A proposed scheme for grading intracranial arteriovenous malformations

1986 ◽  
Vol 65 (4) ◽  
pp. 484-489 ◽  
Author(s):  
Yu-quan Shi ◽  
Xian-cheng Chen
Keyword(s):  
Arteriovenous Malformations ◽  
Surgical Excision ◽  
Venous Drainage ◽  
Morbidity And Mortality ◽  
Intracranial Arteriovenous Malformations ◽  
Surgical Morbidity ◽  
Operative Morbidity ◽  
Content Type ◽  
Grade Classification ◽  
Grading Scale

✓ A four-grade classification scheme for intracranial arteriovenous malformations (AVM's) is proposed. Grading is based on 1) the size of the AVM; 2) its location and depth; 3) its arterial supply; and 4) its venous drainage. Each of these aspects is divided into four grades with respect to the difficulty it poses for surgical excision. A description of the grading system and its application is given. This grading scale has been correlated with the operative morbidity and mortality in 100 cases of excised intracranial AVM's. The results show that the higher the grade of AVM, the greater the risk of surgical morbidity and mortality. This grading scale is simple and easy to apply. It can guide neurosurgeons in selecting AVM patients suitable for operation, in determining the best type of operation to perform, and in predicting operative difficulties as well as postoperative results.

Dural arteriovenous malformation of the skull base with intraosseous vascular nidus

1994 ◽  
Vol 81 (4) ◽  
pp. 620-623 ◽  
Author(s):  
Ghaus M. Malik ◽  
Asim Mahmood ◽  
Bharat A. Mehta
Keyword(s):  
Arteriovenous Malformation ◽  
Skull Base ◽  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Dural Arteriovenous Malformation ◽  
Intracranial Arteriovenous Malformations ◽  
Content Type ◽  
Small Subgroup ◽  
Fine Print ◽  
Dural Venous Sinuses

✓ Intracranial arteriovenous malformations (AVM's) have been classified as pure pial, pure dural, and mixed pial and dural. Dural AVM's are relatively uncommon, with 377 cases documented up to 1990. These lesions were believed to be situated within the walls of the sinuses, but during the last decade researchers discovered a small subgroup of dural AVM's in extrasinusal locations such as the skull base and tentorium. Two of the 17 patients who were studied between 1976 and 1993 had dural AVM's that were entirely intraosseous except for their venous drainage, which was via the dural venous sinuses. Although such intraosseous dural AVM's have not been previously described, the authors elected to group these malformations with dural AVM's because their venous drainage was intracranial and angiograms revealed identical features.

Surgical approaches to trigonal arteriovenous malformations

1987 ◽  
Vol 67 (4) ◽  
pp. 511-517 ◽  
Author(s):  
Hunt Batjer ◽  
Duke Samson
Keyword(s):  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Parahippocampal Gyrus ◽  
Surgical Approaches ◽  
Middle Temporal Gyrus ◽  
Intracranial Arteriovenous Malformations ◽  
Content Type ◽  
Lateral Posterior ◽  
The Mean ◽  
Multiple Episodes

✓ Only about 5% of intracranial arteriovenous malformations (AVM's) are located predominantly within the ventricular system. Between July, 1981, and February, 1986, 15 patients were treated at the authors' institution for AVM's within the ventricular trigone. The mean age of this patient population was 24 years, and two-thirds were female. Intracranial hemorrhage was by far the most frequent presenting symptom and intraventricular hemorrhage occurred in 11 cases, with multiple episodes being documented in five. Arterial supply of the malformations was quite uniform, with the lateral posterior choroidal or posterior temporal branch of the posterior cerebral artery (PCA) being the most frequent source. Venous drainage was similarly stereotypic, with predominant outflow into the galenic system in all but one patient. An interhemispheric surgical approach was used in eight patients, a middle or inferior temporal gyrus incision was performed in six, and a subtemporal route was chosen in a single patient. Operative results suggest that these lesions can be removed with reasonable safety. An interhemispheric approach is recommended if the nidus projects medially from the trigone and is observed medial to the P2-P3 junction of the PCA on angiography. A middle temporal gyrus approach is suggested if the nidus is lateral to the P2-P3 junction, even when the lesion is located in the dominant hemisphere. A subtemporal approach should be reserved for inferiorly projecting AVM's with cortical representation on the fusiform or parahippocampal gyrus in the nondominant hemisphere.

