scholarly journals Combined strategies on the treatment of cerebellar arteriovenous malformation

2021 ◽  
Vol 4 (1) ◽  
pp. V16
Author(s):  
Marcos Dellaretti ◽  
Diego da Silveira ◽  
Tancredo Alcântara Ferreira Junior
Keyword(s):  
Patient Outcome ◽  
Decision Making ◽  
Arteriovenous Malformation ◽  
Arteriovenous Malformations ◽  
Endovascular Embolization ◽  
Interventional Treatment ◽  
Suboccipital Craniotomy ◽  
Microsurgical Resection ◽  
Cerebral Avms ◽  
Combined Strategy

Cerebellar arteriovenous malformations (AVMs) comprise 10%–15% of all intracranial AVMs and have a higher risk for morbidity and mortality than supratentorial AVMs. Patients with cerebellar AVMs present with hemorrhage more often than patients with cerebral AVMs, justifying an interventional treatment. Patient outcome can be predicted with specific grade systems, guiding vascular neurosurgeons in decision-making. The authors present the case of a 42-year-old man incidentally diagnosed with an unruptured cerebellar inferior vermian AVM, which was managed through a combined strategy of preoperative endovascular embolization of the main arterial feeders followed by microsurgical resection via midline suboccipital craniotomy, with a favorable outcome.The video can be found here: https://youtu.be/3WESejZbk90

scholarly journals Microsurgical resection of an anterior medullary arteriovenous malformation

2021 ◽  
Vol 4 (1) ◽  
pp. V4
Author(s):  
Joshua S. Catapano ◽  
Rohin Singh ◽  
Visish M. Srinivasan ◽  
Michael T. Lawton
Keyword(s):  
Arteriovenous Malformation ◽  
Potential Risk ◽  
Arteriovenous Malformations ◽  
Open Surgery ◽  
Treatment Options ◽  
Current Treatment ◽  
Endovascular Embolization ◽  
Link Type ◽  
Far Lateral ◽  
Microsurgical Resection

Arteriovenous malformations (AVMs) in the brainstem, specifically medullary AVMs, are exceedingly rare and difficult to treat. These lesions are commonly more aggressive than supratentorial AVMs and pose their own unique treatment challenges. Current treatment options for these AVMs consist of endovascular embolization or open surgery. Radiosurgery is not favored because it is associated with potential risk to the brainstem and lower obliteration rates. Here the authors report the case of a 27-year-old man with a ruptured anterior medullary AVM. The patient underwent a successful far-lateral craniotomy for resection of the AVM.The video can be found here: https://youtu.be/lyOfOQ3sBdU

Vascular Reconstruction of a Brachial Artery Aneurysm Proximally to an Arteriovenous Malformation

2019 ◽  
Vol 54 (1) ◽  
pp. 75-79
Author(s):  
Curtis Woodford ◽  
Elizabeth Tai ◽  
Sebastian Mafeld ◽  
Husain A. Al-Mubarak ◽  
Arash Jaberi ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Radial Artery ◽  
Brachial Artery ◽  
Arteriovenous Malformations ◽  
Femoral Vein ◽  
Artery Aneurysm ◽  
Vascular Reconstruction ◽  
Endovascular Embolization ◽  
Antecubital Fossa ◽  
Interposition Graft

Brachial artery aneurysms and arteriovenous malformations (AVM) are limb-threatening vascular anomalies. This patient presented with a bilobed brachial artery aneurysm in the antecubital fossa proximally to an AVM arising from the dorsal interosseous and ulnar arteries that had been treated with endovascular embolization, leaving the hand solely supplied by the radial artery. The aneurysm continued to increase in size and imaging revealed concomitant thrombus. A femoral vein interposition graft was used to repair the aneurysm, and postoperatively, the patient retained full left arm function.

Radiosurgery as a microsurgical adjunct: outcomes after microsurgical resection of intracranial arteriovenous malformations previously treated with stereotactic radiosurgery

2021 ◽  
pp. 1-12
Author(s):  
Mark Bigder ◽  
Omar Choudhri ◽  
Mihir Gupta ◽  
Santosh Gummidipundi ◽  
Summer S. Han ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Perioperative Period ◽  
Low Grade ◽  
High Grade ◽  
Eligibility Criteria ◽  
Previously Treated ◽  
Microsurgical Resection ◽  
Cerebral Avms ◽  
Staged Treatment

