N-butyl cyanoacrylate transvenous arteriovenous malformation embolization with arterial balloon assistance: Defining parameters for a transvenous approach as a potential upfront treatment option in managing cerebral arteriovenous malformations

Background Transvenous embolisation is a promising technique but the benefits remain uncertain. We hypothesised that transvenous embolisation leads to a higher rate of arteriovenous malformation angiographic occlusion than transarterial embolisation. Methods The Transvenous Approach for the Treatment of cerebral Arteriovenous Malformations (TATAM) is an investigator initiated, multicentre, prospective, phase 2, randomised controlled clinical trial. To test the hypothesis that transvenous embolisation is superior to transarterial embolisation for arteriovenous malformation obliteration, 76 patients with arteriovenous malformations considered curable by up to two sessions of endovascular therapy will be randomly allocated 1:1 to treatment with either transvenous embolisation (with or without transarterial embolisation) (experimental arm) or transarterial embolisation alone (control arm). The primary endpoint of the trial is complete arteriovenous malformation occlusion, assessed by catheter cerebral angiography. Complete occlusions will be confirmed at 3 months, while incompletely occluded arteriovenous malformations, considered treatment failures, will then be eligible for complementary treatments by surgery, radiation therapy, or even transvenous embolisation. Standard procedural safety outcomes will also be assessed. Patient selection will be validated by a case selection committee, and participating centres with limited experience in transvenous embolisation will be proctored. Discussion The TATAM trial is a transparent research framework designed to offer a promising but still unvalidated treatment to selected arteriovenous malformation patients. Clinical Trial Registration-URL: http://www.clinicaltrials.gov . Unique identifier: NCT03691870.

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Intrarater and interrater reliability of the pediatric arteriovenous malformation compactness score in children

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.2.peds12465 ◽

2013 ◽

Vol 11 (5) ◽

pp. 547-551 ◽

Cited By ~ 8

Author(s):

Fabio A. Frisoli ◽

Shih-Shan Lang ◽

Arastoo Vossough ◽

Anne Marie Cahill ◽

Gregory G. Heuer ◽

...

Keyword(s):

Arteriovenous Malformation ◽

Recurrence Rate ◽

Arteriovenous Malformations ◽

Interrater Reliability ◽

Intrarater Reliability ◽

Cerebral Arteriovenous Malformations ◽

Perfect Agreement ◽

Interventional Radiologist ◽

Κ Statistic

Object Cerebral arteriovenous malformations (AVMs) have a higher postresection recurrence rate in children than in adults. The authors' previous study demonstrated that a diffuse AVM (low compactness score) predicts postresection recurrence. The aims of this study were to evaluate the intra- and interrater reliability of the AVM compactness score. Methods Angiograms of 24 patients assigned a preoperative compactness score (scale of 1–3; 1 = most diffuse, 3 = most compact) in the authors' previous study were rerated by the same pediatric neuroradiologist 9 months later. A pediatric neurosurgeon, pediatric neuroradiology fellow, and interventional radiologist blinded to each other's ratings, the original ratings, and AVM recurrence also rated each AVM's compactness. Intrarater and interrater reliability were calculated using the κ statistic. Results Of the 24 AVMs, scores by the original neuroradiologist were 1 in 6 patients, 2 in 16 patients, and 3 in 2 patients. Intrarater reliability was 1.0. The κ statistic among the 4 raters was 0.69 (95% CI 0.44–0.89), which indicates substantial reliability. The interrater reliability between the neuroradiologist and neuroradiology fellow was moderate (κ = 0.59 [95%CI 0.20–0.89]) and was substantial between the neuroradiologist and neurosurgeon (κ = 0.74 [95% CI 0.41–1.0]). The neuroradiologist and interventional radiologist had perfect agreement (κ = 1.0). Conclusions Intrarater and interrater reliability of the AVM compactness score were excellent and substantial, respectively. These results demonstrate that the AVM compactness score is reproducible. However, the neuroradiologist and interventional radiologist had perfect agreement, which indicates that the compactness score is applied most accurately by those with extensive angiography experience.

