Delayed hemorrhage following resection of an arteriovenous malformation in the brain

2003 ◽  
Vol 99 (6) ◽  
pp. 967-971 ◽  
Author(s):  
Michael K. morgan ◽  
Mark Winder ◽  
Nicholas S. Little ◽  
Simon Finfer ◽  
Elizabeth Ritson
Keyword(s):  
Blood Pressure ◽  
Mortality Rate ◽  
Morbidity Rate ◽  
Content Type ◽  
Delayed Hemorrhage ◽  
Martin Grade ◽  
Permanent Morbidity ◽  
The Brain ◽  
Grade Iii ◽  
Fine Print

Object. Between 1989 and 2002 the authors treated 416 cases of angiographically confirmed arteriovenous malformations (AVMs) of the brain. Methods. Three hundred fifty-five patients underwent resection of an AVM; 2% died and 12% experienced a permanent morbidity (1.7% experienced a deterioration of modified Rankin Scale [mRS] score of 3–5). Patient outcomes in this series were based on the Spetzler—Martin grade. For patients with Grade I and II AVMs the rate of permanent morbidity was 1% and the rate of mortality was 0.5%. For patients with Grade III AVMs the morbidity rate was 18.9% (2.7% experienced a deterioration of mRS score of 3–5) and the mortality rate was 2.7%. For patients with Grade IV and V AVMs the morbidity rate was 25.6% (5.1% experienced a deterioration of mRS score of 3–5) and the mortality rate was 7.7%. No patient with a Spetzler—Martin Grade I or II lesion had a worsened outcome due to delayed hemorrhage, whereas 3.6% of patients with a Grade III and 12.8% of patients with Grade IV and V AVMs experienced delayed hemorrhage that led to a permanent downgrade in function. With the introduction of an aggressive postoperative blood pressure protocol (for AVMs with grades > II and sizes > 3.5 cm in diameter) the incidence of delayed postoperative hemorrhage leading to mortality or permanent morbidity decreased from 4.4 to 1%. This difference was significant. Neither case selection nor complications other than delayed hemorrhage changed between these two periods. Conclusions. In selected cases an aggressive postoperative blood pressure protocol is likely to reduce delayed hemorrhage following AVM resection.

Surgical experiences with giant intracranial aneurysms

1984 ◽  
Vol 61 (6) ◽  
pp. 1009-1028 ◽  
Author(s):  
Lindsay Symon ◽  
Janos Vajda
Keyword(s):  
Blood Pressure ◽  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Intracranial Aneurysms ◽  
Visual Loss ◽  
Considerable Improvement ◽  
Brain Circulation ◽  
Content Type ◽  
Space Occupying Lesion ◽  
Fine Print

✓ A series of 35 patients with 36 giant aneurysms is presented. Thirteen patients presented following subarachnoid hemorrhage (SAH) and 22 with evidence of a space-occupying lesion without recent SAH. The preferred technique of temporary trapping of the aneurysm, evacuation of the contained thrombus, and occlusion of the neck by a suitable clip is described. The danger of attempted ligation in atheromatous vessels is stressed. Intraoperatively, blood pressure was adjusted to keep the general brain circulation within autoregulatory limits. Direct occlusion of the aneurysm was possible in over 80% of the cases. The mortality rate was 8% in 36 operations. Six percent of patients had a poor result. Considerable improvement in visual loss was evident in six of seven patients in whom this was a presenting feature, and in four of seven with disturbed eye movements.

Surgery for cerebral arteriovenous malformation: risks related to lenticulostriate arterial supply

1997 ◽  
Vol 86 (5) ◽  
pp. 801-805 ◽  
Author(s):  
Michael K. Morgan ◽  
Katharine J. Drummond ◽  
Verity Grinnell ◽  
William Sorby
Keyword(s):  
Cerebral Arteriovenous Malformation ◽  
Arterial Supply ◽  
Content Type ◽  
Increased Risk ◽  
Complications Of Surgery ◽  
Grade Ii ◽  
Martin Grade ◽  
Grade Iii ◽  
Fine Print

