Management of arteriovenous malformations of the brain stem

1986 ◽  
Vol 64 (6) ◽  
pp. 857-864 ◽  
Author(s):  
Robert A. Solomon ◽  
Bennett M. Stein
Keyword(s):  
Radiation Therapy ◽  
Brain Stem ◽  
Arteriovenous Malformations ◽  
Treated Group ◽  
Intracranial Arteriovenous Malformations ◽  
Content Type ◽  
Embolization Therapy ◽  
Complete Obliteration ◽  
The Brain ◽  
Fine Print

✓ In a series of 250 intracranial arteriovenous malformations (AVM's), 12 malformations involved the brain stem. Nine of these lesions were treated surgically, with complete obliteration in eight. There were no operative deaths, and only two patients were made worse by surgery. In the nonsurgically treated group, one patient had embolization therapy and two patients underwent radiation therapy. Results in these three patients have not been satisfactory. These data indicate that brain-stem AVM's can be surgically removed with acceptable morbidity.

Arteriovenous malformations in the posterior fossa

1977 ◽  
Vol 47 (1) ◽  
pp. 50-56 ◽  
Author(s):  
Hiroshi Matsumura ◽  
Yasumasa Makita ◽  
Kuniyuki Someda ◽  
Akinori Kondo
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Stem ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Cerebellopontine Angle ◽  
Anterior Part ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ We have operated on 12 of 14 cases of arteriovenous malformation (AVM) in the posterior fossa since 1968, with one death. The lesions were in the cerebellum in 10 cases (three anteromedial, one central, three lateral, and three posteromedial), and in the cerebellopontine angle in two; in two cases the lesions were directly related to the brain stem. The AVM's in the anterior part of the cerebellum were operated on through a transtentorial occipital approach.

Vascular malformations of the brain stem

1989 ◽  
Vol 70 (6) ◽  
pp. 847-852 ◽  
Author(s):  
Douglas Chyatte
Keyword(s):  
Brain Stem ◽  
Vascular Malformation ◽  
Vascular Malformations ◽  
Surgical Removal ◽  
Content Type ◽  
Appropriate Treatment ◽  
Complete Obliteration ◽  
Time Of Presentation ◽  
The Brain ◽  
Fine Print

✓ Vascular malformations of the brain stem are unusual lesions that may pose a diagnostic and therapeutic challenge. Seven patients with vascular malformations involving the brain stem were evaluated; six were treated surgically, with complete obliteration of the lesion in five patients. In five patients symptoms developed only after a hemorrhage had occurred, and three of these suffered a rebleed before appropriate treatment was given. Angiography failed to demonstrate lesions in three cases, which did not appear to protect from repeat hemorrhage since two of the three rebled. There were no operative deaths, and no patients were made permanently worse after surgery. Useful recovery occurred commonly after appropriate treatment and appeared to be possible even in patients who had suffered a catastrophic neurological deficit at the time of presentation. These data indicate that surgical removal of the lesion may be warranted in some patients with symptomatic brain-stem vascular malformation.

Stereotactic radiosurgery for arteriovenous malformations of the brain

1991 ◽  
Vol 75 (4) ◽  
pp. 512-524 ◽  
Author(s):  
L. Dade Lunsford ◽  
Douglas Kondziolka ◽  
John C. Flickinger ◽  
David J. Bissonette ◽  
Charles A. Jungreis ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Neurological Deficits ◽  
Content Type ◽  
Complete Obliteration ◽  
Latency Interval ◽  
Subtotal Removal ◽  
The Brain ◽  
Fine Print