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A Technical Note

Interventional Neuroradiology ◽

10.1177/159101991301900104 ◽

2013 ◽

Vol 19 (1) ◽

pp. 27-34 ◽

Cited By ~ 21

Author(s):

V.M. Pereira ◽

A. Marcos-Gonzalez ◽

I. Radovanovic ◽

P. Bijlenga ◽

A.P. Narata ◽

...

Keyword(s):

Endovascular Treatment ◽

Young Patient ◽

Arteriovenous Malformations ◽

Technical Note ◽

Cerebral Arteriovenous Malformations ◽

Arterial Access ◽

Therapeutic Method ◽

Endovascular Approach ◽

Ruptured Avm ◽

Transvenous Approach

Ruptured cerebral arteriovenous malformations (AVMs) usually require treatment to avoid re-bleeding. Depending on the angioarchitecture and center strategy, the treatment can be surgical, endovascular, radiosurgical or combined methods. The classic endovascular approach is transarterial, but sometimes it is not always applicable. The transvenous approach has been described as an alternative for the endovascular treatment of small AVMs when arterial access or another therapeutic method is not possible. This approach can be considered when the nidus is small and if there is a single draining vein. We present a technical note on a transvenous approach for the treatment of a ruptured AVM in a young patient.

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Cerebral Arteriovenous Malformations with Associated Arterial Aneurysms: Hemodynamic and Therapeutic Considerations

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100027487 ◽

1988 ◽

Vol 15 (2) ◽

pp. 130-134 ◽

Cited By ~ 55

Author(s):

Douglas Kondziolka ◽

Bruce J. Nixon ◽

Pierre Lasjaunias ◽

William S. Tucker ◽

...

Keyword(s):

Blood Flow ◽

Arteriovenous Malformation ◽

Endovascular Treatment ◽

Arteriovenous Malformations ◽

Local Blood Flow ◽

Cerebral Arteriovenous Malformations ◽

Regional Hemodynamics ◽

The Common ◽

Arterial Aneurysms ◽

Therapeutic Considerations

ABSTRACT:The common vascular anomalies of cerebral aneurysm and arteriovenous malformation may exist independently, or together as part of a closely related hemodynamic pairing. Resection or embolization of an AVM may be followed by a decrease in local blood flow, and lead to regression of a suitably situated proximal aneurysm. However, aneurysms located outside the angioarchitecture of the AVM, which remain flow-unrelated to the malformation, will likely not regress, and may in fact enlarge. Two cases are presented which demonstrate these vascular relationships, in order to better understand the regional hemodynamics of these anomalies prior to surgical or endovascular treatment planning.

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

Journal of Neurosurgery ◽

10.3171/jns.2001.95.2.0346 ◽

2001 ◽

Vol 95 (2) ◽

pp. 346-349 ◽

Cited By ~ 32

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.

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Retrograde flow in the distal aortic arch and proximal descending aorta—a clue to presence of a major cerebral arteriovenous malformation

Cardiology in the Young ◽

10.1017/s104795110000144x ◽

1993 ◽

Vol 3 (2) ◽

pp. 161-163 ◽

Cited By ~ 4

Author(s):

Andrew M. Davis ◽

Samuel Menahem

Keyword(s):

Early Diagnosis ◽

Arteriovenous Malformation ◽

Cardiac Failure ◽

Arteriovenous Malformations ◽

Cerebral Arteriovenous Malformation ◽

Cranial Ultrasound ◽

Retrograde Flow ◽

Cerebral Arteriovenous Malformations ◽

Descending Aorta ◽

Satisfactory Outcome

SummaryTwo neonates are described presenting in severe cardiac failure within a few hours of birth. Echocardiography and the demonstration by color-coded Doppler of retrograde diastolic flow in the proximal descending aorta suggested the presence of large cerebral arteriovenous malformations. Such lesions were demonstrated by cranial ultrasound. The early diagnosis permitted early intervention, albeit with less than satisfactory outcome.