OBJECTIVE Microsurgical resection of arteriovenous malformations (AVMs) can be aided by staged treatment consisting of stereotactic radiosurgery followed by resection in a delayed fashion. This approach is particularly useful for high Spetzler-Martin (SM) grade lesions because radiosurgery can reduce flow through the AVM, downgrade the SM rating, and induce histopathological changes that additively render the AVM more manageable for resection. The authors present their 28-year experience in managing AVMs with adjunctive radiosurgery followed by resection. METHODS The authors retrospectively reviewed records of patients treated for cerebral AVMs at their institution between January 1990 and August 2019. All patients who underwent stereotactic radiosurgery (with or without embolization), followed by resection, were included in the study. Of 1245 patients, 95 met the eligibility criteria. Univariate and multivariate regression analyses were performed to assess relationships between key variables and clinical outcomes. RESULTS The majority of lesions treated (53.9%) were high grade (SM grade IV–V), 31.5% were intermediate (SM grade III), and 16.6% were low grade (SM grade I–II). Hemorrhage was the initial presenting sign in half of all patients (49.5%). Complete resection was achieved among 84% of patients, whereas 16% had partial resection, the majority of whom received additional radiosurgery. Modified Rankin Scale (mRS) scores of 0–2 were achieved in 79.8% of patients, and 20.2% had poor (mRS scores 3–6) outcomes. Improved (44.8%) or stable (19%) mRS scores were observed among 63.8% of patients, whereas 36.2% had a decline in mRS scores. This includes 22 patients (23.4%) with AVM hemorrhage and 6 deaths (6.7%) outside the perioperative period but prior to AVM obliteration. CONCLUSIONS Stereotactic radiosurgery is a useful adjunct in the presurgical management of cerebral AVMs. Multimodal therapy allowed for high rates of AVM obliteration and acceptable morbidity rates, despite the predominance of high-grade lesions in this series of patients.

scholarly journals Embolization of the choroidal artery in the treatment of cerebral arteriovenous malformations

2017 ◽  
Vol 126 (4) ◽  
pp. 1114-1122 ◽  
Author(s):  
Alaa Elkordy ◽  
Hidenori Endo ◽  
Kenichi Sato ◽  
Yasushi Matsumoto ◽  
Ryushi Kondo ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Open Surgery ◽  
Gamma Knife Radiosurgery ◽  
Internal Capsule ◽  
Endovascular Embolization ◽  
Anterior Choroidal Artery ◽  
Cerebral Avms ◽  
Anterior Choroidal ◽  
Choroidal Artery

OBJECTIVE The anterior and posterior choroidal arteries are often recruited to supply arteriovenous malformations (AVMs) involving important paraventricular structures, such as the basal ganglia, internal capsule, optic radiation, lateral geniculate body, and medial temporal lobe. Endovascular embolization through these arteries is theoretically dangerous because they supply eloquent territories, are of small caliber, and lack collaterals. This study aimed to investigate the safety and efficacy of embolization through these arteries. METHODS This study retrospectively reviewed 13 patients with cerebral AVMs who underwent endovascular embolization through the choroidal arteries between 2006 and 2014. Embolization was performed as a palliative procedure before open surgery or Gamma Knife radiosurgery. Computed tomography and MRI were performed the day after embolization to assess any surgical complications. The incidence and type of complications and their association with clinical outcomes were analyzed. RESULTS Decreased blood flow was achieved in all patients after embolization. Postoperative CT detected no hemorrhagic complications. In contrast, postoperative MRI detected that 4 of the 13 patients (30.7%) developed infarctions: 3 patients after embolization through the anterior choroidal artery, and 1 patient after embolization through the lateral posterior choroidal artery. Two of the 4 patients in whom embolization was from the cisternal segment of the anterior choroidal artery (proximal to the plexal point) developed symptomatic infarction of the posterior limb of the internal capsule, 1 of whom developed morbidity (7.7%). The treatment-related mortality rate was 0%. Additional treatment was performed in 12 patients: open surgery in 9 and Gamma Knife radiosurgery in 3 patients. Complete obliteration was confirmed by angiography at the last follow-up in 10 patients. Recurrent bleeding from the AVMs did not occur in any of the cases during the follow-up period. CONCLUSIONS Ischemic complications are possible following the embolization of cerebral AVMs through the choroidal artery, even with modern neurointerventional devices and techniques. Although further study is needed, embolization through the choroidal artery may be an appropriate treatment option when the risk of surgery or radiosurgery is considered to outweigh the risk of embolization.

scholarly journals Outcome of Endovascular Treatment of Cerebral Arteriovenous Malformations with Ethylene Vinyl Alcohol Coploymer

