scholarly journals Acute surgical management of children with ruptured brain arteriovenous malformation

2021 ◽  
pp. 1-9
Author(s):  
Sarah Stricker ◽  
Grégoire Boulouis ◽  
Sandro Benichi ◽  
Marie Bourgeois ◽  
Florent Gariel ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Arteriovenous Malformation ◽  
Intracranial Hypertension ◽  
Volume Ratio ◽  
Brain Arteriovenous Malformation ◽  
Decompressive Hemicraniectomy ◽  
Point Increase ◽  
Additional Surgery ◽  
Ruptured Avm ◽  
Martin Grade

OBJECTIVERupture of brain arteriovenous malformation (AVM) is the main etiology of intracerebral hemorrhage (ICH) in children. Ensuing intracranial hypertension is among the modifiable prognosis factors and sometimes requires emergency hemorrhage evacuation (HE). The authors aimed to analyze variables associated with HE in children with ruptured AVM.METHODSThis study was a single-center retrospective analysis of children treated for ruptured AVM. The authors evaluated the occurrence of HE, its association with other acute surgical procedures (e.g., nidal excision, decompressive hemicraniectomy), and clinical outcome. Variables associated with each intervention were analyzed using univariable and multivariable models. Clinical outcome was assessed at 18 months using the ordinal King’s Outcome Scale for Childhood Head Injury.RESULTSA total of 104 patients were treated for 112 episodes of ruptured AVM between 2002 and 2018. In the 51 children (45.5% of cases) who underwent HE, 37 procedures were performed early (i.e., within 24 hours after initial cerebral imaging) and 14 late. Determinants of HE were a lower initial Glasgow Coma Scale score (adjusted odds ratio [aOR] 0.83, 95% CI 0.71–0.97 per point increase); higher ICH/brain volume ratio (aOR 18.6, 95% CI 13–26.5 per percent increase); superficial AVM location; and the presence of a brain herniation (aOR 3.7, 95% CI 1.3–10.4). Concurrent nidal surgery was acutely performed in 69% of Spetzler-Martin grade I–II ruptured AVMs and in 25% of Spetzler-Martin grade III lesions. Factors associated with nidal surgery were superficial AVMs, late HE, and absent alteration of consciousness at presentation. Only 8 cases required additional surgery due to intracranial hypertension. At 18 months, overall mortality was less than 4%, 58% of patients had a favorable outcome regardless of surgical intervention, and 87% were functioning independently.CONCLUSIONSHE is a lifesaving procedure performed in approximately half of the children who suffer AVM rupture. The good overall outcome justifies intensive initial management.

The Ruptured Arteriovenous Malformation Grading Scale (RAGS): An Extension of the Hunt and Hess Scale to Predict Clinical Outcome for Patients With Ruptured Brain Arteriovenous Malformations

Neurosurgery ◽  
2019 ◽  
Vol 87 (2) ◽  
pp. 193-199 ◽  
Author(s):  
Michael A Silva ◽  
Pui Man Rosalind Lai ◽  
Rose Du ◽  
Mohammad A Aziz-Sultan ◽  
Nirav J Patel
Keyword(s):  
Clinical Outcome ◽  
Arteriovenous Malformation ◽  
Venous Drainage ◽  
Receiver Operating Curve ◽  
Simple Extension ◽  
Grading Systems ◽  
Ruptured Avm ◽  
Grading Scale ◽  
Ordinal Logistic Regression Model

Abstract BACKGROUND Arteriovenous malformation (AVM) rupture is highly morbid. Outcomes after AVM rupture differ from other types of brain hemorrhage. There are no specific widely used grading systems designed to predict clinical outcome after AVM rupture. OBJECTIVE To develop an all-comers scoring system to grade patients with AVM rupture and predict clinical outcome more accurately than grading systems currently in use. METHODS We retrospectively reviewed patients who presented to our institution with a ruptured AVM. Using change in modified Rankin Score (mRS) as our response variable, we generated an ordinal logistic regression model to test for significant predictor variables. The full model was sequentially condensed until the simplest model with the highest area under the receiver operating curve (AUROC) was achieved. RESULTS A total of 115 patients who presented with ruptured AVMs were included in the study, with a mean follow-up time of 4 yr. The Ruptured AVM Grading Scale (RAGS) consists of the Hunt and Hess (HH) score (1-5), patient age (<35 = 0, 35-70 = 1, and >70 = 2), deep venous drainage (1), and eloquence (1). The RAGS score outperformed other neurosurgical grading scales in predicting change in mRS, with an AUROC greater than 0.80 across all follow-up periods. CONCLUSION The RAGS score is a simple extension of the HH scale that predicts clinical outcome after AVM rupture more accurately than other grading systems.

