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.

Combined endovascular embolization and surgery in the management of cerebral arteriovenous malformations: experience with 101 cases

1991 ◽  
Vol 75 (6) ◽  
pp. 856-864 ◽  
Author(s):  
Fernando Viñuela ◽  
Jacques E. Dion ◽  
Gary Duckwiler ◽  
Neil A. Martin ◽  
Pedro Lylyk ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Right Hemisphere ◽  
Endovascular Embolization ◽  
Pulmonary Complications ◽  
Surgical Removal ◽  
Cerebral Arteriovenous Malformations ◽  
Content Type ◽  
Grade Ii ◽  
The Right ◽  
Fine Print

✓ The authors describe their experience with 101 cerebral arteriovenous malformations (AVM's) treated by endovascular embolization followed by surgical removal. Fifty-three patients presented with intracranial hemorrhage and 35 had seizures. Based on the classification of Spetzler and Martin, two AVM's were Grade I, 13 were Grade II, 26 were Grade III, 43 were Grade IV, and 17 were Grade V, Fifty-six AVM's were in the right hemisphere, 28 were in the left hemisphere, 12 were in the corpus callosum, and five involved the cerebellum. In 50 cases, presurgical obliteration of 50% to 75% of the AVM nidus was achieved by embolization, and in 31 cases this percentage increased to between 75% and 90%. In 97 (96%) patients, complete surgical removal of the AVM was obtained. Morbidity resulting from preoperative endovascular embolization was classified as mild in 3.9% of the cases, moderate in 6.9%, and severe in 1.98%. The death rate related to embolization was 0.9%. The immediate postsurgical morbidity was classified as mild in 5.9% of the cases, moderate in 10.8%, and severe in 5.9%. The overall long-term morbidity was mild in 5.9% of the cases, moderate in 6.9%, and severe in 1.98%. Two patients (1.98%) died due to intractable intraoperative hemorrhage and two (1.98%) as a result of postsurgical pulmonary complications.

Treatment of cerebral arteriovenous malformations

1980 ◽  
Vol 52 (5) ◽  
pp. 705-708 ◽  
Author(s):  
Laurence D. Cromwell ◽  
A. Basil Harris
Keyword(s):  
Arteriovenous Malformations ◽  
Direct Injection ◽  
Surgical Excision ◽  
Cerebral Arteriovenous Malformations ◽  
Content Type ◽  
Significant Damage ◽  
Fine Print ◽  
Adjacent Brain

✓ It is believed that surgical excision of arteriovenous malformations is the best treatment when technically feasible without causing significant damage to adjacent brain. The introduction of polymers or particulate emboli by catheter has been used either alone or as an adjunct in attempts to reduce the size of these lesions prior to surgery; however, it is seldom possible to embolize the entire malformation. The authors have used direct injection of a 50% mixture of bucrylate and iophendylate into the feeding arteries supplying the area at craniotomy, with success in three cases. The cases are described to illustrate the method.

Microvascular embolization of cerebral arteriovenous malformations

1979 ◽  
Vol 51 (5) ◽  
pp. 621-627 ◽  
Author(s):  
Sean Mullan ◽  
Henry Kawanaga ◽  
Nicholas J. Patronas
Keyword(s):  
Arteriovenous Malformations ◽  
Cerebral Arteriovenous Malformations ◽  
Content Type ◽  
Established Technique ◽  
Partial Success ◽  
Fine Print

✓ A useful variation of an established technique is described for embolization of cerebral arteriovenous malformations. Silastic sponge emboli that fit into No. 16, 17, and 18 stub adapters are passed through standard-sized transfemoral catheters. Of 28 treated patients, obliteration was regarded as very successful in 16. Partial success was achieved in four. Eight were regarded as failures because the reticulum was too large for these microemboli.

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

2001 ◽  
Vol 95 (2) ◽  
pp. 346-349 ◽  
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.

Pathology of arteriovenous malformations embolized with isobutyl-2-cyanoacrylate (bucrylate)

1981 ◽  
Vol 55 (5) ◽  
pp. 819-825 ◽  
Author(s):  
Harry V. Vinters ◽  
Gérard Debrun ◽  
John C. E. Kaufmann ◽  
Charles G. Drake
Keyword(s):  
Arteriovenous Malformations ◽  
Therapeutic Embolization ◽  
Brain Parenchyma ◽  
Pathological Examination ◽  
Foreign Body Giant Cell ◽  
Cell Reaction ◽  
Cerebral Arteriovenous Malformations ◽  
Content Type ◽  
Fine Print ◽  
Adjacent Brain

✓ There is controversy as to the possible toxic effects of isobutyl-2-cyanoacrylate (bucrylate) when this substance is used for purposes of therapeutic embolization. Two cases are presented in which cerebral arteriovenous malformations were resected, one 42 days and the other a year after bucrylate embolization. In both, pathological examination revealed a brisk intimal foreign-body giant-cell reaction wherever bucrylate was present in a vessel, along with chronic inflammation in the vessel walls and adjacent brain parenchyma. The findings are discussed in the light of other observations on the histotoxicity of bucrylate.

