Stereotaxic clipping of arterial aneurysms and arteriovenous malformations

1977 ◽  
Vol 46 (1) ◽  
pp. 12-23 ◽  
Author(s):  
Edward I. Kandel ◽  
Vyacheslav V. Peresedov
Keyword(s):  
Arteriovenous Malformations ◽  
Internal Carotid ◽  
Special Device ◽  
Content Type ◽  
Arterial Aneurysms ◽  
Direct Attack ◽  
Fine Print

✓ In carefully selected cases of arterial aneurysms and deep-seated arteriovenous malformations (AVM), when direct attack may be dangerous or impossible, the authors advocate stereotaxic clipping. A special device and technique for its application are described. The instrument is introduced through a trephine opening and clipping is monitored by angiography. Successful results have been obtained in 10 operations performed on eight patients, three of whom had arterial aneurysms (two internal carotid and one anterior cerebral-anterior communicating) and five with AVM's.

Occurrence of severe vasospasm following intraventricular hemorrhage from an arteriovenous malformation

1997 ◽  
Vol 87 (3) ◽  
pp. 436-439 ◽  
Author(s):  
Keiichiro Maeda ◽  
Hiroki Kurita ◽  
Tsuneo Nakamura ◽  
Masaaki Usui ◽  
Kazuo Tsutsumi ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Intraventricular Hemorrhage ◽  
Arteriovenous Malformations ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
The Other ◽  
Content Type ◽  
Radiological Features ◽  
Internal Carotid Arteries ◽  
Fine Print

✓ The authors present two rare cases of severe cerebral vasospasm following the rupture of arteriovenous malformations (AVMs). Computerized tomography revealed intracerebral hemorrhage in the thalamus in one case and in the putamen in the other, both accompanied by cast formation of intraventricular clots without radiological evidence of subarachnoid hemorrhage. Initial angiograms showed arterial narrowing of the bilateral internal carotid arteries in the supraclinoid portion but failed to demonstrate an arteriovenous shunt. Subsequent angiograms clearly demonstrated the existence of an AVM. Radiological features and possible mechanisms are discussed.

Localization of intraventricular arteriovenous malformations by ventriculography combined with stereoscopic arteriography

1973 ◽  
Vol 38 (2) ◽  
pp. 249-250 ◽  
Author(s):  
Arthur M. Gerber ◽  
George Karkazis ◽  
Sean Mullan
Keyword(s):  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Direct Approach ◽  
Content Type ◽  
Arterial Aneurysms ◽  
Fine Print

✓ Two cases are presented to illustrate the value of air ventriculography combined with stereoscopic arteriography in locating intraventricular vascular malformations and arterial aneurysms. This procedure permits the neurosurgeon to plan a more direct approach to the lesion.

Multiple arteriovenous malformations involving the scalp, dura, retina, cerebrum, and posterior fossa

1971 ◽  
Vol 34 (1) ◽  
pp. 95-98 ◽  
Author(s):  
N. Tamaki ◽  
K. Fujita ◽  
H. Yamashita
Keyword(s):  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Internal Carotid ◽  
Symptomatic Improvement ◽  
Content Type ◽  
Fine Print

✓ A case is presented of multiple arteriovenous malformations involving the scalp, dura, retina, cerebrum, and posterior fossa in one patient who also had an internal carotid aneurysm. Cobalt irradiation was followed by symptomatic improvement.