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H E Mohram ◽  
M A Habib ◽  
S H Mourad ◽  
A H Abozeid ◽  
A M M Salem
Keyword(s):  
Arteriovenous Malformations ◽  
Interventional Procedures ◽  
Endovascular Embolization ◽  
Vascular Territory ◽  
Cure Rate ◽  
Cerebral Arteriovenous Malformations ◽  
University Hospitals ◽  
Curative Intent ◽  
Ethylene Vinyl Alcohol ◽  
Cerebral Avms

Abstract Background Cerebral AVMs are very rare lesions, and this rarity contributes to the difficulty of treating them. There is no consensus concerning the method of treatment to be chosen among neurosurgery, radiosurgery or embolization. Onyx embolization could serve as a curative option with accepted morbidity and mortality. The introduction of Onyx and of catheters with detachable tips has no doubt increased the rate of endovascular occlusion, and decreased the risks associated with treatment in our experience. Objective The aim of the study was to assess the outcome of the use of Onyx in the treatment of intracranial AVMs as curative embolization or before neuro- or radiosurgery Patients and Methods This analytical prospective study was conducted on 25 patients who were diagnosed with cerebral arteriovenous malformations and underwent endovascular embolization with EVOH copolymer with curative intent during the study period. Interventional procedures were done in the neuro – endovascular unit, neurosurgery department Ain Shams University Hospitals and associate neuroendovascular unit in El Matarya Teaching Hospital in the period between September 2014 and April 2017. Results Actually comparing these results especially concerning the cure rate along with other studies was somewhat confusing and problematic owing to the diversity in results between studies across the last 15 years. Conclusion For the cases that are not fulfilling these criteria, embolization should be offered as preparing step for other modality of treatment. In our experience, for curative embolization, the AVM should be small sized (< 3 cm), supplied by one vascular territory, with feeders that can tolerate reflux up to 2–3 cm, with clear proximal parts of the draining veins, and not located in deep structures.

scholarly journals De novo arteriovenous malformation in a patient with hereditary hemorrhagic telangiectasia

2016 ◽  
Vol 17 (3) ◽  
pp. 330-335 ◽  
Author(s):  
Yusuke Shimoda ◽  
Toshiya Osanai ◽  
Naoki Nakayama ◽  
Satoshi Ushikoshi ◽  
Masaaki Hokari ◽  
...  
Keyword(s):  
Family History ◽  
Arteriovenous Malformation ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Arteriovenous Malformations ◽  
Autosomal Dominant ◽  
De Novo ◽  
The Family ◽  
Systemic Disorder ◽  
History Of ◽  
Cerebral Avms

Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant systemic disorder characterized by the enlargement of capillaries, recurrent nosebleeds, and multiple arteriovenous malformations (AVMs). Although cerebral AVMs are traditionally considered to be congenital lesions, some reports have described de novo AVMs, which suggests that the authors believed them to be dynamic conditions. In this article, the authors describe the case of a 5-year-old boy with HHT in whom a de novo cerebral AVM was detected after a negative MRI result at 5 months. To the authors’ knowledge, this is the first report of a de novo AVM in a patient with HHT. In patients with a family history of HHT, de novo AVMs are possible, even when no lesions are detected at the first screening. Therefore, regular screenings need to be performed, and the family should be informed that AVMs could still develop despite normal MRI 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.

scholarly journals Microsurgical resection of unruptured cerebellar arteriovenous malformation presenting with trigeminal neuralgia

2021 ◽  
Vol 4 (1) ◽  
pp. V13
Author(s):  
Walter Marani ◽  
Nicola Montemurro ◽  
Shoichiro Tsuji ◽  
Paolo Perrini ◽  
Kosumo Noda ◽  
...  
Keyword(s):  
Natural History ◽  
Trigeminal Neuralgia ◽  
Arteriovenous Malformation ◽  
Arteriovenous Malformations ◽  
Cerebellopontine Angle ◽  
Complete Resection ◽  
Neurovascular Compression ◽  
History Of ◽  
Microsurgical Resection ◽  
Compression Syndromes

