Effectiveness and Pitfall of Embolization of Cerebral Arteriovenous Malformations

1999 ◽  
Vol 5 (1_suppl) ◽  
pp. 151-156 ◽  
Author(s):  
S. Miyachi ◽  
M. Negoro ◽  
T. Okamoto ◽  
O. Suzuki ◽  
J. Yoshida
Keyword(s):  
High Risk ◽  
Functional Imaging ◽  
Brain Function ◽  
Arteriovenous Malformations ◽  
High Flow ◽  
Surgical Removal ◽  
Cerebral Arteriovenous Malformations ◽  
Total Occlusion ◽  
Embolic Materials ◽  
The Relationship

We studied the course of perisurgical complications of 66 AVMs and discussed the approapriate precautions. Of 66 patients with AVMs, 14 underwent postembolization surgical removal, and 43 underwent radiosurgery. Four patients were cured with total occlusion of their AVM by embolization alone. 48 patients achieved a more than 70% occlusion of the nidus. We observed 12 complications including 3 permanent and 9 temporary. Four complications occurred immediately after the embolization due to overembolization or thromboembolism, and 7 were observed several hours later which might have been caused by retrograde thrombosis or a chemical reaction to the glue. While presurgical embolization deep-seated feeders must be embolized along with fistulous or high-flow feeders, 4 cases of 2nd embolization following radiosurgery showed that meningeal feeders developed or recanalized in cases embolized with absorbable particles. Thus, preradiosurgically, fistulous and meningeal feeders should be treated, and the nidus must be packed with embolic materials with no risk of recanalization. Successful nidus packing performed in 10 AVMs yielded a further nidus reduction before radiosurgery. The intranidal aneurysms which pose a high risk of rebleeding were also embolized. In order to avoid complications in the embolization of AVM, the angioarchitecture, hemodynamics and the relationship to brain function should be well recognized by preoperative functional imaging and superselective angiograms, and adequate embolic materials should be properly injected. As an embolization strategy, the priority of the target feeders should depend on the treatment to follow, and aggressive embolization of risky feeders or causing abrupt hemodynamic change should be avoided.

Unruptured Cerebral Arteriovenous Malformations Presenting with Intracranial Hypertension

Neurosurgery ◽  
1988 ◽  
Vol 23 (4) ◽  
pp. 484-490 ◽  
Author(s):  
Daniel L. Barrow
Keyword(s):  
Intracranial Hypertension ◽  
Arteriovenous Malformations ◽  
Perfusion Pressure ◽  
Pseudotumor Cerebri ◽  
Surgical Removal ◽  
Cerebral Arteriovenous Malformations ◽  
Normal Perfusion Pressure Breakthrough ◽  
The Relationship

Abstract Two cases of unruptured pial arteriovenous malformations (AVMs) presenting with intracranial hypertension and papilledema are reported. In the absence of previous hemorrhage or associated hydrocephalus, such a manifestation of pial AVMs is quite unusual. Both patients experienced prompt and sustained resolution of papilledema after surgical removal of the malformation. One case was complicated by the normal perfusion pressure breakthrough phenomenon postoperatively. The pathophysiology of intracranial hypertension associated with unruptured pial AVMs and the relationship to pseudotumor cerebri are discussed.

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.

scholarly journals Adenosine-induced Cardiac Standstill to Facilitate Endovascular Embolisation of Cerebral Arteriovenous Malformations in Children

2009 ◽  
Vol 37 (4) ◽  
pp. 619-623 ◽  
Author(s):  
G. D. Puri ◽  
I. Sen ◽  
J. R. Bapuraj
Keyword(s):  
General Anaesthesia ◽  
Arteriovenous Malformations ◽  
High Flow ◽  
Cerebral Arteriovenous Malformations ◽  
Neurological Outcomes ◽  
Endovascular Embolisation ◽  
Glue Injection ◽  
Controlled Deposition ◽  
One Year

This report describes three children, aged eight to 11 years, with high-flow cerebral arteriovenous malformations who underwent interventional neuroradiological procedures involving glue (N-butyl cyanoacrylate) embolisation under general anaesthesia. The procedure was facilitated by relative hypotension induced by esmolol infusion and intravenous adenosine boluses. To allow controlled deposition of N-butyl cyanoacrylate into the arteriovenous malformations, glue injection was synchronised with the onset of adenosine-induced brief cardiac standstill. This resulted in satisfactory obliteration of the arteriovenous malformations nidus in all cases. The haemodynamic modulations, including the adenosine-induced brief cardiac standstill, was noted to not affect the BIS values in our patients. All patients had satisfactory obliteration of their arteriovenous malformations and had good neurological outcomes at one-year follow-up.