Arterial aneurysms associated with cerebral arteriovenous malformations: classification, incidence, and risk of hemorrhage

1998 ◽  
Vol 89 (4) ◽  
pp. 539-546 ◽  
Author(s):  
Gary Redekop ◽  
Karel TerBrugge ◽  
Walter Montanera ◽  
Robert Willinsky
Keyword(s):  
Arteriovenous Malformations ◽  
Clinical Presentation ◽  
Cerebral Arteriovenous Malformations ◽  
Content Type ◽  
Risk Of Bleeding ◽  
Risk Rate ◽  
Risk Of Hemorrhage ◽  
Arterial Aneurysms ◽  
Fine Print

Object. The goal of this study was to develop a classification system for aneurysms associated with arteriovenous malformations (AVMs) based on their anatomical and pathophysiological relationships and to determine the incidence and bleeding rates for these aneurysms as well as the effects of AVM treatment on their natural history. Methods. Of 632 patients with AVMs, intranidal aneurysms were found in 35 (5.5%) and flow-related aneurysms in 71 (11.2%). Patients with intranidal aneurysms presented more frequently with hemorrhage (72% compared with 40%, p < 0.001) and had a 9.8% per year risk rate of bleeding during follow-up review. Twelve (17%) of the patients with flow-related aneurysms associated with an AVM presented with hemorrhage from an aneurysm, whereas 15 (21%) bled from their AVM. Seventeen patients underwent angiography after AVM treatment (mean 2.25 years). Of 23 proximal aneurysms, 18 (78.3%) were unchanged, four (17.4%) were smaller, and one (4.3%) had disappeared, whereas four (80%) of five distal aneurysms regressed completely and one was unchanged. Sixteen patients underwent angiography after partial AVM treatment (mean 3.8 years). In cases with less than a 50% reduction in the AVM, no aneurysms regressed, although two enlarged and bled. In cases with greater than a 50% reduction in the AVM, two of three distal aneurysms disappeared and five proximal aneurysms were unchanged. Conclusions. Arterial aneurysms associated with cerebral AVMs may be classified as intranidal, flow-related, or unrelated to the AVM nidus. Intranidal aneurysms have a high correlation with hemorrhagic clinical presentation and a risk of bleeding during the follow-up period that considerably exceeds that which would be expected in their absence. Patients with flow-related aneurysms in association with an AVM may present with hemorrhage from either lesion. Aneurysms that arise on distal feeding arteries near the nidus have a high probability of regressing with substantial or curative AVM therapy.

One-stage excision of high-flow arteriovenous malformations

1985 ◽  
Vol 62 (1) ◽  
pp. 128-131 ◽  
Author(s):  
Joël Bonnal ◽  
Jacques-Daniel Born ◽  
Pol Hans
Keyword(s):  
Carotid Artery ◽  
Arteriovenous Malformations ◽  
Internal Carotid ◽  
Systemic Arterial Pressure ◽  
High Flow ◽  
Brain Swelling ◽  
Content Type ◽  
A New Technique ◽  
Cervical Internal Carotid Artery ◽  
Fine Print

✓ The authors describe two cases of high-flow arteriovenous malformations which illustrate a new technique to reduce the risk of brain swelling and diffuse hemorrhage during or after operation. This technique, used in the latter of the two cases, includes occlusion of the shunt, followed by the progressive tightening of a Selverstone clamp placed on the cervical internal carotid artery, lowering of the systemic arterial pressure, and the use of barbiturate anesthesia. Clamping and anesthesia are maintained for a 24-hour period after surgery.

Traumatic carotid-cavernous fistula due to transection of the intracavernous carotid artery

1984 ◽  
Vol 60 (5) ◽  
pp. 1080-1084 ◽  
Author(s):  
Ibrahim A. Sbeih ◽  
Sean A. O'Laoire
Keyword(s):  
Carotid Artery ◽  
Internal Carotid ◽  
High Flow ◽  
Carotid Cavernous Fistula ◽  
Content Type ◽  
Cavernous Fistula ◽  
Complete Transection ◽  
Intracavernous Carotid Artery ◽  
Direct Attack ◽  
Fine Print

✓ The authors report a case of a high-flow posttraumatic carotid-cavernous fistula, with complete steal of the blood flow from the ipsilateral internal carotid artery (ICA). Direct attack on the intracavernous carotid artery was performed using the approach of Parkinson with temporary isolation of the ICA. Complete transection of the artery within the cavernous sinus was encountered. The fistula was occluded by clipping the two ends of the ICA within the sinus. The implications of this previously unreported finding are discussed.

