Pure sylvian fissure arteriovenous malformations

2000 ◽  
Vol 92 (1) ◽  
pp. 39-44 ◽  
Author(s):  
Gary Zimmerman ◽  
Adam I. Lewis ◽  
John M. Tew
Keyword(s):  
Arteriovenous Malformations ◽  
Short Term Memory ◽  
Vascular Malformations ◽  
Neuropsychological Testing ◽  
Memory Loss ◽  
Complete Removal ◽  
Sylvian Fissure ◽  
Neurological Deficits ◽  
Content Type ◽  
Fine Print

Object. Pure sylvian fissure arteriovenous malformations (AVMs) are vascular malformations confined to the sylvian fissure without parenchymal involvement. Because the branches of the middle cerebral artery are arteries of passage and the margins between the AVM and the insula cortex may be ill defined, many surgeons regard pure sylvian fissure AVMs as inoperable. The authors reviewed their surgical experience with eight patients harboring pure sylvian fissure AVMs to determine the incidence of operative morbidity.Methods. All eight patients experienced seizures, five (63%) had headaches, and three (38%) experienced hemorrhages. Preoperatively, six patients (75%) were normal neurologically and two (25%) had neurological deficits. Five (63%) of eight sylvian fissure AVMs were located in the dominant hemisphere. The size of the nidus ranged from 6 to 27 cm3 (mean 14 cm3).Complete removal of the AVM was documented by postoperative angiography in every case. Seizures were reduced or eliminated and headaches were relieved in all affected patients. Transient neurological deficits, which included aphasia, short-term memory loss, and hemiparesis, occurred in four patients (50%). Within 3 months, all patients were functioning independently with no new neurological deficits. The status of two patients who had had preoperative neurological deficits improved postoperatively. Neuropsychological testing showed no new cognitive deficits.Conclusions. With appreciation for transient instances of postoperative morbidity, the outcome was excellent in all patients. The authors thus advocate microsurgery as the primary treatment for pure sylvian fissure AVMs.

Stereotactic craniotomy in the resection of small arteriovenous malformations

1991 ◽  
Vol 75 (1) ◽  
pp. 40-44 ◽  
Author(s):  
Michael B. Sisti ◽  
Robert A. Solomon ◽  
Bennett M. Stein
Keyword(s):  
Arteriovenous Malformations ◽  
Complete Removal ◽  
Neurological Deficits ◽  
Content Type ◽  
Neurological Improvement ◽  
Stereotactic Frame ◽  
Microsurgical Resection ◽  
The Brain ◽  
Radiological Studies ◽  
Fine Print

✓ Surgical resection of 10 obscure arteriovenous malformations (AVM's) was accomplished with craniotomy guided by computerized tomography (CT) or angiography and the use of the Brown-Roberts-Wells stereotactic frame. Stereotactic craniotomy was invaluable for resection of the following types of AVM's: 1) AVM's with a nidus less than 2 cm in diameter, 2) AVM's located in an eloquent area of the brain, and 3) AVM's located deep in the brain. Stereotactic localization of these AVM's on preoperative radiological studies provides a precise route to the nidus, often avoiding important areas of the brain. This series included six male and four female patients with a mean age of 32 years. All patients presented with an intracerebral hemorrhage, from which eight made a complete neurological recovery prior to surgery. Two AVM's were located on the cortex, three were found subcortically, and five were situated near the ventricles or in the deep white matter. As a guide, angiography was used in six cases and CT in four cases. In each instance, the study providing the best image of the AVM nidus was employed. Postoperatively, no neurological deficits were found in eight patients and, in the two patients with preoperative deficits, neurological improvement was observed after recovery from surgery. Postoperative studies revealed complete removal of the AVM in all patients, and all lesions were confirmed histologically. The authors conclude that stereotactic craniotomy provides the optimum operative approach for the localization and microsurgical resection of AVM's that are either obscure or located deep in the brain.

Modified classification of spinal cord vascular lesions

2002 ◽  
Vol 96 (2) ◽  
pp. 145-156 ◽  
Author(s):  
Robert F. Spetzler ◽  
Paul W. Detwiler ◽  
Howard A. Riina ◽  
Randall W. Porter
Keyword(s):  
Spinal Cord ◽  
Classification System ◽  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Relevant Literature ◽  
Vascular Lesions ◽  
Cavernous Malformations ◽  
Content Type ◽  
Arteriovenous Fistulas ◽  
Fine Print