✓ The aim of this study was to compare complications of surgery in arteriovenous malformations (AVMs) supplied by the middle cerebral artery (MCA) with and without a lenticulostriate arterial contribution. Ninety-two consecutive surgical resections of AVMs with an angiographically demonstrated MCA supply were performed between January 1989 and July 1996. Ten of these cases had a significant lenticulostriate arterial contribution. The cases were graded according to the Spetzler—Martin classification. There were no deaths and 4.3% of cases developed new major neurological deficit by the 3-month follow-up examination. All cases had angiographically confirmed obliteration of the AVM. There were no complications in 16 patients with Spetzler—Martin Grade I AVMs, one case of complications in 40 patients with Grade II AVMs, eight cases of complications in 26 patients with Grade III AVMs, and seven cases of complications in 10 patients with Grade IV and V AVMs. The supply of blood from lenticulostriate branches was associated with complications in eight of the 10 cases. The effect of the presence of a lenticulostriate arterial supply was most apparent in cases of Grade III AVMs: complications were experienced in three of 20 patients whose AVMs were not supplied by the arteries and in five of six patients whose AVMs were fed by the lenticulostriate arteries. This difference is significant (p < 0.0001). The conclusions drawn from this study are that for Grade III AVMs, the presence of a lenticulostriate arterial supply can be considered a factor predictive of an increased risk of surgical complications.

Changes in extracellular potassium concentration in cortex and brain stem during the acute phase of experimental closed head injury

1981 ◽  
Vol 55 (5) ◽  
pp. 708-717 ◽  
Author(s):  
Hiroshi Takahashi ◽  
Shinya Manaka ◽  
Keiji Sano
Keyword(s):  
Blood Pressure ◽  
Brain Stem ◽  
Low Voltage ◽  
Potassium Concentration ◽  
Control Level ◽  
Extracellular Potassium ◽  
Content Type ◽  
The Impact ◽  
The Brain ◽  
Fine Print

✓ A high potassium concentration ([K+]o) in brain tissue impedes neuronal activity, as observed in spreading cortical depression. Experimental studies were performed on mice and rats to determine the role of changes of [K+]o in cerebral concussion. In the first experiment, a 600 gm-cm impact was delivered to the vertex of the mouse skull. This impact induced arrest of spontaneous movement for 465 ± 55.9 seconds (mean ± SD), accompanied by apnea, bradycardia, and low-voltage electroencephalographic recordings (EEG). The injury was also frequently followed immediately by epilepsy. This impact induced an increase of cortical [K+]o from the control level of 4.1 ± 1.8 mM to 20–30 mM, with gradual recovery within 30 minutes to the control level. In the second experiment, an impact of 9000 gm-cm was delivered to the midline parieto-occipital area of the rat and produced concussion-like phenomena similar to those elicited in mice. This level of trauma induced a significant increase of cortical [K+]o from the control level of 4.2 ± 0.8 mM to 20–50 mM in all of the rats, and also a significant increase of brain-stem [K+]o from 3.9 ± 0.6 to 20–30 mM in 73% of the rats. In these latter rats, the impact also induced apnea and a transient elevation of blood pressure, and resulted in low-voltage EEG recordings. In 23% of the rats in which [K+]o changes in the brain stem were not significant, the impact caused a transient reduction of blood pressure. The present study disclosed that an increase of [K+]o in the cerebral cortex and also in the brain stem is an important element in the phenomenon of concussion.

The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment

1990 ◽  
Vol 73 (3) ◽  
pp. 387-391 ◽  
Author(s):  
Stephen L. Ondra ◽  
Henry Troupp ◽  
Eugene D. George ◽  
Karen Schwab
Keyword(s):  
Mortality Rate ◽  
Arteriovenous Malformations ◽  
Original Population ◽  
Major Morbidity ◽  
Content Type ◽  
History Of ◽  
The Mean ◽  
The Brain ◽  
Fine Print

✓ The authors have updated a series of 166 prospectively followed unoperated symptomatic patients with arteriovenous malformations (AVM's) of the brain. Follow-up data were obtained for 160 (96%) of the original population, with a mean follow-up period of 23.7 years. The rate of major rebleeding was 4.0% per year, and the mortality rate was 1.0% per year. At follow-up review, 23% of the series were dead from AVM hemorrhage. The combined rate of major morbidity and mortality was 2.7% per year. These annual rates remained essentially constant over the entire period of the study. There was no difference in the incidence of rebleeding or death regardless of presentation with or without evidence of hemorrhage. The mean interval between initial presentation and subsequent hemorrhage was 7.7 years.