✓ Stereotactic radiosurgery successfully obliterates carefully selected arteriovenous malformations (AVM's) of the brain. In an initial 3-year experience using the 201-source cobalt-60 gamma knife at the University of Pittsburgh, 227 patients with AVM's were treated. Symptoms at presentation included prior hemorrhage in 143 patients (63%), headache in 104 (46%), and seizures in 70 (31%). Neurological deficits were present in 102 patients (45%). Prior surgical resection (resulting in subtotal removal) had been performed in 36 patients (16%). In 47 selected patients (21%), embolization procedures were performed in an attempt to reduce the AVM size prior to radiosurgery. The lesions were classified according to the Spetzler grading system: 64 (28%) were Grade VI (inoperable), 22 (10%) were Grade IV, 90 (40%) were Grade III, 43 (19%) were Grade II, and eight (4%) were Grade I. With the aid of computer imaging-integrated isodose plans for single-treatment irradiation, total coverage of the AVM nidus was possible in 216 patients (95%). The location and volume of the AVM were the most important factors for the selection of radiation dose. Magnetic resonance (MR) imaging was performed at 6-month intervals in 161 patients. Seventeen patients who had MR evidence of complete obliteration underwent angiography within 3 months of imaging: in 14 (82%) complete obliteration was confirmed. Complete angiographic obliteration was confirmed in 37 (80%) of 46 patients at 2 years, the earliest confirmation being 4 months (mean 17 months) after radiosurgery. The 2-year obliteration rates according to volume were: all eight (100%) AVM's less than 1 cu cm; 22 (85%) of 26 AVM's of 1 to 4 cu cm; and seven (58%) of 12 AVM's greater than 4 cu cm. Magnetic resonance imaging revealed postirradiation changes in 38 (24%) of 161 patients at a mean interval of 10.2 months after radiosurgery; only 10 (26%) of those 38 patients were symptomatic. In the entire series, two patients developed permanent new neurological deficits believed to be treatment-related. Two patients died of repeat hemorrhage at 6 and 23 months after treatment during the latency interval prior to obliteration. Stereotactic radiosurgery is an important method to obliterate AVM's, especially those previously considered inoperable. Success and complication risks are related to the AVM location and the volume treated.

Surgical treatment of vascular lesions in the brain stem

1975 ◽  
Vol 42 (1) ◽  
pp. 23-31 ◽  
Author(s):  
Shelley N. Chou ◽  
Donald L. Erickson ◽  
Humberto J. Ortiz-Suarez
Keyword(s):  
Surgical Treatment ◽  
Brain Stem ◽  
Arteriovenous Malformations ◽  
Vascular Lesions ◽  
Surgical Removal ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ The authors report the total surgical removal of five vascular lesions of the brain stem, three hemangioblastomas and two arteriovenous malformations. One patient died; among the others, the quality of survival is excellent. Factors favoring surgical removal of such lesions are discussed.

Surgical removal of arteriovenous malformations from the brain stem and cerebellopontine angle

1975 ◽  
Vol 43 (6) ◽  
pp. 661-670 ◽  
Author(s):  
Charles G. Drake
Keyword(s):  
Arteriovenous Malformation ◽  
Brain Stem ◽  
Arteriovenous Malformations ◽  
Cerebellopontine Angle ◽  
Neurological Deficits ◽  
Surgical Removal ◽  
Surgical Experience ◽  
Content Type ◽  
The Brain ◽  
Fine Print

✓ The author reports his surgical experience with five cases of arteriovenous malformation of the brain stem and cerebellopontine angle causing multiple hemorrhages and severe neurological deficits. Surgical removal of the lesions had good results in four cases; there was one death.

Surgical treatment of cryptic AVM's and associated hematoma in the brain stem and spinal cord

1986 ◽  
Vol 65 (2) ◽  
pp. 188-193 ◽  
Author(s):  
Richard J. Veerapen ◽  
Ibrahim Abdeaziz Sbeih ◽  
Sean A. O'Laoire
Keyword(s):  
Spinal Cord ◽  
Surgical Treatment ◽  
Brain Stem ◽  
Arteriovenous Malformations ◽  
Vascular Tissue ◽  
Content Type ◽  
The Third ◽  
The Brain ◽  
Fine Print

✓ Most surgically treated cases of brain-stem hematomas have been attributed to rupture of cryptic arteriovenous malformations (AVM's); however, very few cases have been histologically proven. Similarly, there are very few reports of surgically treated spontaneous hematomyelia, in which the hemorrhage has been histologically confirmed as being due to a purely intramedullary AVM. The authors report three cases with surgically treated, histologically confirmed AVM's, of which two were in the brain stem and the third was in the spinal cord. In all these cases, abnormal vascular tissue in the wall of the hematoma cavity was recognized at operation and excised.

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.

Cervical spinal cord in experimental hydrocephalus

1972 ◽  
Vol 37 (5) ◽  
pp. 538-542 ◽  
Author(s):  
George J. Dohrmann
Keyword(s):  
Spinal Cord ◽  
Brain Stem ◽  
Cervical Spinal Cord ◽  
Central Canal ◽  
Content Type ◽  
Experimental Hydrocephalus ◽  
Physiological Pressure ◽  
The Brain ◽  
Shunting Procedure ◽  
Fine Print