The Role of Intravascular Embolization Prior to Radiosurgery of Cerebral Arteriovenous Malformations

1999 ◽  
Vol 5 (1_suppl) ◽  
pp. 171-176 ◽  
Author(s):  
H.K. Inoue ◽  
Y. Nagaseki ◽  
I. Naitou ◽  
M. Negishi ◽  
M. Hirato ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Latency Period ◽  
High Flow ◽  
Low Flow ◽  
Flow Volume ◽  
Cerebral Arteriovenous Malformations ◽  
Venous Obstruction ◽  
Risk Of Hemorrhage

The role of intravascular embolization prior to radiosurgery of cerebral arteriovenous malformations was evaluated based on the basis of the results of gamma knife radiosurgery in relation to hemorrhage and early obliteration after treatment. Nine of 213 patients experienced hemorrhage 4 to 42 months after radiosurgery. All AVMs in these patients had dilated feeding arteries, and the flow of the AVM was rapid and/or high. An intranidal aneurysm was seen in one patient. Drainage of all AVMs consisted of a single and/or deep draining veins, and venous obstruction was found in six. Sixty-three of 87 patients followed for more than four years after radiosurgery were examined angiographically, and total obliteration of AVM was observed in 52 of them (82.5%). Early obliteration was found in 19 of the 34 patients examined within 12 months. The obliteration rate was significantly higher in slow- and low-flow AVMs (73.9%) than in rapid- and/or high-flow AVMs (18.2%). It is concluded that the role of intravascular embolization prior to radiosurgery is not only decreasing the size of the AVM but decreasing the risk of hemorrhage and shortening the latency period by decreasing their flow rate and flow volume.

Treatment of Cerebral Arteriovenous Malformations with a Combination of Preoperative Embolization and Surgery

Neurosurgery ◽  
1991 ◽  
Vol 29 (3) ◽  
pp. 358-368 ◽  
Author(s):  
Alberto Pasqualin ◽  
Renato Scienza ◽  
Fabrizia Cioffi ◽  
Giovanni Barone ◽  
Aldo Benati ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Arteriovenous Malformations ◽  
Combined Treatment ◽  
Neurological Deficits ◽  
Preoperative Embolization ◽  
Surgical Removal ◽  
Cerebral Arteriovenous Malformations ◽  
Selective Embolization ◽  
Intraoperative Bleeding ◽  
Microsurgical Approach

Abstract Forty-nine patients with cerebral arteriovenous malformations (AVMs) were treated with preoperative embolization followed by resection using a microsurgical approach. In 27 patients, the AVM was located in an eloquent area; in 32 patients, the volume of the AVM was over 20 cm3. Preoperatively, flow-directed embolization was performed in 10 patients (28 procedures), selective embolization with threads was performed in 35 patients (46 procedures), and a combination of flow-directed and selective embolization was performed in 4 patients (12 procedures). The percentage of reduction of the AVM volume averaged 36% after embolization. Five minor complications (transient neurological deficits, in 2 cases associated with ischemic areas on the CT scan) were observed after embolization. The interval between the last embolization and surgery was as follows: within 10 days in 7 patients; between 11 and 20 days in 3 patients; between 21 and 30 days in 10 patients; between 31 and 60 days in 11 patients; and 2 months later in 18 patients. The efficacy of this combined treatment (embolization plus surgery) was evaluated by the incidence of hyperemic complications and the clinical outcome. Hyperemic complications occurred more frequently in patients with an AVM volume greater than 20 cm3. When compared with flow-directed embolization, selective embolization was linked with decreased bleeding during surgery; postoperatively, the incidence of cerebral edema was also lower. Clinical outcome was better after selective embolization, with no occurrence of major deficits and no mortality. When the percentage of reduction of the AVM volume after embolization was 40% or more, the incidence of intraoperative hyperemic complications was lower; moreover, new permanent deficits were never observed in patients with this volume reduction. A retrospective clinical comparison of two groups of patients with similar AVM volumes (>20 cm3)—those given combined treatment (n = 32) versus those treated by direct surgery alone (n = 27)—showed that intraoperative bleeding appeared to decrease in patients treated by embolization; the incidence of postoperative hyperemic complications was not different in the two groups. New major deficits and deaths were less frequent in patients treated by embolization (P= 0.05 for the incidence of major deficits); postoperative epilepsy was also less common in these patients. In conclusion, combined treatment with selective preoperative embolization and direct surgery may help the neurosurgeon in the treatment of large, high-flow AVMs, reducing the risks connected with their surgical removal. (Neurosurgery 29:358-368, 1991)

scholarly journals Target Embolization of AVMs: Identification of Sites and Results of Treatment