Cerebellar arteriovenous malformations (AVMs) represent 10%–15% of all intracranial AVMs and are associated with a greater risk for hemorrhagic presentation compared with supratentorial AVMs. When they reach the cerebellopontine angle cistern, neurovascular compression syndromes, including trigeminal neuralgia and hemifacial spasm, can occur. Due to the aggressive natural history of cerebellar AVM, an effective treatment strategy is required. In this video, the authors demonstrate the technical nuances of microsurgical resection of an unruptured cerebellar AVM in a 24-year-old female presenting with trigeminal neuralgia. The patient underwent right retrosigmoid craniotomy and complete resection of the AVM with resolution of trigeminal neuralgia.The video can be found here: https://youtu.be/6GmNjgFQwx8

scholarly journals The First Successful Endovascular Management of Posterior Fossa Arteriovenous Malformations in Nepal: Case Series

2020 ◽  
Vol 58 (232) ◽  
Author(s):  
Subash Phuyal ◽  
Pooja Agrawal ◽  
Kapil Dawadi ◽  
Raju Paudel ◽  
Ritesh Lamsal
Keyword(s):  
Clinical Outcomes ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Treatment Options ◽  
Case Series ◽  
Endovascular Embolization ◽  
Endovascular Management ◽  
Endovascular Techniques ◽  
Risk Of Rupture ◽  
Microsurgical Resection

Posterior fossa arteriovenous malformations represent 7–15% of all intracranial AVMs. They carry a higher risk of rupture than supratentorial AVMs and are associated with considerable rates of morbidity and mortality. Available treatment options include conservative management, microsurgical resection, radiosurgery, endovascular embolization, or combinations of these modalities. Recent advances in endovascular techniques have revolutionized their management with better clinical outcomes. We illustrate two cases of posterior fossa AVMs treated by endovascular techniques with good clinical outcomes. The first patient also had associated flow-related aneurysms. One of these aneurysms had already ruptured, so it was coiled first followed by AVM nidus embolization using the same microcatheter. The second patient had a diffuse type of posterior fossa AVM for which staged-embolization was planned and the first-stage partial embolization was successfully performed.

scholarly journals Microsurgical treatment of arteriovenous malformations in pediatric patients: the Boston Children's Hospital experience

2015 ◽  
Vol 15 (1) ◽  
pp. 71-77 ◽  
Author(s):  
Bradley A. Gross ◽  
Armide Storey ◽  
Darren B. Orbach ◽  
R. Michael Scott ◽  
Edward R. Smith
Keyword(s):  
Arteriovenous Malformations ◽  
Neurological Complications ◽  
Neurological Deficits ◽  
Preoperative Embolization ◽  
Recurrence Rates ◽  
Microsurgical Treatment ◽  
Obliteration Rate ◽  
Microsurgical Resection ◽  
Martin Grade ◽  
Cerebral Avms

OBJECT Outcomes of microsurgical treatment of arteriovenous malformations (AVMs) in children are infrequently reported across large cohorts. METHODS The authors undertook a retrospective review of departmental and hospital databases to obtain the medical data of all patients up to 18 years of age who were diagnosed with cerebral AVMs. Demographic and AVM angioarchitectural characteristics were analyzed, and for the patients who underwent surgery, the authors also analyzed the estimated intraoperative blood loss, postoperative angiographically confirmed obliteration rates, and neurological complications and outcomes classified according to the modified Rankin Scale (mRS). RESULTS Of 117 children with cerebral AVMs, 94 underwent microsurgical resection (80%). Twenty (21%) of these 94 patients underwent adjunctive preoperative embolization. The overall postoperative angiographically confirmed obliteration rate was 94%. As part of a new protocol, the last 50 patients in this series underwent immediate perioperative angiography, improving the subsequent obliteration rate from 86% to 100% (p = 0.01). No other factors, such as a hemorrhagic AVM, size of the AVM, location, drainage, or Spetzler-Martin grade, had a statistically significant impact on the obliteration rate. Perioperative neurological deficits occurred in 17% of the patients, but the vast majority of these (77%) were predictable visual field cuts. Arteriovenous malformations that were hemorrhagic or located in noneloquent regions were each associated with lower rates of postoperative neurological complications (p = 0.05 and 0.002, respectively). In total, 94% of the children had good functional outcomes (mRS Scores 0–2), and these outcomes were significantly influenced by the mRS score on presentation before surgery (p = 0.01). A review of 1- and 5-year follow-up data indicated an overall annual hemorrhage rate of 0.3% and a recurrence rate of 0.9%. CONCLUSIONS Microsurgical resection of AVMs in children is associated with high rates of angiographically confirmed obliteration and low rates of significant neurological complications. Implementation of a protocol using perioperative angiography in this series led to complete radiographically confirmed obliteration of all AVMs, with low annual repeat hemorrhage and recurrence rates.

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