scholarly journals ARTERIOVENOUS MALFORMATIONS OF THE BRAIN: ACHIEVEMENTS, ANALYSIS OF DIAGNOSIS AND TACTICS OF SURGICAL TREATMENT IN THE CONDITIONS OF THE REPUBLICAN RESEARCH CENTER OF EMERGENCY MEDICAL CARE (20-YEAR OF THE CLINIC EXPERIENCE)

2022 ◽  
Vol 14 (4) ◽  
Author(s):  
A.M. KHADJIBAEV ◽  
K.E. MAKHKAMOV ◽  
M.K. MAKHKAMOV ◽  
A.B. SALAEV ◽  
D.U. ISRAILOV ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Endovascular Embolization ◽  
Research Center ◽  
Emergency Medical Care ◽  
Brain Avm ◽  
Clinic Experience ◽  
The Brain ◽  
Combined Technique ◽  
Grade Iii

Aim. To assess the results of the activities of the neurosurgical service of the Republican Research Center of Emergency Medicine (RRCEM) over a twenty-year period of operation with an analysis of the results of neurosurgical care for patients with arteriovenous malformations of the brain (AVM). Material and Methods. The analysis was carried out of 54 patients examined and operated on for AVM, in the period from 2001 to 2020, who were treated at the Department of Adult Neurosurgery of the RRCEM. Results. The basis of our principle of a differentiated surgical approach in the treatment of AVM is the determination of the AVM grading according to the Spetzler-Martin and Lawton-Young scales. Limiting only microsurgical AVM resection is advisable for AVMs – I and II grades according to the Spetzler-Martin and Lawton-Young scales. For patients with high grades of AVMs – grade III and more, it is more expedient to use a combined technique, and with deeply located AVMs, endovascular embolization.

scholarly journals A theory for polymicrogyria and brain arteriovenous malformations in HHT

Neurology ◽  
2018 ◽  
Vol 92 (1) ◽  
pp. 34-42 ◽  
Author(s):  
Jesse M. Klostranec ◽  
Long Chen ◽  
Shobhit Mathur ◽  
Jamie McDonald ◽  
Marie E. Faughnan ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Fluid Shear Stress ◽  
Transmembrane Protein ◽  
Dominant Negative ◽  
Spatial Proximity ◽  
Imaging Data ◽  
Fluid Shear ◽  
Brain Avm ◽  
Close Spatial Proximity ◽  
The Brain

Hereditary hemorrhagic telangiectasia (HHT) is generally considered a disorder of endothelial dysfunction, characterized by the development of multiple systemic arteriovenous malformations (AVMs), including within the brain. However, there have recently been a number of reports correlating HHT with malformations of cortical development, of which polymicrogyria is the most common type. Here we present 7 new cases demonstrating polymicrogyria in HHT, 6 of which demonstrate a brain AVM (bAVM) in close spatial proximity, with the aim of providing a common origin for the association. Upon reviewing patient genetics and imaging data and comparing with previously reported findings, we form 2 new conclusions: (1) polymicrogyria in HHT appears exclusively associated with a subset of mutations in the transmembrane protein endoglin that is involved with blood flow–related mechanotransduction signaling during angiogenesis and (2) the polymicrogyria is characteristically unilateral, typically focal, and correlates with vascular regions experiencing low fluid shear stress during corticogenesis in utero. Integrating these with findings in the literature from genetics and molecular biology experiments, we propose a theory suggesting haploinsufficient endoglin mutations, especially those that are dominant-negative, may predispose focal, aberrant hypersprouting angiogenesis during corticogenesis that leads to the production of polymicrogyria. This hypoxic insult may further serve as the revealing trigger for later development of a spatially coincident bAVM. This hypothesis suggests an essential role for endoglin-mediated hemodynamic mechanotransduction in normal corticogenesis.