✓ Adult dogs were rendered hydrocephalic by the injection of kaolin into the cisterna magna. One group of dogs was sacrificed 1 month after kaolin administration, and ventriculojugular shunts were performed on the other group. Hydrocephalic dogs with shunts were sacrificed 1 day or 1 week after the shunting procedure. All dogs were perfused with formalin at physiological pressure, and the brain stem and cervical spinal cord were examined by light microscopy. Subarachnoid granulomata encompassed the superior cervical spinal cord and dependent surface of the brain stem. Rarefaction of the posterior white columns and clefts or cavities involving the gray matter posterior to the central canal and/or posterior white columns were present in the spinal cords of both hydrocephalic and shunted hydrocephalic dogs. Predominantly in the dogs with shunts, hemorrhages were noted in the spinal cord in association with the clefts or cavities. A mechanism of ischemia followed by reflow of blood is postulated to explain the hemorrhages in the spinal cords of hydrocephalic dogs with shunts.

Long-term complications after gamma knife surgery for arteriovenous malformations

2005 ◽  
Vol 102 (Special_Supplement) ◽  
pp. 34-37 ◽  
Author(s):  
Masahiro Izawa ◽  
Motohiro Hayashi ◽  
Mikhail Chernov ◽  
Koutarou Nakaya ◽  
Taku Ochiai ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Cyst Formation ◽  
Gamma Knife Surgery ◽  
Content Type ◽  
Delayed Hemorrhage ◽  
Complete Obliteration ◽  
Risk Of Hemorrhage ◽  
Fine Print

Object. The authors analyzed of the long-term complications that occur 2 or more years after gamma knife surgery (GKS) for intracranial arteriovenous malformations (AVMs). Methods. Patients with previously untreated intracranial AVMs that were managed by GKS and followed for at least 2 years after treatment were selected for analysis (237 cases). Complete AVM obliteration was attained in 130 cases (54.9%), and incomplete obliteration in 107 cases (45.1%). Long-term complications were observed in 22 patients (9.3%). These complications included hemorrhage (eight cases), delayed cyst formation (eight cases), increase of seizure frequency (four cases), and middle cerebral artery stenosis and increased white matter signal intensity on T2-weighted magnetic resonance imaging (one case of each). The long-term complications were associated with larger nidus volume (p < 0.001) and a lobar location of the AVM (p < 0.01). Delayed hemorrhage was associated only with incomplete obliteration of the nidus (p < 0.05). Partial obliteration conveyed no benefit. Delayed cyst formation was associated with a higher maximal GKS dose (p < 0.001), larger nidus volume (p < 0.001), complete nidus obliteration (p < 0.01), and a lobar location of the AVM (p < 0.05). Conclusions. Incomplete obliteration of the nidus is the most important factor associated with delayed hemorrhagic complications. Partial obliteration does not seem to reduce the risk of hemorrhage. Complete obliteration can be complicated by delayed cyst formation, especially if high maximal treatment doses have been administered.

Intraoperative monitoring of brain-stem auditory evoked potentials

1982 ◽  
Vol 57 (5) ◽  
pp. 674-681 ◽  
Author(s):  
Betty L. Grundy ◽  
Peter J. Jannetta ◽  
Phyllis T. Procopio ◽  
Agnes Lina ◽  
J. Robert Boston ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
Brain Stem ◽  
Auditory Nerve ◽  
Intraoperative Monitoring ◽  
Cerebellopontine Angle ◽  
Auditory Evoked Potentials ◽  
Irreversible Loss ◽  
Content Type ◽  
Complete Obliteration ◽  
Fine Print

✓ Brain-stem auditory evoked potentials (BAEP) were monitored during 54 neurosurgical operations in the cerebellopontine angle. The BAEP were irreversibly obliterated in five patients who required deliberate section of the auditory nerve. Technical difficulties interfered with monitoring in three cases, and three patients had deafness and absent BAEP preoperatively. Reversible alterations in BAEP were seen during 32 operations, with recovery after as long as 177 minutes of virtually complete obliteration. Changes in BAEP were associated with surgical retraction, operative manipulation, positioning of the head and neck for retromastoid craniectomy, and the combination of hypocarbia and moderate hypotension. In 19 cases, waveforms improved after specific interventions made by the surgeon or anesthesiologist because of deteriorating BAEP. In 13 other cases, BAEP recovered after maneuvers not specifically related to the electrophysiological monitoring, most often completion of operative manipulation. Whenever BAEP returned toward normal by the end of anesthesia, even after transient obliteration, hearing was preserved. Irreversible loss of BAEP occurred only when the auditory nerve was deliberately sacrificed. The authors conclude that monitoring of BAEP may help prevent injury to the auditory nerve and brain stem during operations in the cerebellopontine angle.

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