Microsurgery for 67 intracranial arteriovenous malformations less than 3 cm in diameter

1993 ◽  
Vol 79 (5) ◽  
pp. 653-660 ◽  
Author(s):  
Michael B. Sisti ◽  
Abraham Kader ◽  
Bennett M. Stein
Keyword(s):  
Arteriovenous Malformations ◽  
Operative Mortality ◽  
Surgical Results ◽  
Cure Rate ◽  
Intracranial Arteriovenous Malformations ◽  
Surgical Morbidity ◽  
Content Type ◽  
Microsurgical Technique ◽  
Neurological Morbidity ◽  
Fine Print

✓ The surgical outcome in a series of small arteriovenous malformations (AVM's) that might have been considered optimal for radiosurgery is reviewed. In a total microsurgical series of 360 patients, 67 (19%) underwent resection of AVM's less than 3 cm in largest diameter, regardless of location. Many of these lesions (45%) were in locations that might be considered surgically inaccessible such as the thalamus, brain stem, medial hemisphere, and paraventricular regions. Complete angiographic obliteration of the AVM by microsurgical technique was accomplished in 63 patients (94%) with a surgical morbidity of 1.5% and no operative mortality. Patients with hemispheric AVM's had a cure rate of 100% and no neurological morbidity. Stereotactically guided craniotomy was used in 14 patients (21%) to locate and resect deep or concealed malformations. The results from five major radiosurgery centers treating similar-sized AVM's are analyzed. The authors' surgical results compare favorably with those from radiosurgery centers which, in their opinion, supports the conclusion that microneurosurgery is superior to radiosurgery, except for a small percentage of lesions that are truly inoperable on the basis of inaccessibility.

Unusual clinical manifestations of dural arteriovenous malformations

1986 ◽  
Vol 64 (4) ◽  
pp. 554-558 ◽  
Author(s):  
Fernando Viñuela ◽  
Allan J. Fox ◽  
David M. Pelz ◽  
Charles G. Drake
Keyword(s):  
Arteriovenous Malformations ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Surgical Excision ◽  
Venous Drainage ◽  
Endovascular Embolization ◽  
External Carotid Artery ◽  
External Carotid ◽  
Content Type ◽  
Visual Disturbances

✓ Fourteen patients had classical angiographic findings of intracranial dural arteriovenous malformations (AVM's). They presented with unusual central neurological signs and symptoms, including visual disturbances, hemiparesis, speech disturbances, gait ataxia, diffuse increased intracranial pressure, and intracranial hemorrhage. In 12 of the 14 patients there was a direct correlation between the clinical presentation and the venous drainage characteristics of the AVM's. The symptoms were probably related to a regional steal phenomenon in two patients. Six patients had direct surgical excision of the dural AVM. Five patients underwent endovascular embolization of the malformation and, in one case, the AVM was removed surgically after embolization. In one patient, the external carotid artery in the neck was ligated. Ten of the 14 patients had substantial clinical improvement or cure. A complete anatomical obliteration of the malformation was obtained in seven cases. None of the patients deteriorated clinically after therapy.

Natural course of unoperated intracranial arteriovenous malformations: study of 50 cases

1989 ◽  
Vol 71 (6) ◽  
pp. 805-809 ◽  
Author(s):  
Youichi Itoyama ◽  
Syouzaburou Uemura ◽  
Yukitaka Ushio ◽  
Jun-Ichi Kuratsu ◽  
Nobuhito Nonaka ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Poor Prognosis ◽  
Clinical Course ◽  
Initial Symptom ◽  
Intracranial Arteriovenous Malformations ◽  
Good Clinical Outcome ◽  
Content Type ◽  
Initial Rupture ◽  
High Incidence

✓ The clinical course of 50 patients with conservatively treated intracranial arteriovenous malformations (AVM's) was followed, most of them for more than 5 years. The average follow-up period was 13.4 years. The initial symptom was intracranial bleeding in 29 patients (58%) and seizure in 15 patients (30%). Small and deep-seated AVM's were associated with a high incidence of bleeding; however, repeated hemorrhages were not necessarily indicative of a poor prognosis. Children younger than 15 years had a better prognosis than adults. There was no correlation between pregnancy and bleeding. In the hemorrhage group, the incidence of rebleeding was 6.9% in the 1st year after initial rupture, 1.91% per year after 5 years, and 0.92% per year after 15 years. The overall incidence of rebleeding was 34.5% in the hemorrhage group. Of the 50 patients, 37 (74%) had a good clinical outcome, four (8%) had a fair outcome, and four (8%) had a poor outcome; five patients died.

Treatment of cerebral arteriovenous malformations

1980 ◽  
Vol 52 (5) ◽  
pp. 705-708 ◽  
Author(s):  
Laurence D. Cromwell ◽  
A. Basil Harris
Keyword(s):  
Arteriovenous Malformations ◽  
Direct Injection ◽  
Surgical Excision ◽  
Cerebral Arteriovenous Malformations ◽  
Content Type ◽  
Significant Damage ◽  
Fine Print ◽  
Adjacent Brain

✓ It is believed that surgical excision of arteriovenous malformations is the best treatment when technically feasible without causing significant damage to adjacent brain. The introduction of polymers or particulate emboli by catheter has been used either alone or as an adjunct in attempts to reduce the size of these lesions prior to surgery; however, it is seldom possible to embolize the entire malformation. The authors have used direct injection of a 50% mixture of bucrylate and iophendylate into the feeding arteries supplying the area at craniotomy, with success in three cases. The cases are described to illustrate the method.