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Known and unknown cerebral arteriovenous malformations in pregnancies: haemorrhage risk and influence on obstetric management

The Neuroradiology Journal ◽

10.1177/1971400917712264 ◽

2017 ◽

Vol 30 (5) ◽

pp. 437-441 ◽

Cited By ~ 5

Author(s):

Xianli Lv ◽

Wei Li ◽

Hongwei He ◽

Chuhan Jiang ◽

Youxiang Li

Keyword(s):

Caesarean Section ◽

Confidence Interval ◽

Arteriovenous Malformation ◽

Vaginal Delivery ◽

Arteriovenous Malformations ◽

Cerebral Arteriovenous Malformations ◽

Haemorrhage Risk ◽

Pregnancy History ◽

Obstetric Management ◽

Haemorrhage Rate

Objective The objective of this study was to evaluate the haemorrhage risk of known and unknown cerebral arteriovenous malformations and their obstetric management. Methods A retrospective review was performed and analysed 67 consecutive cases of arteriovenous malformation with pregnancy history. Results Sixty-seven cases of arteriovenous malformation with pregnancy histories were identified. In 14 cases (20.9%) of arteriovenous malformation diagnosed before pregnancy, 11 cases were treated (10 embolisation and one surgery), there was no haemorrhage in 14 pregnancies, 14 healthy babies were delivered by caesarean section in 12 pregnancies (85.7%) and vaginal delivery in two pregnancies (14.3%). In 53 cases (89.1%) of arteriovenous malformation diagnosed during/after pregnancy, there was one (1.6%) case of subarachnoid haemorrhage at 38 weeks’ gestation in 64 pregnancies, 64 healthy babies were delivered by caesarean section in 11 pregnancies (17.2%) and vaginal delivery in 53 pregnancies (82.8%). This resulted in 1.6% (95% confidence interval 0–4.6%) haemorrhage rate per pregnancy in unknown arteriovenous malformations. Known arteriovenous malformation gravida was prone to caesarean section; however, vaginal delivery did not increase the haemorrhage risk in unknown arteriovenous malformation gravidas (1.8% vs. 0%, P = 1.000). Conclusion Prior treatment for ruptured arteriovenous malformation could prevent its haemorrhage during pregnancy and the haemorrhage risk of unruptured arteriovenous malformation in pregnancies is low. Although known arteriovenous malformation gravida is prone to caesarean section, vaginal delivery seems not to increase the haemorrhage risk in unknown arteriovenous malformation gravidas.

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Anaesthesia for Closed Embolisation of Cerebral Arteriovenous Malformations

Anaesthesia and Intensive Care ◽

10.1177/0310057x8801600313 ◽

1988 ◽

Vol 16 (3) ◽

pp. 318-323 ◽

Cited By ~ 12

Author(s):

B. J. O'Mahony ◽

S. N. C. Bolsin

Keyword(s):

Arteriovenous Malformation ◽

Glyceryl Trinitrate ◽

Sodium Nitroprusside ◽

Arteriovenous Malformations ◽

Anaesthetic Management ◽

Cerebral Arteriovenous Malformation ◽

Vascular Network ◽

Arterial Hypotension ◽

Cerebral Arteriovenous Malformations ◽

Neurological Assessment

Cerebral arteriovenous malformation embolisation is a therapeutic, neuroradiological procedure involving injection of bucrylate glue into the nidus of the A V malformation to obliterate the abnormal vascular network. These procedures may involve significant risks, are often long and thereby necessitate the need for some form of sedation and for adequate monitoring of the cerebral, cardiovascular and respiratory systems. The anaesthetic management of a series of twenty patients undergoing embolisation of a cerebral arteriovenous malformation is outlined, seven general and nineteen neurolept anaesthetics being administered. Neurolept anaesthesia is the preferred technique as neurological assessment during the procedure is possible and complications may be diagnosed immediately. Systemic arterial hypotension may facilitate the embolisation process and various agents, including glyceryl trinitrate and sodium nitroprusside, have been employed for this purpose.

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Gamma Knife surgery for basal ganglia and thalamic arteriovenous malformations

Journal of Neurosurgery ◽

10.3171/2011.12.jns11542 ◽

2012 ◽

Vol 116 (4) ◽

pp. 899-908 ◽

Cited By ~ 5

Author(s):

Ching-Hsiao Cheng ◽

R. Webster Crowley ◽

Chun-Po Yen ◽

David Schlesinger ◽

Mark E. Shaffrey ◽

...