Bleeding from cerebral arteriovenous malformations as part of their natural history

1983 ◽  
Vol 58 (3) ◽  
pp. 331-337 ◽  
Author(s):  
Carl J. Graf ◽  
George E. Perret ◽  
James C. Torner
Keyword(s):  
First Year ◽  
Cerebral Arteriovenous Malformations ◽  
Recurrent Hemorrhage ◽  
Content Type ◽  
Rebleeding Rate ◽  
Ruptured Avm ◽  
The Mean ◽  
Print Size ◽  
Fine Print

✓ The case records of 191 patients with a cerebral arteriovenous malformation (AVM) were reviewed to determine bleeding characteristics of these lesions. Possible influences of age, sex, the location and size of the AVM, type of initial hemorrhage, and condition of the patients were analyzed. Of these 191 patients, 102 had a single hemorrhage, 32 had a recurrent hemorrhage, and 57 never bled. The follow-up period for patients with an unruptured AVM was a mean of 4.8 years and a maximum of 31 years; for those with a ruptured AVM, the mean was 2 years, and the maximum 37 years. Size of the AVM was significantly related to the risk of first hemorrhage. The average yearly risk for first hemorrhage was between 2% and 3%. Bleeding occurred most frequently in the 11- to 35-year-old age group. The risk of rebleeding increased with advancing age. Among 93 patients followed after their AVM had ruptured, the risk of rebleeding was 6% in 1 year. After the first year, the average rebleeding rate was about 2% per year up to 20 years.

Surgical removal of corpus callosum infiltrated by low-grade glioma: functional outcome and oncological considerations

2004 ◽  
Vol 100 (3) ◽  
pp. 431-437 ◽  
Author(s):  
Hugues Duffau ◽  
Ihab Khalil ◽  
Peggy Gatignol ◽  
Dominique Denvil ◽  
Laurent Capelle
Keyword(s):  
Corpus Callosum ◽  
Functional Outcome ◽  
Surgical Removal ◽  
Low Grade ◽  
Extensive Resection ◽  
Content Type ◽  
The Impact ◽  
Fine Print

Object. Although still controversial, many authors currently advocate extensive resection in the treatment of low-grade gliomas (LGGs). Because these tumors usually migrate along white matter pathways, the corpus callosum is often invaded. Nevertheless, there is evidently no specific study featuring resection of the corpus callosum infiltrated by glioma, despite abundant literature concerning callosotomy in epilepsy surgery or transcallosal ventricular approaches. The aim of this paper was to analyze functional outcome following removal of corpus callosum invaded by LGG and to analyze the impact of this callosectomy on the quality of resection. Methods. Between 1996 and 2002, a total of 32 patients harboring an LGG involving part of the corpus callosum and having no or only a mild preoperative deficit underwent surgery aided by intraoperative electrical mapping to preserve eloquent structures identified on stimulation and to perform the most extensive resection possible. Preoperatively, no clinical response was elicited on stimulation of the corpus callosum; thus, the part of this structure that was invaded by LGG was removed. Despite immediate postoperative neurological worsening, all patients but one recovered within 3 months and returned to a normal socioprofessional life. The additional callosectomy allowed for nine total resections, 18 subtotal resections, and five partial resections. Furthermore, only two cases of contralateral hemispherical migration occurred during a median follow up of 3 years. Conclusions. Resection of the corpus callosum infiltrated by glioma improves the quality of tumor removal without increasing the risk of sequelae.

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.