Management of dural arteriovenous malformations of the anterior cranial fossa

1990 ◽  
Vol 72 (5) ◽  
pp. 692-697 ◽  
Author(s):  
Neil A. Martin ◽  
Wesley A. King ◽  
Charles B. Wilson ◽  
Stephen Nutik ◽  
L. Phillip Carter ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Venous Drainage ◽  
Anterior Cranial Fossa ◽  
Venous Aneurysm ◽  
Content Type ◽  
Cortical Vein ◽  
Sagittal Sinus ◽  
Feeding Vessels ◽  
Cranial Fossa

✓ Eight patients with dural arteriovenous malformations (AVM's) of the anterior cranial fossa are presented, and the pertinent literature is reviewed. Unlike cases of dural AVM's in other locations, sudden massive intracerebral hemorrhage was the most frequent reason for presentation. Other symptoms included tinnitus, retro-orbital headache, and a generalized seizure. The malformations were supplied consistently by the anterior ethmoidal artery, usually in combination with other less prominent feeding vessels. The lesion's venous drainage was through the superior sagittal sinus via a cortical vein; in addition, in two cases a subfrontal vein drained the AVM. A venous aneurysm was encountered near the site of anastomosis with the dural feeder in most cases, and was found in all patients who presented with hemorrhage. The AVM was obliterated surgically in six patients, with favorable results achieved in five. One patient died postoperatively from a pulmonary complication. Because of their anatomy and proclivity for hemorrhage, these vascular malformations represent a unique group of dural AVM's. Surgical management of anterior fossa dural AVM's carries low morbidity, and is indicated when the lesions have caused hemorrhage or when there is an associated venous aneurysm.

Analysis of the causes of treatment failure in gamma knife radiosurgery for intracranial arteriovenous malformations

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 104-106 ◽  
Author(s):  
Yang Kwon ◽  
Sang Ryong Jeon ◽  
Jeong Hoon Kim ◽  
Jung Kyo Lee ◽  
Dong Sook Ra ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Treatment Failure ◽  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Intracranial Arteriovenous Malformations ◽  
Content Type ◽  
The Mean ◽  
Fine Print

Object. The authors sought to analyze causes for treatment failure following gamma knife radiosurgery (GKS) for intracranial arteriovenous malformations (AVMs), in cases in which the nidus could still be observed on angiography 3 years postsurgery. Methods. Four hundred fifteen patients with AVMs were treated with GKS between April 1990 and March 2000. The mean margin dose was 23.6 Gy (range 10–25 Gy), and the mean nidus volume was 5.3 cm3 (range 0.4–41.7 cm3). The KULA treatment planning system and conventional subtraction angiography were used in treatment planning. One hundred twenty-three of these 415 patients underwent follow-up angiography after GKS. After 3 years the nidus was totally obliterated in 98 patients (80%) and partial obliteration was noted in the remaining 25. There were several reasons why complete obliteration was not achieved in all cases: inadequate nidus definition in four patients, changes in the size and location of the nidus in five patients due to recanalization after embolization or reexpansion after hematoma reabsorption, a large AVM volume in five patients, a suboptimal radiation dose to the thalamic and basal ganglia in eight patients, and radioresistance in three patients with an intranidal fistula. Conclusions. The causes of failed GKS for treatment of AVMs seen on 3-year follow-up angiograms include inadequate nidus definition, large nidus volume, suboptimal radiation dose, recanalization/reexpansion, and radioresistance associated with an intranidal fistula.

Intraoperative color-flow Doppler imaging of AVM's and aneurysms

1988 ◽  
Vol 68 (4) ◽  
pp. 635-639 ◽  
Author(s):  
Keith L. Black ◽  
Jonathan M. Rubin ◽  
William F. Chandler ◽  
John E. McGillicuddy
Keyword(s):  
Arteriovenous Malformations ◽  
Doppler Sonography ◽  
Giant Aneurysm ◽  
Surgical Excision ◽  
Doppler Imaging ◽  
Vascular Lesions ◽  
Color Flow ◽  
Content Type ◽  
Color Flow Doppler Sonography ◽  
Spinal Arteriovenous Malformations

✓ The use of intraoperative color-flow Doppler sonography to image cerebral and spinal arteriovenous malformations (AVM's) and a giant aneurysm is reported in 10 patients. The technique is a useful adjunct in localizing vascular lesions, identifying feeding or draining vessels, and confirming intraoperative surgical excision of AVM's or ligation of giant aneurysms. Imaging of lesions deeper than 4 to 5 cm is, however, limited with the equipment design now commercially available.

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