scholarly journals Clinical Outcome After First and Recurrent Hemorrhage in Patients With Untreated Brain Arteriovenous Malformation

Stroke ◽  
2006 ◽  
Vol 37 (5) ◽  
pp. 1243-1247 ◽  
Author(s):  
Jae H. Choi ◽  
Henning Mast ◽  
Robert R. Sciacca ◽  
Andreas Hartmann ◽  
Alexander V. Khaw ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Arteriovenous Malformation ◽  
Brain Arteriovenous Malformation ◽  
Recurrent Hemorrhage

scholarly journals Onyx extravasation during embolization of a brain arteriovenous malformation

2016 ◽  
Vol 23 (2) ◽  
pp. 200-205 ◽  
Author(s):  
Hiroyuki Ikeda ◽  
Hirotoshi Imamura ◽  
Yuji Agawa ◽  
Yukihiro Imai ◽  
Shoichi Tani ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Immunohistochemical Staining ◽  
Pathological Findings ◽  
Brain Arteriovenous Malformation ◽  
Total Resection ◽  
Pathological Analysis ◽  
Brain Avm ◽  
Cerebellar Tissue ◽  
Martin Grade ◽  
The Brain

During Onyx embolization to treat brain arteriovenous malformation (AVM), carefully observing the penetration of Onyx to the nidus is important in order to avoid complications such as hemorrhage, ischemia, and difficulty with microcatheter removal. We encountered a case of Onyx extravasation during embolization of a cerebellar AVM confirmed by surgical resection and pathological analysis. The patient was a 44-year-old man with Spetzler-Martin grade I cerebellar AVM who underwent Onyx embolization prior to resection of the brain AVM. While injecting Onyx into the nidus using the “plug-and-push” technique, Onyx extravasation was observed. Onyx injection was paused and subsequently restarted, thereby allowing continuation of embolization. An oblate Onyx cast that was entirely covered in cerebellar tissue was removed during total resection of the AVM, performed the same day. The surgically removed oblate Onyx cast did not contain brain tissue or vessel wall, and immunohistochemical staining against glial fibrillary acidic protein (GFAP) showed Onyx penetration into GFAP-positive cerebellar tissue. Onyx extravasation was confirmed based on intraoperative findings during resection as well as pathological findings. The patient has been followed for four years postoperatively, and adverse events caused by Onyx extravasation have not been observed. Unexpected cast of Onyx, remote from the vascular architecture of the AVM, may represent an intra-parenchymal extravasation.

Compartments in arteriovenous malformation nidi demonstrated with rotational three-dimensional digital subtraction angiography by using selective microcatheterization

2002 ◽  
Vol 96 (4) ◽  
pp. 770-774 ◽  
Author(s):  
Yukinari Kakizawa ◽  
Hisashi Nagashima ◽  
Fusakazu Oya ◽  
Kiyoshi Ito ◽  
Yuichiro Tanaka ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Digital Subtraction Angiography ◽  
Three Dimensional ◽  
Treatment Strategies ◽  
Digital Subtraction ◽  
3D Images ◽  
Content Type ◽  
Ruptured Avm ◽  
Martin Grade ◽  
Fine Print

✓ Although in several histological studies of arteriovenous malformation (AVM) nidi the presence of compartments has been documented, no clinical study has been published. The present study was conducted to determine the presence of nidus compartments in clinical cases by using a new radiographic method. Two patients with unruptured and one with a ruptured AVM (all Spetzler—Martin Grade III) were studied. A microcatheter was superselectively introduced into each of two or three feeding arteries of the AVMs under three-dimensional (3D) angiographic guidance to obtain 3D images of the nidus by using rotational digital subtraction angiography. On 3D images the different feeding arteries were found to be independent from one another, which allowed the authors to confirm the presence of compartments. On the other hand, separate feeding arteries often had a common draining vessel. Compartments in AVM nidi were demonstrated by a novel rotational 3D angiographic procedure by using superselective microcatheterization, which should be useful for designing treatment strategies for large and complex AVMs.