The literature on spinal vascular malformations contains a great deal of confusing terminology. Some of the nomenclature is inconsistent with the lesions described. Based on the experience of the senior author (R.F.S.) in the treatment of more than 130 spinal cord vascular lesions and based on a thorough review of the relevant literature, the authors propose a modified classification system for spinal cord vascular lesions. Lesions are divided into three primary or broad categories: neoplasms, aneurysms, and arteriovenous lesions. Neoplastic vascular lesions include hemangioblastomas and cavernous malformations, both of which occur sporadically and familially. The second category consists of spinal aneurysms, which are rare. The third category, spinal cord arteriovenous lesions, is divided into arteriovenous fistulas and arteriovenous malformations (AVMs). Arteriovenous fistulas are subdivided into those that are extradural and those that are intradural, with intradural lesions categorized as either dorsal or ventral. Arteriovenous malformations are subdivided into extradural-intradural and intradural malformations. Intradural lesions are further divided into intramedullary, intramedullary-extramedullary, and conus medullaris, a new category of AVM. This modified classification system for vascular lesions of the spinal cord, based on pathophysiology, neuroimaging features, intraoperative observations, and neuroanatomy, offers several advantages. First, it includes all surgical vascular lesions that affect the spinal cord. Second, it guides treatment by classifying lesions based on location and pathophysiology. Finally, it eliminates the confusion produced by the multitude of unrelated nomenclatural terms found in the literature.

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.

Transient postprandial paresis associated with arteriovenous malformations of the spinal cord

1973 ◽  
Vol 39 (5) ◽  
pp. 652-655 ◽  
Author(s):  
Anthony D. Oliver ◽  
Charles B. Wilson ◽  
Edwin B. Boldrey
Keyword(s):  
Spinal Cord ◽  
Arteriovenous Malformation ◽  
Arteriovenous Malformations ◽  
The Body ◽  
Neurological Deficits ◽  
Clinical Feature ◽  
Content Type ◽  
Spinal Arteriovenous Malformation ◽  
Low Resistance ◽  
Fine Print

✓ Two cases of spinal arteriovenous malformation (AVM) are reported because of a previously unobserved clinical feature: recurrent transient postprandial paresis of the legs. The authors believe the paresis was caused by chronic shunting of blood away from the cord and into the low-resistance AVM. Symptomatic cord ischemia might then be precipitated by vasodilatation in other areas of the body such as the splanchnic, brachial, or uterine vessels. We believe that in some instances this mechanism should be considered as an explanation for episodic neurological deficits seen in association with spinal AVM's.

Spinal cord arteriovenous malformations with significant intramedullary components

1983 ◽  
Vol 59 (3) ◽  
pp. 471-478 ◽  
Author(s):  
Philip Cogen ◽  
Bennett M. Stein
Keyword(s):  
Arteriovenous Malformations ◽  
The Other ◽  
Neurological Deficits ◽  
Content Type ◽  
Postoperative Course ◽  
Microsurgical Techniques ◽  
Spinal Arteriovenous Malformations ◽  
High Degree ◽  
Fine Print

✓ Few neurosurgeons have stressed the occurrence, manifestations, and resectability of intramedullary spinal arteriovenous malformations (AVM's). In six of 17 patients in the authors' series of operable spinal AVM's, the lesions had major intramedullary components. Three of these six patients presented with subarachnoid hemorrhage, and all had catastrophic neurological deficits which gradually improved. The hemorrhages appeared to originate from large venous varices lying adjacent to the intramedullary portion of the AVM. The mechanism explaining the sudden neurological deficit in the other three patients was presumed to be thrombosis within the venous varices associated with their AVM's. The reliability of the various radiographic procedures in identifying the intramedullary components of these AVM's is discussed. These malformations may be removed totally with a high degree of safety using microsurgical techniques. The postoperative course in this series of patients was gratifying in terms of improvement of neurological deficits. Postoperative angiography was not performed on all of these patients. However, the follow-up period averaged 5 years.

Posterior fossa arteriovenous malformations

1986 ◽  
Vol 64 (1) ◽  
pp. 1-10 ◽  
Author(s):  
Charles G. Drake ◽  
Allan H. Friedman ◽  
Sydney J. Peerless
Keyword(s):  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Postoperative Hemorrhage ◽  
Neurological Deficits ◽  
Complete Excision ◽  
Operative Morbidity ◽  
Content Type ◽  
Surgical Exploration ◽  
Fine Print

✓ The authors report their treatment of 66 infratentorial arteriovenous malformations (AVM's) in patients aged 5 to 69 years. Sixty-one of them presented with hemorrhage, three with headache, and two with focal neurological deficits. Five patients underwent surgical exploration only, one was treated with ventriculostomy, three had ligation of the AVM feeding arteries, four underwent intraoperative embolization, and two had pontine hematomas removed; complete excision was attempted in 51 patients and accomplished in 47. Twelve of the patients also had aneurysms (nine of which had ruptured). Of this series, 71% had a good result, 14% a poor result, and 15% died. Most of the operative morbidity was due to massive postoperative hemorrhage, probably related to inadequate hemostasis.

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.

