Platelet aggregation within cerebral arteriovenous malformations

1988 ◽  
Vol 68 (2) ◽  
pp. 198-204 ◽  
Author(s):  
Garnette R. Sutherland ◽  
Martin E. King ◽  
Charles G. Drake ◽  
Sidney J. Peerless ◽  
William C. Vezina
Keyword(s):  
Platelet Aggregation ◽  
Arterial Thrombosis ◽  
Arteriovenous Malformations ◽  
Thrombus Formation ◽  
Short Interval ◽  
Arterial Occlusion ◽  
Blood Pool ◽  
Cerebral Arteriovenous Malformations ◽  
Content Type ◽  
Fine Print

✓ Turbulence within cerebral arteriovenous malformations (AVM's) may lead to endothelial disruption, platelet aggregation, and thrombus formation. This hypothesis would account for many of the pathological features in AVM's, including intimal hyperplasia and arterial thrombosis with or without organization. In this study, a dual-isotope method employing indium-111-labeled platelets and technetium-99m-labeled red blood cells was used to evaluate in vivo platelet aggregation in 20 patients with AVM's. The use of two isotopes allows subtraction of the blood-pool platelets and calculation of the ratio of the indium deposited:the indium in the blood pool (In(D)/In(BP)). After a 24-hour incubation period, eight of the 20 patients demonstrated platelet aggregation in their AVM's with a mean In(D)/In(BP) ratio of 0.71 ± 0.36 (± standard deviation). Seven of these AVM's were available for pathological study and all of them demonstrated evidence of arterial thrombosis of variable age. In the remaining 12 patients, the In(D)/In(BP) ratio was not significantly elevated (mean 0.02 ± 0.13), indicating the absence of active platelet aggregation during this short interval of study. Five of these AVM's were pathologically examined, four of which showed evidence of arterial occlusion. It is concluded that platelet aggregation is a common occurrence in cerebral AVM's and may account for the dynamic histopathology often seen in these lesions.

Interhemispheric approach for the surgical removal of thalamocaudate arteriovenous malformations

1987 ◽  
Vol 66 (3) ◽  
pp. 345-351 ◽  
Author(s):  
Robert A. Solomon ◽  
Bennett M. Stein
Keyword(s):  
Corpus Callosum ◽  
Arteriovenous Malformations ◽  
Surgical Removal ◽  
Cerebral Arteriovenous Malformations ◽  
Total Removal ◽  
Recurrent Hemorrhage ◽  
Content Type ◽  
Interhemispheric Approach ◽  
Parinaud’S Syndrome ◽  
Fine Print

✓ A series of 250 surgically treated cerebral arteriovenous malformations (AVM's) is presented, in which 22 lesions were located primarily in the thalamus and caudate nucleus. A standardized interhemispheric approach through the posterior corpus callosum and into the atrium of the lateral ventricle was utilized for the surgical removal of these AVM's. Total removal was confirmed by angiography in 18 patients; removal was subtotal in four cases. There were no deaths in this group of patients. Disturbances of recent memory pre- and postoperatively were seen in half of the patients, but most of these deficits were temporary. Other complications included: postoperative homonymous hemianopsia (six cases), transient hemiparesis (three cases), hemisensory loss (two cases), Parinaud's syndrome (one case), and recurrent hemorrhage 2 years after surgery (one case). All 22 patients returned to their previous occupations and are leading independent lives. The results of this experience indicate that thalamocaudate AVM's can be effectively treated by resection.

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.

Microvascular embolization of cerebral arteriovenous malformations

1979 ◽  
Vol 51 (5) ◽  
pp. 621-627 ◽  
Author(s):  
Sean Mullan ◽  
Henry Kawanaga ◽  
Nicholas J. Patronas
Keyword(s):  
Arteriovenous Malformations ◽  
Cerebral Arteriovenous Malformations ◽  
Content Type ◽  
Established Technique ◽  
Partial Success ◽  
Fine Print

✓ A useful variation of an established technique is described for embolization of cerebral arteriovenous malformations. Silastic sponge emboli that fit into No. 16, 17, and 18 stub adapters are passed through standard-sized transfemoral catheters. Of 28 treated patients, obliteration was regarded as very successful in 16. Partial success was achieved in four. Eight were regarded as failures because the reticulum was too large for these microemboli.