Staged Treatment of Arteriovenous Malformations of the Brain

Neurosurgery ◽  
1987 ◽  
Vol 21 (3) ◽  
pp. 314-323 ◽  
Author(s):  
Brian T. Andrews ◽  
Charles B. Wilson
Keyword(s):  
Intracranial Hemorrhage ◽  
Surgical Procedures ◽  
Arteriovenous Malformations ◽  
Perfusion Pressure ◽  
Good Condition ◽  
Endovascular Embolization ◽  
External Carotid ◽  
Normal Perfusion Pressure Breakthrough ◽  
Staged Treatment ◽  
The Brain

Abstract Twenty-eight patients treated for arteriovenous malformations (AVMs) of the brain had staged therapy consisting of multiple surgical procedures or endovascular embolization followed by surgical treatment. There were 10 men and 18 women, aged 15 to 60 years (mean, 34 years). The clinical symptoms were those associated with intracranial hemorrhage in 13 patients, progressive neurological deficit not due to hemorrhage in 6, intractable headache in 5, and seizures in 4. Four groups were identified based upon the reason for staging therapy. Thirteen patients with large high flow AVMs (Group A) had staged treatment because of the risk of normal perfusion pressure breakthrough. The initial afferent artery occlusion was accomplished surgically in 9 patients and by endovascular embolization in 4. Postoperatively, no patient in this group had malignant cerebral edema or intracranial hemorrhage suggestive of normal perfusion pressure breakthrough, but 1 patient had an intraventricular hemorrhage after initial embolization. In 9 patients (Group B), the AVM had a complex multiple arterial supply that precluded resection from a single operative exposure. Seven had supratentorial AVMs, and 2 had AVMs of the posterior fossa. In 6 of these cases, the AVM was located in the midline and received bilateral arterial input. Six patients had staged surgical procedures, and 3 had an initial endovascular embolization followed by operation. Two patients had intracerebral hemorrhages, one after an initial surgical procedure and another after initial embolization. In 4 patients (Group C), the AVM had a major dural component that was treated separately from the parenchymal component. In 3 of these patients, embolization through the external carotid artery satisfactorily obliterated the dural component; in the remaining patient, a persistent internal carotid supply necessitated resection of the dural malformation. The parenchymal component was excised surgically in 2 patients. Two patients (Group D) had separate surgical procedures to treat an aneurysm associated with a parenchymal AVM. Overall, 19 of 28 patients had complete excision and 9 had partial obliteration of their AVMs. Late follow-up of 27 patients at a mean of 18.6 months showed that 16 patients were in excellent condition and 8 were in good condition. Three patients were in poor condition with debilitating neurological deficits. One patient had a delayed intracranial hemorrhage 22 months after incomplete obliteration of her AVM. Staged treatment of selected AVMs of the brain may avoid the occurrence of normal perfusion pressure breakthrough. This approach also allows satisfactory obliteration of selected malformations that have multiple complex arterial supplies or a dural component and those associated with an aneurysm.

scholarly journals Galvos smegenų arterioveninės malformacijos

2009 ◽  
Vol 7 (3-4) ◽  
pp. 0-0
Author(s):  
Irena Bičkutė ◽  
Mindaugas Avižonis
Keyword(s):  
Arteriovenous Malformation ◽  
Vascular Disease ◽  
Key Words ◽  
Arteriovenous Malformations ◽  
Regional Hospital ◽  
Capillary Network ◽  
Physiological Changes ◽  
Brain Avm ◽  
Life Threatening ◽  
The Brain

Irena Bičkutė1, Mindaugas Avižonis21 Švenčionių rajono ligoninė, Partizanų g. 4, LT-18126 Švenčionys2 Mykolo Marcinkevičiaus ligoninė, Kauno g. 7/2, LT-03215 VilniusEl paštas: [email protected] Galvos smegenų arterioveninė malformacija (AVM) – įgimta smegenų patologija, kuriai būdingos patologinės arterijų ir venų jungtys, kuriomis arterinis kraujas patenka į smegenų venas, aplenkdamas normalų kapiliarų tinklą. Ši patologija reta, tačiau sukelia daug anatominių ir fiziologinių pokyčių, kelia pavojų gyvybei. Straipsnyje trumpai aprašoma AVM paplitimas, kilmė, patologija, klinika, diagnostika ir gydymas. Reikšminiai žodžiai: galvos smegenų arterioveninė malformacija, etiologija, epidemiologija, klinika, diagnostika, gydymas. Arteriovenous malformations of the brain Irena Bičkutė1, Mindaugas Avižonis21 The Švenčioniai Regional Hospital, Partizanų g. 4, LT-18126 Švenčionys, Lithuania2 The Mykolas Marcinkevičius Hospital, Kauno str. 7/2, LT-03215 Vilnius, LithuaniaE-mail: [email protected] Arteriovenous malformation (AVM) of the brain is a congenital vascular disease and has three morphologic components: the dysplastic vascular nidus, the feeding arteries, and the draining veins. The underlying lesion appears to represent a perpetuation of primitive arteriovenous communications which normally should be replaced by an intervening capillary network. AVM is potentially life-threatening and causes many anatomical and physiological changes. This article contains a description of epidemiology, etiology, pathology, clinic, diagnostics and treatment of brain AVM. Key words: arteriovenous malformation of the brain, etiology, epidemiology, clinic, diagnostics, treatment

