Sacral neurofibrosarcoma: an angiographic evaluation

1974 ◽  
Vol 40 (6) ◽  
pp. 767-771 ◽  
Author(s):  
Vladimir Grnja ◽  
William E. Allen ◽  
Dana J. Osborn ◽  
E. Leon Kier
Keyword(s):  
Tumor Vessels ◽  
Content Type ◽  
Multiple Tumor ◽  
Feeding Vessels ◽  
Fine Print

✓ A case of an intrasacral neurofibrosarcoma with presacral extension is presented and its angiographic features described. Arteriography demonstrated a large vascular pre-sacral mass with multiple tumor vessels. Identification of the feeding vessels and the pre-sacral extent of the tumor as outlined by angiography played an important part in the management of this tumor.

Giant arteriovenous fistula of the vein of Galen in early infancy treated successfully with surgery

1980 ◽  
Vol 53 (5) ◽  
pp. 703-706 ◽  
Author(s):  
Jose Andres Alvarez-Garijo ◽  
Manuel Vila Mengual ◽  
Dario Taboada Gomila ◽  
Adela Alonso Martin
Keyword(s):  
Heart Failure ◽  
Arteriovenous Fistula ◽  
Vein Of Galen ◽  
Cerebral Damage ◽  
Left Hemiparesis ◽  
Content Type ◽  
Feeding Vessels ◽  
Unusual Lesion ◽  
Persistent Hydrocephalus ◽  
Fine Print

✓ A giant arteriovenous fistula in a newborn infant was treated by surgical occlusion of the feeding vessels at 20 days of life. Congestive heart failure responded favorably to operative treatment. Because of persistent hydrocephalus, a shunt was inserted at 2 months of age. At 9 months of age, the child remained without signs of cardiac failure. Cerebral damage was manifested by a mild left hemiparesis. Successful surgical treatment of this unusual lesion in a neonate is exceptional.

Clinical significance of pedicle aneurysms on feeding vessels, especially those located in infratentorial arteriovenous malformations

2000 ◽  
Vol 92 (6) ◽  
pp. 995-1001 ◽  
Author(s):  
Manfred Westphal ◽  
Ulrich Grzyska
Keyword(s):  
Arteriovenous Malformations ◽  
Endovascular Techniques ◽  
Treatment Procedure ◽  
Major Hemorrhage ◽  
Content Type ◽  
Ruptured Aneurysms ◽  
Aggressive Management ◽  
Feeding Vessels ◽  
Fine Print ◽  
Feeding Vessel

Object. The diminishing threshold for the application of neuroimaging leads to an increasingly frequent diagnosis of previously asymptomatic arteriovenous malformations (AVMs). In such a context, it is warranted to define the criteria that make a lesion potentially hazardous so that neurosurgeons and patients reach a decision concerning how to manage the AVM. In addition to the proposed grading system for AVMs, which assesses the risk of an actual treatment procedure, several studies have been concerned with the evaluation of angioarchitectural features. The goal of the present study is to demonstrate the significance of feeding vessel pedicle aneurysms, especially those found in infratentorial AVMs.Methods. To determine the incidence of associated aneurysms, the authors reviewed an unselected cohort of 242 consecutive patients with AVMs managed between 1989 and 1999. Within this group were 240 patients who were treated by surgery, endovascular techniques, or a combination of both. Of these patients, 216 harbored a supratentorial and 24 an infratentorial AVM. Two additional patients with supratentorial AVMs underwent treatment of ruptured aneurysms without treatment of the AVMs. In six of the patients with supratentorial AVMs, proximal flow-related aneurysms were found on major feeding arteries, only one of which had caused hemorrhage. In only one patient were there additional distal feeding vessel pedicle aneurysms near the AVM, one of which had caused a major hemorrhage. In contrast, four of 24 patients with infratentorial AVMs had distal feeding artery pedicle aneurysms. Three of these aneurysms had caused hemorrhage.Conclusions. Pedicle aneurysms on feeding vessels are frequently associated with hemorrhage (four of five cases in this series). In our cohort of 242 treated patients (240 treated for AVM and two for an aneurysm), feeding vessel pedicle aneurysms appear to occur more frequently in conjunction with infratentorial AVMs, which justifies aggressive management to prevent incidences of morbidity associated with rupture of the aneurysm.