Associated arteriovenous malformation of the orbit and brain: a case of Wyburn-Mason syndrome without retinal involvement

2001 ◽  
Vol 95 (2) ◽  
pp. 346-349 ◽  
Author(s):  
Francisco A. Ponce ◽  
Patrick P. Han ◽  
Robert F. Spetzler ◽  
Alexa Canady ◽  
Iman Feiz-Erfan
Keyword(s):  
Arteriovenous Malformation ◽  
Arteriovenous Malformations ◽  
Rare Condition ◽  
Cerebral Arteriovenous Malformations ◽  
Cutaneous Lesions ◽  
Content Type ◽  
Gestational Period ◽  
Fourth Case ◽  
The Face ◽  
Fine Print

✓ Wyburn-Mason syndrome is a rare condition associated with multiple cerebral arteriovenous malformations. The disease, also called retinoencephalofacial angiomatosis, includes lesions of the retina, brain, and skin. This disorder stems from a vascular dysgenesis of the embryological anterior plexus early in the gestational period when the primitive vascular mesoderm is shared by the involved structures. The timing of the insult to the embryonic tissue determines which structures are affected. Extensions of the lesions vary widely but cutaneous lesions are unusual. Among reports in the literature, only three cases appear to have manifested without retinal involvement. The authors report the fourth case of Wyburn-Mason syndrome in which there was no retinal involvement and the first to involve neither the retina nor the face.

Pathology of arteriovenous malformations embolized with isobutyl-2-cyanoacrylate (bucrylate)

1981 ◽  
Vol 55 (5) ◽  
pp. 819-825 ◽  
Author(s):  
Harry V. Vinters ◽  
Gérard Debrun ◽  
John C. E. Kaufmann ◽  
Charles G. Drake
Keyword(s):  
Arteriovenous Malformations ◽  
Therapeutic Embolization ◽  
Brain Parenchyma ◽  
Pathological Examination ◽  
Foreign Body Giant Cell ◽  
Cell Reaction ◽  
Cerebral Arteriovenous Malformations ◽  
Content Type ◽  
Fine Print ◽  
Adjacent Brain

✓ There is controversy as to the possible toxic effects of isobutyl-2-cyanoacrylate (bucrylate) when this substance is used for purposes of therapeutic embolization. Two cases are presented in which cerebral arteriovenous malformations were resected, one 42 days and the other a year after bucrylate embolization. In both, pathological examination revealed a brisk intimal foreign-body giant-cell reaction wherever bucrylate was present in a vessel, along with chronic inflammation in the vessel walls and adjacent brain parenchyma. The findings are discussed in the light of other observations on the histotoxicity of bucrylate.

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.

Multiple cerebral arteriovenous malformations associated with soft-tissue vascular malformations

1981 ◽  
Vol 54 (5) ◽  
pp. 670-672 ◽  
Author(s):  
Ahmed Hanieh ◽  
Peter C. Blumbergs ◽  
Paul G. Carney
Keyword(s):  
Soft Tissue ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Rare Condition ◽  
Cerebral Arteriovenous Malformations ◽  
Intracranial Arteriovenous Malformations ◽  
Content Type ◽  
Fine Print

✓ A patient found unconscious, probably due to a seizure, was discovered to have two intracranial arteriovenous malformations. Multiple arteriovenous malformations is a rare condition, and both lesions were excised successfully.

Seizure control after surgery on cerebral arteriovenous malformations

1993 ◽  
Vol 78 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Hwa-shain Yeh ◽  
John M. Tew ◽  
Maureen Gartner
Keyword(s):  
Arteriovenous Malformations ◽  
Seizure Control ◽  
Temporal Structure ◽  
Young Patients ◽  
Visual Field Defects ◽  
Cerebral Arteriovenous Malformations ◽  
Seizure Onset ◽  
Content Type ◽  
Fine Print

