), and increased nidus volume (p<0.05). Quality of life deterioration either in physical component (p<0.01), mental component (p<0.01), and KPS (p<0.05) was highly correlated with increased cavernoma volume.Conclusion: Low margin dose Gamma Knife radiosurgery for intracerebral cavernoma offers reasonable seizure control and improved quality of life while conferring a low risk of treatment complications including adverse radiation effect.

Download Full-text

Seizure Freedom Reduces Illness Intrusiveness and Improves Quality of Life in Epilepsy

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100008842 ◽

2008 ◽

Vol 35 (3) ◽

pp. 280-286 ◽

Cited By ~ 20

Author(s):

Sonia Poochikian-Sarkissian ◽

Souraya Sidani ◽

Richard Wennberg ◽

Gerald M. Devins

Keyword(s):

Quality Of Life ◽

Health Care Providers ◽

Seizure Control ◽

Multiple Stressors ◽

Personal Control ◽

Well Being ◽

Seizure Freedom ◽

Care Providers ◽

Illness Intrusiveness

Background:Chronic illnesses are associated with multiple stressors that compromise quality of life (QOL). Implicit in many of these stressors is the concept of illness intrusiveness: the disruption of lifestyles, activities, and interests due to the constraints imposed by chronic disease and its treatment. The purpose of this study was to examine illness intrusiveness and QOL in epilepsy in patients with different levels of seizure control.Methods:Cross-sectional data were obtained and compared between two groups of patients categorized by presence of seizures: seizure freedom or continued seizures (N=145). Standard instruments measured the following variables: illness intrusiveness, perceived personal control, subjective well-being, and disease specific QOL.Results:Illness intrusiveness varied inversely and significantly with seizure control. Complete seizure freedom, whether achieved by pharmacological or surgical treatment, was associated with the lowest levels of illness intrusiveness. Seizure freedom was also associated with increased perceived control, positive affect, self-esteem and QOL in epilepsy.Conclusions:The most robust benefits of decreased illness intrusiveness in epilepsy occur when treatment leads to complete seizure control. Therefore every effort should be made by health care providers to achieve seizure freedom to reduce illness intrusiveness and improve QOL in epilepsy.

Download Full-text

Stenting for chronic venous obstructions a new era

Phlebology The Journal of Venous Disease ◽

10.1177/0268355513476449 ◽

2013 ◽

Vol 28 (1_suppl) ◽

pp. 117-122 ◽

Cited By ~ 21

Author(s):

R De Graaf ◽

C Arnoldussen ◽

C H A Wittens

Keyword(s):

Bypass Surgery ◽

Imaging Techniques ◽

Primary Treatment ◽

Lessons Learned ◽

Stent Design ◽

New Era ◽

Arteriovenous Fistulas ◽

Endovascular Approach ◽

Technical Considerations

Chronic iliocaval venous obstructions have been treated by means of bypass surgery until endovascular treatment emerged as a valuable alternative. With the introduction of new imaging modalities, recanalization techniques and novel stent design the endovascular approach gained even more popularity and surpassed surgery as the primary treatment option. Still, lessons learned from our and others' experience launches a new era in which we should decide on some unsolved issues. Foremost, reproducible imaging techniques should help to define treatment indication. Second, further research is needed to establish the optimal stent design, but also advice on stenting techniques. Finally, if and when arteriovenous fistulas should be used to support early patency is still unclear. This manuscript addresses some of these technical considerations, pitfalls and complications to advice on materials and methods to optimize the quality of your treatment.

Download Full-text

Outcome of intracerebral cavernoma treated by Gamma Knife radiosurgery based on a double-blind assessment of treatment indication

10.21203/rs.3.rs-550603/v1 ◽

2021 ◽

Author(s):

Chiung-Chyi Shen ◽

Ming-Hsi Sun ◽

Men-Yin Yang ◽

Weir Chiang You ◽

Meei-Ling Sheu ◽

...

Keyword(s):