Cerebral arteriovenous malformations. Part 2: physiology

2009 ◽  
Vol 26 (5) ◽  
pp. E11 ◽  
Author(s):  
Parham Moftakhar ◽  
Jason S. Hauptman ◽  
Dennis Malkasian ◽  
Neil A. Martin
Keyword(s):  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Therapeutic Approaches ◽  
Complex Processes ◽  
Brain Avm ◽  
Flow Phenomena ◽  
Vascular Steal ◽  
Brain Avms ◽  
And Behavior ◽  
The Brain

ObjectThe scientific understanding of the nature of arteriovenous malformations (AVMs) in the brain is evolving. It is clear from current work that AVMs can undergo a variety of phenomena, including growth, remodeling, and/or regression—and the responsible processes are both molecular and physiological. A review of these complex processes is critical to directing future therapeutic approaches. The authors performed a comprehensive review of the literature to evaluate current information regarding the genetics, pathophysiology, and behavior of AVMs.MethodsA comprehensive literature review was conducted using PubMed to reveal the angioarchitecture and cerebral hemodynamics of AVMS as they relate to lesion development.ResultsFeeding artery pressures, brain AVM compartmentalization, venous drainage, flow phenomena, and vascular steal are discussed.ConclusionsThe dynamic nature of brain AVMs is at least in part attributable to hemodynamic and flow-related phenomena. These forces acting on an evolving structure are critical to understanding the challenges in endovascular and surgical therapy. As knowledge in this field continues to progress, the natural history and predicted behavior of these AVMs will become more clearly elucidated.

Incidental Unruptured Arteriovenous Malformation

2019 ◽  
pp. 193-202
Author(s):  
Nicholas C. Bambakidis ◽  
Jeffrey T. Nelson
Keyword(s):  
Decision Making ◽  
Natural History ◽  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Endovascular Embolization ◽  
Cerebral Arteriovenous Malformations ◽  
Eloquent Cortex ◽  
Multimodality Approach ◽  
The Brain ◽  
Efficacy Of Treatment

Abstract: Cerebral arteriovenous malformations are a rare cause of hemorrhage or seizure. They may occur anywhere in the brain and vary considerably in size, arterial and venous drainage, and the degree to which they involve eloquent cortex. Decision-making in terms of treatment depends on an analysis of the expected natural history, the expected number of at risk years, and the anticipated risks and efficacy of treatment. Treatment of unruptured arteriovenous malformations for the prevention of adverse sequelae often requires a multimodality approach, including consideration of the roles of surgical resection, endovascular embolization, and stereotactic radiosurgery. This chapter discusses the diagnosis and management of unruptured cerebral arteriovenous malformations.

Transvenous Approach to Intracranial Arteriovenous Malformations

Neurosurgery ◽  
2015 ◽  
Vol 77 (4) ◽  
pp. 644-652 ◽  
Author(s):  
Omar Choudhri ◽  
Michael E. Ivan ◽  
Michael T. Lawton
Keyword(s):  
Arteriovenous Malformations ◽  
Vascular Malformations ◽  
Venous Drainage ◽  
Endovascular Embolization ◽  
Intracranial Arteriovenous Malformations ◽  
Arteriovenous Fistulas ◽  
Treatment Models ◽  
Dural Arteriovenous Fistulas ◽  
Transvenous Approach ◽  
The Brain

Abstract A compartmental conceptualization of intracranial arteriovenous malformations (AVMs) allows recognition of feeding arteries, an intervening plexiform nidus, and draining veins. AVM therapy involves eliminating the nidus, which is the source of hemorrhage, without compromising normal arterial and venous drainage of the brain. Traditional methods of AVM therapy through microsurgery and endovascular embolization involve arterial devascularization, with preservation of AVM venous drainage, until the nidus is excluded. The transvenous approach in treating vascular malformations was popularized by successful treatment models for dural arteriovenous fistulas. More recently, high-flow intracranial AVMs are being managed with transvenous endovascular approaches, although this novel technique has its challenges and perils. We review the current literature on transvenous AVM therapy and highlight its role for AVM therapy in the present day.

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