Dural arteriovenous malformations

1974 ◽  
Vol 40 (3) ◽  
pp. 322-329 ◽  
Author(s):  
Edward J. Kosnik ◽  
William E. Hunt ◽  
Carole A. Miller
Keyword(s):  
Surgical Treatment ◽  
Arteriovenous Malformations ◽  
Content Type ◽  
Venous Sinuses ◽  
Feeding Vessels ◽  
Physical Findings ◽  
Fine Print

✓ The history, physical findings, and treatment of dural arteriovenous malformations are reviewed. The importance of completely identifying and obliterating the fistula, even at the expense of obliterating major venous sinuses, is emphasized. Failure of surgical treatment usually is the result of mistaking the more obvious dilated feeding vessels for the lesion itself.

Arteriovenous malformations of the brain: choosing embolic materials to enhance safety and ease of excision

1992 ◽  
Vol 77 (2) ◽  
pp. 217-222 ◽  
Author(s):  
Phillip D. Purdy ◽  
H. Hunt Batjer ◽  
Richard C. Risser ◽  
Duke Samson
Keyword(s):  
Arteriovenous Malformations ◽  
Arterial Occlusion ◽  
Technical Difficulty ◽  
Content Type ◽  
Feeding Vessels ◽  
Embolic Materials ◽  
Materials Used ◽  
Proximal Occlusion ◽  
Distal Occlusion ◽  
Fine Print

✓ The authors report their experience with surgical resection of 108 previously embolized arteriovenous malformations (AVM's). Embolization was performed via only transfemoral catheterization in 70 lesions and via the surgical exposure of feeding vessels in 32. The remaining six patients were referred for resection following silicone sphere embolization elsewhere. Materials used included polyvinyl alcohol (PVA) foam, platinum microcoils, detachable silicone balloons, surgical silk, a mixture of 33% ethanol and microfibrillar collagen, and isobutyl cyanoacrylate (IBCA). It is believed that proximal arterial occlusion with balloons is an inferior choice for preresection embolization, because the technical difficulty of placement is high and the nidus of the AVM is unaffected. Vascular coagulation and section and AVM retraction are more difficult with IBCA; therefore, this is also considered an inferior choice. Among the materials studied, the combination of PVA for distal occlusion and microcoils for proximal occlusion appears to be the superior choice. Fewer complications (stroke or hemorrhage) are seen when intraarterial Amytal (amobarbital) testing is used to guide the embolization. Data regarding toxicity, oncogenicity, and vascular metabolism or recanalization associated with PVA, IBCA, and n-butyl cyanoacrylate are reviewed.

Correlation of intraluminal thrombosis in brain tumor vessels with postoperative thrombotic complications: a preliminary report

1998 ◽  
Vol 89 (2) ◽  
pp. 200-205 ◽  
Author(s):  
Raul A. Rodas ◽  
Robert A. Fenstermaker ◽  
Paul E. McKeever ◽  
Mila Blaivas ◽  
Lawrence D. Dickinson ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Brain Tumors ◽  
Control Group ◽  
Neurosurgical Procedures ◽  
Tumor Vessels ◽  
Content Type ◽  
Prophylactic Measures ◽  
Depth Analysis ◽  
Thrombotic Complications ◽  
Fine Print