scholarly journals Case Report: Gyral Brain Arteriovenous Malformation with Presentation Isolated From Intraventricular Hemorrhage

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Rizky Fawzyana Sarengat ◽  
Achmad Firdaus Sani
Keyword(s):  
Arteriovenous Malformation ◽  
Intraventricular Hemorrhage ◽  
Clinical Manifestations ◽  
Chief Complaint ◽  
Communicating Hydrocephalus ◽  
Brain Arteriovenous Malformation ◽  
Centrum Semiovale ◽  
History Of ◽  
Ruptured Avm ◽  
Grade 3

Introduction: Brain Arteriovenous Malformation (BAVM) is a rare disease with an incidence rate of 1.3 out of 100,000 people. The most common clinical manifestations in BAVM patients are intracranial hemorrhage. There were 38.5% of BAVM patients who had intraventricular hemorrhage (IVH), and the rate of IVH without parenchymal bleeding in the ruptured AVM is 7.8%. We reported a case of BAVM with intraventricular hemorrhage presentation without intracerebral hemorrhage (isolated IVH). Case: Male, 15 years old, with a chief complaint of acute decreased consciousness on activity, followed by vomiting and general onset seizures. There was no history of hypertension or trauma before. From the neurological examination, the GCS is 225, and there were positive pathological reflexes on both sides. From a head CT scan without contrast, we found IVH in bilateral lateral ventricles, ventricle III and ventricle IV, communicating hydrocephalus, and brain edema. Head and Neck Computed Tomography Angiography (CTA) found a compact AVM in the left centrum semiovale-cortex parietal (Spetzler Martin AVM grading system grade 3). Patients underwent EVD surgery for hydrocephalus. The following steps are cerebral DSA as the gold standard for AVM diagnostic and targeted embolization to prevent further bleeding. Conclusion: One of the causes of Isolated Intraventricular Hemorrhage (IIVH) is AVM. In this case, although the topography of AVM is in the gyral, it can cause IIVH manifestation if there is contact between the AVM nidus and the ventricle.

scholarly journals Predictors of intracranial hemorrhage volume and distribution in brain arteriovenous malformation

2018 ◽  
Vol 24 (2) ◽  
pp. 183-188 ◽  
Author(s):  
Jay F Yu ◽  
Andrew D Nicholson ◽  
Jeffrey Nelson ◽  
Matthew D Alexander ◽  
Stephanie H Tse ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Arteriovenous Malformation ◽  
Intracranial Hemorrhage ◽  
Multivariable Analysis ◽  
Venous Drainage ◽  
Brain Arteriovenous Malformation ◽  
Univariable Analysis ◽  
Computed Tomography Images ◽  
Few Data ◽  
Multiple Feeding

Background and purpose Despite evidence regarding risk factors for brain arteriovenous malformation (bAVM)-associated spontaneous intracranial hemorrhage (ICH), few data exist describing the spectrum of clinical outcomes that bAVM-associated ICH may manifest. This study aimed to identify the demographical, clinical, and bAVM anatomical variables associated with ICH volume and the presence of intraventricular hemorrhage (IVH) of ruptured bAVMs, two indicators of worse clinical outcome, to help better predict outcome for unruptured bAVMs. Methods Computed tomography images ( n = 169) of patients with ruptured bAVM in a prospectively maintained institutional database were retrospectively reviewed to calculate ICH volume and the presence or absence of IVH. Demographic, clinical, and bAVM characteristics information was summarized and analyzed with univariable and multivariable regression models to identify the associations of these features with ICH volume and the presence of IVH. Results Patient sex, exclusively deep venous drainage, and lobar location were associated with ICH volume in univariable analysis; exclusively deep venous drainage remained significant in multivariable analysis (PI = 0.33, 95% CI: 0.21–0.52, p < 0.001). Exclusively deep venous drainage, multiple feeding arteries, and venous stenosis were associated with IVH in univariable analysis; exclusively deep venous drainage (OR = 7.27, 95% CI: 1.94–27.29, p = 0.003) remained significant in multivariable analysis. Conclusions Variables associated with ICH volume and the presence of IVH in ruptured bAVMs were evaluated and identified. They impart information that may help predict the clinical outcome of unruptured bAVM, in turn aiding clinicians in treatment planning.

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