Cerebral hemodynamics and metabolism in patients with cerebral arteriovenous malformations: an evaluation using positron emission tomography scanning

2002 ◽  
Vol 97 (6) ◽  
pp. 1314-1321 ◽  
Author(s):  
Toru Iwama ◽  
Kohei Hayashida ◽  
Jun C. Takahashi ◽  
Izumi Nagata ◽  
Nobuo Hashimoto
Keyword(s):  
Positron Emission Tomography ◽  
Arteriovenous Malformations ◽  
High Flow ◽  
Emission Tomography ◽  
Neurological Deficits ◽  
Regional Cerebral Blood ◽  
Content Type ◽  
Positron Emission ◽  
The Mean ◽  
Fine Print

Object. The purpose of this study was to evaluate cerebral hemodynamic and metabolic features in patients with arteriovenous malformations (AVMs) by using positron emission tomography (PET) scanning. Methods. Twenty-four patients with supratentorial cerebral AVMs participated in PET studies in which 15O inhalation steady-state methods were used. The authors recorded the values of regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), the regional oxygen extraction fraction (rOEF), and the regional cerebral metabolic rate of O2 (rCMRO2) at three designated regions of interest (ROIs) in each patient. These ROIs included perilesional (ROI-p), ipsilateral remote (ROI-i), and contralateral symmetrical (ROI-c) brain regions. To identify the factors that exert a direct effect on the hemodynamics of brains affected by AVM, we also separated the lesions according to their size and flow type shown on angiograms, and grouped the patients according to the presence or absence of progressive neurological deficits. We then compared the PET parameters at different ROIs in individual patients and evaluated the mean values obtained for all 24 patients according to AVM flow type and size, and the presence or absence of progressive neurological deficits. Conclusions. Overall, mean rCBV and rOEF values were significantly higher in ROI-p than in ROI-c (p = 0.00046 and p = 0.015, respectively). No significant differences were seen between the ROI-i and ROI-c with respect to rCBF, rCBV, and rOEF. Mean rCMRO2 values were similar in the three ROIs; however, the mean rCBF was significantly lower in the ROI-p than in the ROI-c in patients with high-flow AVMs (p = 0.019), large AVMs (p = 0.017), and progressive neurological deficits (p = 0.021). Furthermore, the mean rOEF values were significantly higher in the ROI-p than in the ROI-c in patients with high-flow AVMs (p = 0.005), large AVMs (p = 0.019), and progressive neurological deficits (p = 0.017). The PET studies revealed hemodynamic impairment characterized by decreased rCBF and increased rOEF and rCBV values in the ROI-p of patients with large, high-flow AVMs regardless of whether they exhibited progressive neurological deficits.

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.

Preoperative embolization of cerebral arteriovenous malformations with silk sutures: analysis and clinical correlation of complications revealed on computerized tomography scanning

2000 ◽  
Vol 92 (6) ◽  
pp. 955-960 ◽  
Author(s):  
Joon K. Song ◽  
Joseph M. Eskridge ◽  
Eun-Chul Chung ◽  
Lindsey C. Blake ◽  
J. Paul Elliott ◽  
...  
Keyword(s):  
Computerized Tomography ◽  
Arteriovenous Malformations ◽  
Neurological Deficits ◽  
Ct Scans ◽  
Preoperative Embolization ◽  
Cerebral Arteriovenous Malformations ◽  
Arteriovenous Shunting ◽  
Content Type ◽  
Ct Findings ◽  
Fine Print

Object. The aim of this study was to determine the incidence and clinical significance of complications related to preoperative embolization of cerebral arteriovenous malformations (AVMs) with silk sutures as documented on postprocedure computerized tomography (CT) scans.Methods. The CT scans were obtained within 12 to 24 hours after 221 (96%) of 230 consecutive embolizations in 70 patients. These CT scans were evaluated for the presence of ischemia, infarction, hemorrhage, or contrast agent extravasation. Adverse patient outcomes were determined after each embolization and were correlated with CT findings. New abnormalities demonstrated on CT scans were also correlated with the Spetzler—Martin AVM grade, degree of arteriovenous shunting, and location. New abnormalities, the majority of them infarcts, resulted from 29 (13%) of 221 embolization procedures. In 11 (38%) of 29 cases of new CT findings, patients were asymptomatic, including 10 with new infarcts on CT scans. New neurological deficits occurred in 20 (8.7%) of 230 total embolization procedures in 19 patients, including one death. Permanent deficits occurred in nine patients (3.9% per embolization procedure, 12.8% per patient). Of the patients with new neurological deficits, 18 (90%) of 20 embolization procedures resulted in new abnormalities on CT scans. Two patients with new transient neurological deficits had no new findings on CT scans. Spetzler—Martin grade, AVM location, degree of arteriovenous shunting, and higher numbers of procedures were not statistically associated with a higher incidence of abnormalities on CT scans or new permanent neurological deficits.Conclusions. Silk sutures are an effective and relatively safe embolic agent. After brain AVM embolization with silk sutures, new abnormalities were found on CT scans obtained in one of eight procedures. When a new CT finding occurred, the patient had roughly equal chances of having no new symptoms, having new transient neurological deficits, or having new permanent neurological deficits.

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