Object. Thrombotic complications (deep vein thrombosis and/or pulmonary embolization [DVT/PE]) occur in 18 to 50% of patients harboring brain tumors who undergo neurosurgical procedures. Such patients are at risk for DVT/PE because of immobility, paresis, hypovolemia, and lengthy surgery. The present study was undertaken to see whether tumor patients at highest risk for DVT/PE could be identified so that augmentation of prophylactic measures might be used to reduce the incidence of thrombotic complications. Methods. The authors conducted a retrospective analysis of 488 patients enrolled in their brain tumor registries between 1988 and 1995, identifying 57 patients (12%) with recorded symptomatic DVT, PE, or both postoperatively. In 24 of these 57 cases histological specimens were retrievable for review, allowing an in-depth analysis. Forty-five patients were lost to follow-up review, and the remaining 386 patients had no record of systemic thrombosis. Slides of pathological specimens were retrievable in 50 cases in which there was no DVT/PE. From these 50 cases, 25 were selected at random to represent the control group by a blinded observer. Seventeen (71%) of the 24 brain tumor specimens obtained in patients with DVT/PE stained positively for intraluminal thrombosis (ILT) after hematoxylin and eosin had been applied. The odds ratio associated with the presence of ILT was 17.8, with a confidence interval ranging from 4 to 79.3. No evidence of ILT was found in 22 patients (88%) within the control group (p < 0.0001, Fisher's exact test). Other factors that may predispose patients with brain tumors to DVT/PE—limb paresis, extent of tumor removal, and duration of the surgery—were also analyzed and found not to be statistically significant. Therefore, these factors were not the basis for differences seen between the study and control groups. Conclusions. These preliminary observations suggest that the presence of ILT within malignant glioma or glioblastoma tumor vessels may represent a marker of tumor-induced hypercoagulability.

Resection of a large temporooccipital parenchymal arteriovenous fistula by using deep hypothermic circulatory bypass

1997 ◽  
Vol 87 (6) ◽  
pp. 934-939 ◽  
Author(s):  
Fredric B. Meyer ◽  
Robert E. Grady ◽  
Martin D. Abel ◽  
Douglas A. Nichols ◽  
Sergio S. Caminha ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Arteriovenous Fistula ◽  
Postoperative Management ◽  
Content Type ◽  
Hypothermic Cardiopulmonary Bypass ◽  
Feeding Vessels ◽  
Fine Print

✓ The authors believe this to be the first published case in which a deep hypothermic cardiopulmonary bypass was used to facilitate resection of a large parenchymal arteriovenous fistula. The use of this procedure facilitated resection of the lesion by allowing compression and manipulation of large venous varices that were overlying the deeper arterial feeding vessels. The surgical rationale, technique, and intra- and postoperative management are discussed.

CO2 reactivity in arteriovenous malformations of the brain: a transcranial Doppler ultrasound study

1994 ◽  
Vol 80 (4) ◽  
pp. 624-630 ◽  
Author(s):  
Antônio A F. De Salles ◽  
Iñaki Manchola
Keyword(s):  
Carbon Dioxide ◽  
Doppler Ultrasound ◽  
Transcranial Doppler ◽  
Arteriovenous Malformations ◽  
Transcranial Doppler Ultrasound ◽  
Content Type ◽  
Control Subjects ◽  
Feeding Vessels ◽  
Carbon Dioxide Reactivity ◽  
Fine Print

✓ Arteriovenous malformations (AVM's) are congenital tangles of vessels that have a high blood flow through a low-resistance nidus. The vessels in the nidus may lack normal vasoreactivity in response to changes in PaCO2 or perfusion pressure (autoregulation). Arteriovenous malformation hemodynamics have been assessed based on the response of AVM feeding arteries to hypocapnia. Twenty-five AVM patients, aged 34 ± 11 years (mean ± standard deviation), were admitted to the Massachusetts General Hospital for proton-beam radiation therapy. Fourteen healthy volunteers aged 30 ± 7 years served as control subjects. Angiograms with calibrated markers permitting magnification correction were available for all patients. The limits of the middle cerebral artery, as determined by transcranial Doppler ultrasonography, were compared to measurements made on the angiograms. Hyperventilation was induced at a rate set by a metronome. Fixed bilateral Doppler probes allowed almost simultaneous sampling of two vessels. Volunteer control subjects were hyperventilated in two steps. The two PaCO2 step decreases were significant (mean resting PaCO2 40.6 ± 3.5 mm Hg, Step 1 level 29.4 ± 3.5 mm Hg and Step 2 level 23.8 ± 3.5 mm Hg; p < 0.01). These decreases induced a significant decrease in mean flow velocity (Vm) and an increase in the pulsatility index (p < 0.001). Mean carbon dioxide reactivity (%ΔVm/ΔPaCO2) was 2.74 ± 1.0 for Step 1 and 1.44 ± 1.8 for Step 2 (p < 0.003). The mean PaCO2 decrease in patients was from 39.5 ± 4.0 mm Hg to 27.0 ± 3.5 mm Hg. Carbon dioxide reactivity was 0.92 ± 1.12 for feeding vessels and 2.59 ± 1.78 for nonfeeding vessels (p < 0.001). Transcranial Doppler ultrasound and angiographic depth measurements correlated well. Hyperventilation induced significantly more hemodynamic changes in control and nonfeeding middle cerebral arteries than in feeding vessels. Impaired CO2 reactivity may help to identify AVM feeding vessels as well as the relative magnitude of the flow provided to the malformation.