Gamma knife radiosurgery as a single treatment modality for large cerebral arteriovenous malformations

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 113-119 ◽  
Author(s):  
D. Hung-Chi Pan ◽  
Wan-Yuo Guo ◽  
Wen-Yuh Chung ◽  
Cheng-Ying Shiau ◽  
Yue-Cune Chang ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Radiation Treatment ◽  
Gamma Knife Radiosurgery ◽  
Consecutive Series ◽  
Content Type ◽  
Obliteration Rate ◽  
Complete Obliteration ◽  
Fine Print

Object. A consecutive series of 240 patients with arteriovenous malformations (AVMs) treated by gamma knife radiosurgery (GKS) between March 1993 and March 1999 was evaluated to assess the efficacy and safety of radiosurgery for cerebral AVMs larger than 10 cm3 in volume. Methods. Seventy-six patients (32%) had AVM nidus volumes of more than 10 cm3. During radiosurgery, targeting and delineation of AVM nidi were based on integrated stereotactic magnetic resonance (MR) imaging and x-ray angiography. The radiation treatment was performed using multiple small isocenters to improve conformity of the treatment volume. The mean dose inside the nidus was kept between 20 Gy and 24 Gy. The margin dose ranged between 15 to 18 Gy placed at the 55 to 60% isodose centers. Follow up ranged from 12 to 73 months. There was complete obliteration in 24 patients with an AVM volume of more than 10 cm3 and in 91 patients with an AVM volume of less than 10 cm3. The latency for complete obliteration in larger-volume AVMs was significantly longer. In Kaplan—Meier analysis, the complete obliteration rate in 40 months was 77% in AVMs with volumes between 10 to 15 cm3, as compared with 25% for AVMs with a volume of more than 15 cm3. In the latter, the obliteration rate had increased to 58% at 50 months. The follow-up MR images revealed that large-volume AVMs had higher incidences of postradiosurgical edema, petechiae, and hemorrhage. The bleeding rate before cure was 9.2% (seven of 76) for AVMs with a volume exceeding 10 cm3, and 1.8% (three of 164) for AVMs with a volume less than 10 cm3. Although focal edema was more frequently found in large AVMs, most of the cases were reversible. Permanent neurological complications were found in 3.9% (three of 76) of the patients with an AVM volume of more than 10 cm3, 3.8% (three of 80) of those with AVM volume of 3 to 10 cm3, and 2.4% (two of 84) of those with an AVM volume less than 3 cm3. These differences in complications rate were not significant. Conclusions. Recent improvement of radiosurgery in conjunction with stereotactic MR targeting and multiplanar dose planning has permitted the treatment of larger AVMs. It is suggested that gamma knife radiosurgery is effective for treating AVMs as large as 30 cm3 in volume with an acceptable risk.

Factors related to complete occlusion of arteriovenous malformations after gamma knife radiosurgery

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 96-101 ◽  
Author(s):  
Jong Hee Chang ◽  
Jin Woo Chang ◽  
Yong Gou Park ◽  
Sang Sup Chung
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Maximum Diameter ◽  
Content Type ◽  
Complete Occlusion ◽  
Factors Associated ◽  
Martin Grade ◽  
Fine Print

Object. The authors sought to evaluate the effects of gamma knife radiosurgery (GKS) on cerebral arteriovenous malformations (AVMs) and the factors associated with complete occlusion. Methods. A total of 301 radiosurgical procedures for 277 cerebral AVMs were performed between December 1988 and December 1999. Two hundred seventy-eight lesions in 254 patients who were treated with GKS from May 1992 to December 1999 were analyzed. Several clinical and radiological parameters were evaluated. Conclusions. The total obliteration rate for the cases with an adequate radiological follow up of more than 2 years was 78.9%. In multivariate analysis, maximum diameter, angiographically delineated shape of the AVM nidus, and the number of draining veins significantly influenced the result of radiosurgery. In addition, margin radiation dose, Spetzler—Martin grade, and the flow pattern of the AVM nidus also had some influence on the outcome. In addition to the size, topography, and radiosurgical parameters of AVMs, it would seem to be necessary to consider the angioarchitectural and hemodynamic aspects to select proper candidates for radiosurgery.