Quality Of Life ◽

Gamma Knife ◽

Seizure Control ◽

Gamma Knife Radiosurgery ◽

Neurological Deficits ◽

Seizure Freedom ◽

Double Blind ◽

Treatment Indications ◽

Double Blinded

Abstract Purpose The benefit and risk profile of Gamma Knife radiosurgery (GKRS) for intracerebral cavernoma remains undefined due to the low incidence of bleeding and spontaneous regression of cavernoma. We retrieved cases from a prospectively collected database to assess the outcome of intracerebral cavernoma treated with GKRS using a double blinded review process for treatment. Methods From 2003 to 2018, 94 cases of cavernoma were treated by GKRS with margin dose of 11–12 Gy. The treatment indications were doubly blinded assessed by two experienced neurosurgeon and afterward assessed for neurological outcome, radiologic response, and quality of life. Results Seven of 16(43.7%) achieved seizure freedom and 9 of 16 (56.3%) achieved decreased seizures. Rebleeding occurred in 2 cases (2.1%) at 13 and 52 months post GKRS. The nidus volume demonstrated the decrease in 20 (21.3%) cases, 69(73.4%) stable and 5 (7.3%) increase. Eight-seven of 94 (92.5%) cases achieve improvement in their quality of life. The effective seizure control was correlated with patients harboring a single lesion (p < 0.05) and deep seated location of the cavernoma (p < 0.01). New neurological deficits were correlated with decreased mental (p < 0.001) and physical (p < 0.05) components of quality of life testing, KPS (p < 0.001), deep seated location (p < 0.01), and increased nidus volume (p < 0.05). Quality of life deterioration either in physical component (p < 0.01), mental component (p < 0.01), and KPS (p < 0.05) was correlated with increased cavernoma volume. Conclusion Low margin dose GKRS for intracerebral cavernoma offers reasonable seizure control and improved quality of life with a low risk of treatment complications.

Download Full-text

Outcome of intracerebral cavernoma treated by Gamma Knife radiosurgery based on a double-blind assessment of treatment indication

Radiation Oncology ◽

10.1186/s13014-021-01885-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Chiung-Chyi Shen ◽

Ming Hsi Sun ◽

Meng-Yin Yang ◽

Weir-Chiang You ◽

Meei-Ling Sheu ◽

...

Keyword(s):

Quality Of Life ◽

Gamma Knife ◽

Seizure Control ◽

Gamma Knife Radiosurgery ◽

Neurological Deficits ◽

Seizure Freedom ◽

Double Blind ◽

Highly Correlated

Abstract Background The benefit and the risk profile of Gamma Knife radiosurgery (GKRS) for intracerebral cavernoma remains incompletely defined in part due to the natural history of low incidence of bleeding and spontaneous regression of this vascular malformation. In this study, we retrieved cases from a prospectively collected database to assess the outcome of intracerebral cavernoma treated with GKRS using a double blinded review process for treatment. Methods From 2003 to 2018, there were 94 cases of cavernoma treated by GKRS in the doubly blinded assessments by two experienced neurological and approved for GKRS treatment. All the patients received GKRS with margin dose of 11–12 (Gray) Gy and afterwards were assessed for neurological outcome, radiologic response, and quality of life. Results The median age of the patients was 48 (15–85) years with median follow up of 77 (26–180) months post SRS. The mean target volume was 1.93 ± 3.45 cc. In those who has pre-SRS epilepsy, 7 of 16 (43.7%) achieved seizure freedom (Engel I/II) and 9 of 16 (56.3%) achieved decreased seizures (Engel III) after SRS. Rebleeding occurred in 2 cases (2.1%) at 13 and 52 months post SRS. The radiologic assessment demonstrated 20 (21.3%) cases of decreased cavernoma volume, 69 (73.4%) were stable, and 5 (7.3%) increased size. Eighty-seven of 94 (92.5%) cases at the last follow up achieve improvement in their quality of life, but 7 cases (7.4%) showed a deterioration. In statistical analysis, the effective seizure control class (Engel I/II) was highly correlated with patient harboring a single lesion (p < 0.05) and deep seated location of the cavernoma (p < 0.01). New neurological deficits were highly correlated with decreased mental (p < 0.001) and physical (p < 0.05) components of quality of life testing, KPS (p < 0.001), deep seated location (p < 0.01), and increased nidus volume (p < 0.05). Quality of life deterioration either in physical component (p < 0.01), mental component (p < 0.01), and KPS (p < 0.05) was highly correlated with increased cavernoma volume. Conclusion Low margin dose GKRS for intracerebral cavernoma offers reasonable seizure control and improved quality of life while conferring a low risk of treatment complications including adverse radiation effect.

Download Full-text

Value of cone beam computed tomography to evaluate complication of intracranial haemorrhage in endovascular treatment (evt): a case report

Journal Of Cardiovascular, Neurovascular & Stroke ◽

10.32896/cvns.v1n1.16-18 ◽

2019 ◽

Vol 1 (1) ◽

pp. 16-18 ◽

Cited By ~ 1

Author(s):

Norafida Bahari ◽

Nik Azuan Nik Ismail ◽

Jegan Thanabalan ◽

Ahmad Sobri Muda

Keyword(s):

Computed Tomography ◽

Arteriovenous Malformation ◽

Endovascular Treatment ◽

Cone Beam Computed Tomography ◽

Diagnostic Value ◽

Cone Beam ◽

Brain Arteriovenous Malformation ◽

Embolic Materials

In this article, we evaluate the effectiveness of Cone Beam Computed Tomography, through a case study, in assessing the complication of intracranial bleeding during an endovascular treatment of brain arteriovenous malformation when compared to Multislice-Detector Computed Tomography performed immediately after the procedure. The image quality of Cone Beam Computed Tomography has enough diagnostic value in differentiating between haemorrhage, embolic materials and the arteriovenous malformation nidus to facilitate physicians to decide for further management of the patient.

Download Full-text