Lack of neural control and reactivity to vasoactive agents in malignant glioma arteries

1991 ◽  
Vol 74 (4) ◽  
pp. 633-635 ◽  
Author(s):  
Jan-Erik Hardebo ◽  
Jan Kåahrström ◽  
Leif G. Salford
Keyword(s):  
Brain Tumors ◽  
Malignant Glioma ◽  
Blood Brain Barrier ◽  
Neural Control ◽  
Malignant Gliomas ◽  
Brain Barrier ◽  
Vasoactive Agents ◽  
Tumor Vessels ◽  
Content Type ◽  
Fine Print

✓ Vessels in malignant brain tumors have a defective blood-brain barrier. It is important to know if tumor vessels respond to vasoactive agents, since systemic administration of vasodilatory agents together with chemotherapy could increase the access of these drugs to the tumor. It was found that arteries in human malignant gliomas have no neural control and are totally nonreactive to various vasoactive agents. The vessels lose their reactivity within 1 to 2 mm outside the visible tumor front.

The syndromes and surgical treatment of aneurysms of the great vein of Galen

1973 ◽  
Vol 39 (1) ◽  
pp. 89-98 ◽  
Author(s):  
A. Loren Amacher ◽  
John Shillito
Keyword(s):  
Heart Failure ◽  
Surgical Treatment ◽  
Newborn Infants ◽  
Surgical Techniques ◽  
Vein Of Galen ◽  
Content Type ◽  
Point Of Entry ◽  
Feeding Vessels ◽  
Great Vein ◽  
Fine Print

✓ The authors review 37 cases of primary aneurysms of the vein of Galen reported in the literature and present five new ones. The magnitude of the shunt from arterial feeders to the primary aneurysm indicates the age at which the patient's symptoms first appeared as well as the nature and severity of those symptoms. Newborn infants have intractable heart failure, older infants have hydrocephalus, and adolescents have headache and syncope. Four clinical categories, based on the time of onset of symptoms, are described, and the diagnostic studies and surgical techniques discussed. Four-vessel angiography and ligation of the feeding vessels at the point of entry into the vein of Galen are recommended.

Vertebrectomy for treatment of vertebral hemangioma without preoperative embolization

1986 ◽  
Vol 65 (3) ◽  
pp. 404-406 ◽  
Author(s):  
Tony Feuerman ◽  
Paul S. Dwan ◽  
Ronald F. Young
Keyword(s):  
Arterial Embolization ◽  
Preoperative Embolization ◽  
Vertebral Hemangioma ◽  
Transthoracic Approach ◽  
Tumor Vessels ◽  
Content Type ◽  
Vertebral Hemangiomas ◽  
Postoperative Improvement ◽  
Fine Print

✓ Vertebral hemangiomas have usually been treated by resection following preoperative arterial embolization. A case is presented in which no feeding tumor vessels were demonstrable angiographically. The tumor was resected by an arterolateral transthoracic approach without preoperative embolization. There was progressive postoperative improvement of the myelopathy.

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