2007 ◽  
Vol 13 (4) ◽  
pp. 389-394 ◽  
Author(s):  
D. Le Feuvre ◽  
A. Taylor
Keyword(s):  
Natural History ◽  
Neurological Deficit ◽  
Clinical Picture ◽  
Treatment Strategy ◽  
Arteriovenous Malformations ◽  
High Flow ◽  
Cerebral Arteriovenous Malformations ◽  
Venous Flow ◽  
Results Of Treatment ◽  
The Ideal

Although cure of cerebral arteriovenous malformations (AVMs) is the ideal goal it is often only possible with smaller sized lesions. This is certainly true if surgery or radiotherapy is used as the treatment strategy. Endovascular treatment, however, allows the possibility of partial treatment directed at specific areas of AVM architecture. With this in mind we retrospectively reviewed our cohort of AVMs to establish which morphological areas we had identified as targets and how the treatment of the AVM influenced the clinical picture. Over a 36-month period 42 AVMs were treated. In 22 of the patients who presented with a hemorrhage an intranidal aneurysm was identified as a target and treated in nine patients. Other patients presented with headaches (2), neurological deficit (4) and seizures (16) with two patients having their AVM picked up coincidentally. Targets identified included high flow fistulas (12), decreasing venous flow (17) and cure of the AVM (8). Results of targeted treatment showed a lower rehemorrhage rate than anticipated by the natural history. Patients cured did best and targeted embolization improved seizures in nine patients, neurological deficit in four patients and headache in 20 patients. Until safer methods exist to cure large AVMs the use of targeted embolization is acceptable as it protects patients against rehemorrhage and translates into an improvement in their clinical picture.

Recurrent cerebral arteriovenous malformations after negative postoperative angiograms

1996 ◽  
Vol 85 (1) ◽  
pp. 14-18 ◽  
Author(s):  
Abraham Kader ◽  
James T. Goodrich ◽  
William J. Sonstein ◽  
Bennett M. Stein ◽  
Peter W. Carmel ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Surgical Removal ◽  
Cerebral Arteriovenous Malformations ◽  
Delayed Imaging ◽  
Humoral Factors ◽  
Content Type ◽  
Risk Of Hemorrhage ◽  
Success Of Treatment ◽  
Previous Location

✓ Angiography has been considered to be the gold standard to judge the success of treatment for cerebral arteriovenous malformations (AVMs). Patients without residual nidus or early draining veins on postoperative angiograms are considered cured, with the risk of hemorrhage eliminated. A series of five patients with recurrent AVMs after negative postoperative angiography is described. All patients had hemispheric AVMs, presented initially with hemorrhage, and were between 5 and 13 years of age. Recurrence was noted 1 to 9 years later (at 12–16 years of age); after a hemorrhage in three patients, seizures in one, and on follow-up magnetic resonance imaging in one. Four patients underwent angiography that showed recurrence of the AVM at or adjacent to the original site. Three years postsurgery, the fifth patient died from a large intracerebral and intraventricular hemorrhage originating in the previous location of the AVM; however, the patient did not undergo angiography at the time of recurrence. The initial negative angiograms obtained postoperatively in these patients may be explained by postoperative spasm or thrombosis of a small residual malformation. However, in the authors' cumulative experience with 808 patients who have undergone complete surgical removal of AVMs (of whom 667 were older than 18 years of age), no case of recurrent AVM has been observed in an adult. Therefore, actual regrowth of an AVM may occur in children and could be a consequence of their relatively immature cerebral vasculature and may involve active angiogenesis mediated by humoral factors. The present findings argue against the assumption that AVMs are strictly congenital lesions resulting from failure of capillary formation during early embryogenesis. It is concluded that delayed imaging studies should be considered in children at least 1 year after their initial negative postoperative arteriogram to exclude a recurrent AVM.

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