Keyword(s):

Basal Ganglia ◽

Mr Imaging ◽

Gamma Knife ◽

Treatment Option ◽

Arteriovenous Malformations ◽

Gamma Knife Surgery ◽

Neurological Deficits ◽

Cerebral Arteriovenous Malformations ◽

History Of ◽

The Mean

Object Gamma Knife surgery (GKS) has emerged as the treatment of choice for small- to medium-sized cerebral arteriovenous malformations (AVMs) in deep locations. The present study aims to investigate the outcomes of GKS for AVMs in the basal ganglia and thalamus. Methods Between 1989 and 2007, 85 patients with AVMs in the basal ganglia and 97 in the thalamus underwent GKS and were followed up for more than 2 years. The nidus volumes ranged from 0.1 to 29.4 cm3 (mean 3.4 cm3). The mean margin dose at the initial GKS was 21.3 Gy (range 10–28 Gy). Thirty-six patients underwent repeat GKS for residual AVMs at a median 4 years after initial GKS. The mean margin dose at repeat GKS was 21.1 Gy (range 7.5–27 Gy). Results Following a single GKS, total obliteration of the nidus was confirmed on angiograms in 91 patients (50%). In 12 patients (6.6%) a subtotal obliteration was achieved. No flow voids were observed on MR imaging in 14 patients (7.7%). Following single or repeat GKS, total obliteration was angiographically confirmed in 106 patients (58.2%) and subtotal obliteration in 8 patients (4.4%). No flow voids on MR imaging were observed in 18 patients (9.9%). The overall obliteration rates following one or multiple GKSs based on MR imaging or angiography was 68%. A small nidus volume, high margin dose, low number of isocenters, and no history of embolization were significantly associated with an increased rate of obliteration. Twenty-one patients experienced 25 episodes of hemorrhage in 850 risk-years following GKS, yielding an annual hemorrhage rate of 2.9%. Four patients died in this series: 2 due to complications of hemorrhage and 2 due to unrelated diseases. Permanent neurological deficits caused by radiation were noted in 9 patients (4.9%). Conclusions Gamma Knife surgery offers a reasonable chance of obliterating basal ganglia and thalamic AVMs and does so with a low risk of complications. It is an optimal treatment option in patients for whom the anticipated risk of microsurgery is too high.

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Oligodendroglial Proliferative Abnormality Associated with Arteriovenous Malformation: Report of Three Cases with Review of the Literature

Neurosurgery ◽

10.1227/00006123-198812000-00022 ◽

1988 ◽

Vol 23 (6) ◽

pp. 781-785 ◽

Cited By ~ 22

Author(s):

M. Nazek ◽

T. I. Mandybur ◽

S. Kashiwagi

Keyword(s):

White Matter ◽

Arteriovenous Malformation ◽

Arteriovenous Malformations ◽

Vascular Malformations ◽

Careful Consideration ◽

Pathological Features ◽

Review Of The Literature ◽

Cerebral Arteriovenous Malformations ◽

Biopsy Material ◽

Clinical And Pathological Features

Abstract A peculiar nonneoplastic oligodendroglial proliferative abnormality associated with cerebral arteriovenous malformations (AVMs) was present in three patients. Histological examination of biopsy material revealed dense oligodendroglial tissue reminiscent of oligodendroglioma in the white matter adjoining the AVMs. Careful consideration of clinical and pathological features suggested that the evidence was insufficient to qualify the lesion as truly neoplastic (oligodendroglioma); rather, a tissue collapse or a hamartomatous proliferation could be considered to be its cause. The literature contains 14 instances of various vascular malformations associated with primary brain tumors, 5 of which were diagnosed as oligodendrogliomas. It is possible, however, that some of the cases reported in the literature constitute oligodendroglial abnormality similar to that observed in our cases rather than genuine oligodendrogliomas. Attention is drawn to this interesting and prognostically important phenomenon.

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