A new rat model of chronic cerebral hypoperfusion associated with arteriovenous malformations

2002 ◽  
Vol 97 (5) ◽  
pp. 1198-1202 ◽  
Author(s):  
Jian Hai ◽  
Meixiu Ding ◽  
Zhilin Guo ◽  
Bingyu Wang
Keyword(s):  
Electron Microscopy ◽  
Animal Model ◽  
Arteriovenous Malformations ◽  
Perfusion Pressure ◽  
Chronic Cerebral Hypoperfusion ◽  
Cerebral Hypoperfusion ◽  
Model Group ◽  
Content Type ◽  
The Right ◽  
Fine Print

Object. A new experimental model of chronic cerebral hypoperfusion was developed to study the effects of systemic arterial shunting and obstruction of the primary vessel that drains intracranial venous blood on cerebral perfusion pressure (CPP), as well as cerebral pathological changes during restoration of normal perfusion pressure. Methods. Twenty-four Sprague—Dawley rats were randomly assigned to either a sham-operated group, an arteriovenous fistula (AVF) group, or a model group (eight rats each). The animal model was readied by creating a fistula through an end-to-side anastomosis between the right distal external jugular vein (EJV) and the ispilateral common carotid artery (CCA), followed by ligation of the left vein draining the transverse sinus and bilateral external carotid arteries. Systemic mean arterial pressure (MAP), draining vein pressure (DVP), and CPP were monitored and compared among the three groups preoperatively, immediately postoperatively, and again 90 days later. Following occlusion of the fistula after a 90-day interval, blood—brain barrier (BBB) disruption and water content in the right cortical tissues of the middle cerebral artery territory were confirmed and also quantified with transmission electron microscopy. Formation of a fistula resulted in significant decreases in MAP and CPP, and a significant increase in DVP in the AVF and model groups. Ninety days later, there were still significant increases in DVP and decreases in CPP in the model group compared with the other groups (p < 0.05). Damage to the BBB and brain edema were noted in animals in the model group during restoration of normal perfusion pressure by occlusion of the fistula. Electron microscopy studies revealed cerebral vasogenic edema and/or hemorrhage in various amounts, which correlated with absent astrocytic foot processes surrounding some cerebral capillaries. Conclusions. The results demonstrated that an end-to-side anastomosis between the distal EJV and CCA can induce a decrease in CPP, whereas a further chronic state of cerebral hypoperfusion may be caused by venous outflow restriction, which is associated with perfusion pressure breakthrough. This animal model conforms to the basic hemodynamic characteristics of human cerebral arteriovenous malformations.

Cerebral angiography during operation for intracranial aneurysms and arteriovenous malformations

1971 ◽  
Vol 34 (5) ◽  
pp. 706-708 ◽  
Author(s):  
Martin L. Lazar ◽  
Clark C. Watts ◽  
Bassett Kilgore ◽  
Kemp Clark
Keyword(s):  
Cerebral Angiography ◽  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Operative Procedure ◽  
Superficial Temporal Artery ◽  
Technical Problem ◽  
Temporal Artery ◽  
Content Type ◽  
Actual Operation ◽  
Fine Print

✓ Angiography during the operative procedure is desirable, but is often difficult because of the problem of maintaining a needle or cannula in an artery for long periods of time. Cannulation of the superficial temporal artery avoids this technical problem. The artery is easily found, cannulation is simple, and obliteration of the artery is of no consequence. Cerebral angiography then provides a means for prompt evaluation of the surgical procedure at any time during the actual operation.

Sign in / Sign up

Export Citation Format

Share Document