Early aneurysm operation and outcome in two remote Scandinavian populations

1984 ◽  
Vol 60 (6) ◽  
pp. 1160-1162 ◽  
Author(s):  
Matti Vapalahti ◽  
Bengt Ljunggren ◽  
Hans Säveland ◽  
Juha Hernesniemi ◽  
Lennart Brandt ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Mortality Rate ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Morbidity Rate ◽  
Good Recovery ◽  
Southern Sweden ◽  
Content Type ◽  
Referral Center ◽  
Fine Print

✓ The Kuopio University Clinic is the neurosurgical referral center for a population of 930,000 inhabitants in central Finland while the Lund University Clinic is the neurosurgical referral center for a population of 1.46 million inhabitants in southern Sweden. The incidence of aneurysmal subarachnoid hemorrhage (SAH) is approximately 19/100,000/year in central Finland and approximately five/100,000/year in southern Sweden. During the calendar year 1982, 69 patients with a ruptured supratentorial aneurysm were admitted in Lund, and 71 such patients were admitted in Kuopio. Thirty-nine patients in neurological Grades I to III (according to Hunt and Hess) underwent early aneurysm operation in Lund, and 46 such patients were operated on within a week after SAH in Kuopio. In the combined series of 85 Grade I to III patients with aneurysm operation within a week after rupture, 78% made a good recovery; the morbidity rate was 14%, and the mortality rate was 8%.

Complications of endoscopic third ventriculostomy

2002 ◽  
Vol 96 (6) ◽  
pp. 1032-1040 ◽  
Author(s):  
Henry W. S. Schroeder ◽  
Wulf-Rüdiger Niendorf ◽  
Michael R. Gaab
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Multiorgan Failure ◽  
Cerebrospinal Fluid Leak ◽  
Morbidity Rate ◽  
Third Ventriculostomy ◽  
Oculomotor Palsy ◽  
Effective Treatment Option ◽  
Content Type ◽  
Permanent Morbidity ◽  
Fine Print

Object. The purpose of this prospective investigation was to determine the rate of complications associated with endoscopic third ventriculostomy (ETV). Methods. Between March 1993 and October 2001, 193 ETVs were performed in 188 patients at a single institution. The age of the patients ranged from 1 month to 85 years (mean age 39 years). One procedure had to be abandoned because a severe venous hemorrhage blurred the surgeon's view; however, third ventriculostomy was successfully accomplished in that patient 14 days later. In addition, there were two cases in which significant venous hemorrhages could be controlled endoscopically by using irrigation. Postoperative imaging revealed three subdural collections, one tiny thalamic contusion, one cortical hemorrhage at the puncture site, and one severe subarachnoid hemorrhage (SAH). There were two deaths (1% mortality rate) related to the endoscopic procedure; causes of death were one SAH from a torn basilar perforating artery and one wound infection leading to meningitis and septic multiorgan failure. Three permanent deficits occurred (confusion, oculomotor palsy, and diabetes insipidus [1.6% permanent morbidity rate]). Transient deficits included four cases of meningitis, three cases of cerebrospinal fluid leak, two cases of herniation syndrome, two cases of confusion, one case in which there was a decrease of consciousness, two cases of oculomotor palsy, and one case in which there was loss of thirst (7.8% transient morbidity rate). Misplacement of the fenestration was the main reason for severe complications. During the course of the study, the complication rate dropped significantly (no incidences of mortality or permanent morbidity occurred during the last 100 procedures). Conclusions. All permanent and fatal complications occurred during the authors' very early experience, indicating that a steep learning curve was associated with the procedure. Endoscopic third ventriculostomy, if performed correctly, is a safe, simple, and effective treatment option for various forms of noncommunicating hydrocephalus.

Solid cerebellar hemangioblastoma

1973 ◽  
Vol 39 (4) ◽  
pp. 514-518 ◽  
Author(s):  
Shige-Hisa Okawara
Keyword(s):  
Mortality Rate ◽  
Brain Stem ◽  
Solid Tumor ◽  
Cystic Tumor ◽  
Content Type ◽  
Mortality And Morbidity ◽  
Cystic Tumors ◽  
Solid Lesions ◽  
The Brain ◽  
Fine Print

✓ In this report six cases of solid hemangioblastoma were encountered out of 19 cases operated on, and carried a 50% mortality rate compared to 15% for the remaining 13 cases of cystic tumors. The solid tumor cases have more brain-stem signs than those with the cystic tumor. Angiographically the solid lesion often shows diffuse involvement of the brain stem. Operative or autopsy findings confirm that the solid lesions are more likely to involve the brain stem, hence explaining the difficulty in operative treatment and the extremely high mortality and morbidity. Decompressive operation is thought to be the better method of handling these tumors.