✓ Prediction of seizure control after surgery on cerebral arteriovenous malformations (AVM's) is currently unavailable. Between 1982 and 1990, 54 patients (30 males, 24 females) with epilepsy caused by a supratentorial cerebral AVM, without prior manifestation of intracranial hemorrhage, were surgically treated. Patients ranged in age from 11 to 59 years at seizure onset and from 13 to 70 years at surgery; the duration of seizure history ranged from several months to 27 years. The AVM's were located in the temporal (17 cases), frontal (15), parietal (10), rolandic (two), and occipital (two) regions; eight were multilobular. All patients underwent preoperative electroencephalography, intraoperative electrocorticography, and total excision of the AVM; additional cortical excision was performed in 25 cases. Remote seizure foci were identified in the ipsilateral mesial temporal structure in 10 patients with AVM's located in the lateral or posterior temporal lobe and in one with an AVM in the anterior frontal region. Two patients required a second operation to remove a remote seizure focus. Among the 54 patients, there were no operative deaths. After surgical treatment, two patients developed hemiparesis, one had contralateral paresthesia of limbs, two suffered partial visual field defects, and five experienced temporary speech disturbances. Postoperative results of seizure control during follow-up study (mean duration 4.8 years) were excellent in 38 patients (70.4%), good in 10 (18.5%), fair in five (9.3%), and poor in one (1.9%). Results appear to correlate with age at seizure onset, duration of seizures, location of lesions, and cortical excision. Excellent results were shown in 18 (60%) of 30 patients whose age at seizure onset was 30 years or less and in 20 (83.3%) of 24 whose age at seizure onset was greater than 30 years. Eighteen (90%) of 20 patients had excellent results when seizure duration was 1 year or less; only 25% of these underwent cortical excision. Twelve (71%) of the 17 temporal AVM's were associated with demonstrable epileptic foci. Secondary epileptogenesis can occur in humans with supratentorial cerebral AVM's; cortical excision in selected patients can improve the outcome of seizure control. Early surgery of a cerebral AVM in young patients presenting with epilepsy is an important consideration.

Platelet interaction within giant intracranial aneurysms

1982 ◽  
Vol 56 (1) ◽  
pp. 53-61 ◽  
Author(s):  
Garnette R. Sutherland ◽  
Martin E. King ◽  
S. J. Peerless ◽  
William C. Vezina ◽  
G. William Brown ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Intracranial Aneurysms ◽  
Blood Pool ◽  
Mean Value ◽  
Neurological Deficits ◽  
Content Type ◽  
Dual Isotope ◽  
Giant Intracranial Aneurysms ◽  
Platelet Deposition ◽  
Fine Print

✓ Turbulence within intracranial aneurysms may result in tearing of the aneurysmal wall, exposing the subendothelial matrix to circulating platelets. In this study, platelet interaction in giant intracranial aneurysms was evaluated by a dual-isotope technique employing 111In-labeled platelets and 99mTc-labeled red blood cells. The use of two isotopes allows the subtraction of the blood pool and the calculation of the ratio indium deposited:indium blood pool (In(D)/In(BP)). A ratio greater than zero indicates platelet deposition within the aneurysm. Thirteen patients were evaluated in this way, with platelet deposition demonstrated in six. In these six patients, the ratio In(D)/In(BP) was found to be significantly elevated, with a mean value of 0.96 ± 0.65. Three of these six patients had symptoms of recurrent transient neurological deficits; one of these three suffered a complete stroke following documentation of platelet deposition. In this case, the aneurysm was obtained at surgery and was found to contain intraluminal platelet aggregation when viewed by scanning electron microscopy. In the remaining seven patients, the ratio In(D)/In(BP) was found not to be significantly elevated (mean −0.03 ± 0.06), indicating the absence of active platelet deposition. Two of these patients had prior symptoms of cerebral ischemia; one of these was found to have an ulcer in the ipsilateral internal carotid artery which was probably responsible for thromboembolic events to the hemisphere. The authors conclude that platelet aggregation occurs more frequently than previously recognized in giant intracranial aneurysms, and their data substantiate the hypothesis that platelet metabolic products or thrombi originating from a large aneurysm may embolize to distal cerebral vessels.

Development of multiple cerebral arteriovenous malformations documented in an adult by serial angiography

2003 ◽  
Vol 98 (1) ◽  
pp. 190-193 ◽  
Author(s):  
Yoshio Miyasaka ◽  
Kuniaki Nakahara ◽  
Hiroshi Takagi ◽  
Hiroyuki Hagiwara
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Cerebral Angiography ◽  
Arteriovenous Malformations ◽  
Intracerebral Hematoma ◽  
Cerebral Arteriovenous Malformations ◽  
Content Type ◽  
Hematoma Evacuation ◽  
Cerebral Avms ◽  
Fine Print

✓ A 50-year-old woman with a parietal intracerebral hematoma was initially treated by hematoma evacuation. Initial preoperative and follow-up angiograms obtained 6 months later demonstrated no pial arteriovenous malformations (AVMs). She suffered a subarachnoid hemorrhage 8 years later. Results of follow-up cerebral angiography revealed the development of previously undetected multiple cerebral AVMs. This appears to be the first reported case of the development of multiple cerebral AVMs in an adult, demonstrated on serial angiography.

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