A model of focal cortical contusion in gerbils

1982 ◽  
Vol 57 (2) ◽  
pp. 203-209 ◽  
Author(s):  
Alan Crockard ◽  
Joon Kang ◽  
Graeme Ladds
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Surrounding Tissue ◽  
Content Type ◽  
Time Period ◽  
Cortical Contusion ◽  
Capillary Bed ◽  
The Brain ◽  
Fine Print

✓ An experimental model of focal laceration and contusion in gerbils is described. Associated with this injury are systemic changes which are neurogenically mediated and result in an immediate reduction in blood pressure, bradycardia, and generalized reduction in cerebral blood flow. There is generalized edema, as judged by a decreased specific gravity in the brain, probably related to reduced blood flow; superimposed on this, there is an edema gradient which is maximal close to the injury. This, in turn, affects the local capillary bed and prevents any local increase in flow. A separate group studied over a longer time period (6 hours) did not reveal egress of Evans blue into the surrounding tissue and this is in contrast to reports from cold-injury studies.

Dimethyl sulfoxide in the treatment of experimental brain compression

1973 ◽  
Vol 38 (3) ◽  
pp. 345-354 ◽  
Author(s):  
J. C. de la Torre ◽  
D. W. Rowed ◽  
H. M. Kawanaga ◽  
S. Mullan
Keyword(s):  
Brain Injury ◽  
Head Injury ◽  
Mortality Rate ◽  
Dimethyl Sulfoxide ◽  
Rhesus Monkeys ◽  
Neurological Deficits ◽  
Content Type ◽  
Brain Compression ◽  
The Brain ◽  
Fine Print

✓ Forty rhesus monkeys were subjected to acute experimental head injury by extradural balloon compression of the brain. A critical endpoint in the compression was used to inject either saline, urea, or dimethyl sulfoxide (DMSO). All saline-treated animals died. Ten of 15 urea-treated animals survived, while 14 of 15 DMSO-injected monkeys survived. The incidence of neurological deficits seen in survivors was four for urea and one for DMSO. It is concluded that DMSO is capable of modifying the mortality rate and posttraumatic sequelae of brain injury in the experimental model used.

Performance of sulfhydryl boron hydride in patients with grade III and IV astrocytoma: a basis for boron neutron capture therapy

1995 ◽  
Vol 83 (1) ◽  
pp. 79-85 ◽  
Author(s):  
Crister P. Ceberg ◽  
Anders Persson ◽  
Arne Brun ◽  
René Huiskamp ◽  
Ann-Sofie Fyhr ◽  
...  
Keyword(s):  
Tumor Cells ◽  
Neutron Capture ◽  
Boron Concentration ◽  
Neutron Capture Therapy ◽  
Boron Hydride ◽  
Content Type ◽  
Boron Neutron Capture ◽  
The Brain ◽  
Grade Iii ◽  
Fine Print

✓ This study investigated the rationale of boron neutron capture therapy (BNCT) for the treatment of Grade III and IV astrocytoma. The European Community joint research program on BNCT plans to use sulfhydryl boron hydride (BSH) in clinical trials. The work presented here, examines the performance of BSH in eight patients with Grade III and IV astrocytoma using a measurement technique which precisely correlates the boron uptake with the histology of the tumor and the peritumoral brain. Astrocytomas are exceptionally heterogeneous and spread migrating tumor cells into the surrounding brain. The patients were infused with 50 mg BSH per kilogram of body weight at 12, 18, 24 or 48 hours before surgery. At the time of operation, specimens were obtained of the tumor, skin, muscle, dura, blood, urine, and, when surgically possible, the brain adjacent to tumor. In three patients the intracellular boron distribution was investigated by subcellular fractionation. The blood clearance was biphasic with half-lives of 0.6 and 8.2 hours. After 3 days, approximately 70% of the dose injected was excreted in the urine. The maximum boron concentration in the tumor was 20 ppm, 12 hours after the infusion. The tumor-to-blood ratios ranged between 0.2 and 1.4, with the highest values after 18 to 24 hours. In the brain specimens the boron concentration never exceeded 1 ppm. This work confirms a selective uptake of boron in the tumor compared to the surrounding brain and that boron, to some extent, is incorporated in the tumor cells.

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