Seizure control after surgery on cerebral arteriovenous malformations

1993 ◽  
Vol 78 (1) ◽  
pp. 12-18 ◽  
Author(s):  
Hwa-shain Yeh ◽  
John M. Tew ◽  
Maureen Gartner
Keyword(s):  
Arteriovenous Malformations ◽  
Seizure Control ◽  
Temporal Structure ◽  
Young Patients ◽  
Visual Field Defects ◽  
Cerebral Arteriovenous Malformations ◽  
Seizure Onset ◽  
Content Type ◽  
Fine Print

✓ Prediction of seizure control after surgery on cerebral arteriovenous malformations (AVM's) is currently unavailable. Between 1982 and 1990, 54 patients (30 males, 24 females) with epilepsy caused by a supratentorial cerebral AVM, without prior manifestation of intracranial hemorrhage, were surgically treated. Patients ranged in age from 11 to 59 years at seizure onset and from 13 to 70 years at surgery; the duration of seizure history ranged from several months to 27 years. The AVM's were located in the temporal (17 cases), frontal (15), parietal (10), rolandic (two), and occipital (two) regions; eight were multilobular. All patients underwent preoperative electroencephalography, intraoperative electrocorticography, and total excision of the AVM; additional cortical excision was performed in 25 cases. Remote seizure foci were identified in the ipsilateral mesial temporal structure in 10 patients with AVM's located in the lateral or posterior temporal lobe and in one with an AVM in the anterior frontal region. Two patients required a second operation to remove a remote seizure focus. Among the 54 patients, there were no operative deaths. After surgical treatment, two patients developed hemiparesis, one had contralateral paresthesia of limbs, two suffered partial visual field defects, and five experienced temporary speech disturbances. Postoperative results of seizure control during follow-up study (mean duration 4.8 years) were excellent in 38 patients (70.4%), good in 10 (18.5%), fair in five (9.3%), and poor in one (1.9%). Results appear to correlate with age at seizure onset, duration of seizures, location of lesions, and cortical excision. Excellent results were shown in 18 (60%) of 30 patients whose age at seizure onset was 30 years or less and in 20 (83.3%) of 24 whose age at seizure onset was greater than 30 years. Eighteen (90%) of 20 patients had excellent results when seizure duration was 1 year or less; only 25% of these underwent cortical excision. Twelve (71%) of the 17 temporal AVM's were associated with demonstrable epileptic foci. Secondary epileptogenesis can occur in humans with supratentorial cerebral AVM's; cortical excision in selected patients can improve the outcome of seizure control. Early surgery of a cerebral AVM in young patients presenting with epilepsy is an important consideration.

Surgical outcomes in 31 patients with craniopharyngiomas extending outside the suprasellar cistern: an evaluation of the frontobasal interhemispheric approach

2002 ◽  
Vol 96 (4) ◽  
pp. 704-712 ◽  
Author(s):  
Reizo Shirane ◽  
Ching-chan Su ◽  
Yasuko Kusaka ◽  
Hidefumi Jokura ◽  
Takashi Yoshimoto
Keyword(s):  
Visual Field ◽  
Total Removal ◽  
Partial Removal ◽  
Content Type ◽  
Interhemispheric Approach ◽  
Suprasellar Region ◽  
Initial Symptoms ◽  
Orbitozygomatic Approach ◽  
Fine Print

Object. Craniopharyngiomas frequently grow from remnants of the Rathke pouch, which is located on the cisternal surface of the hypothalamic region. These lesions can also extend elsewhere in the infundibulohypophyseal axis. The aim of this study was to establish the usefulness of the frontobasal approach made through a relatively small craniotomy window for the removal of tumors protruding from the sellar—suprasellar region into the third and basal cistern. Methods. Thirty-one patients who were surgically treated for craniopharyngiomas extending outside the sellar—suprasellar region were evaluated. The diagnoses were established in all cases by using magnetic resonance and computerized tomography imaging. The initial symptoms and signs were increased intracranial pressure in eight, vision impairment or visual field defect in 16, hypopituitarism in 17, and psychological disturbances in three cases. All patients underwent surgery via the frontobasal interhemispheric approach, and the average follow-up period was 30 months. Total removal of the lesion was achieved in 22 cases, six patients underwent subtotal resection, and three underwent partial removal due to tumor recurrence after previous surgeries performed with or without adjunctive radiotherapy. Major complications, including impairment of the cranial nerves, were not observed in the immediate postoperative period. One patient exhibited transient memory disturbance due to infarction of the perforating vessels; after 3 months this symptom was ameliorated. None of the patients died during long-term follow up; however, four of the 22 who underwent total removal and six of the nine patients who underwent subtotal or partial removal suffered recurrence. Of the 10 patients with recurrence, six experienced a small recurrence of the lesion (average 3 months postsurgery); after gamma knife surgery (GKS), the size of two of the lesions was unchanged and in four reoperation was performed due to tumor enlargement during the follow-up period. Ultimately, a total of eight patients (four with recurrence and four who had been treated with GKS) underwent reoperation, with gross-total removal via the same approach or combined with the orbitozygomatic approach in patients with very short optic nerves. In no patient was deterioration of visual acuity and visual field observed after surgery. Although all patients except four children and one adult were receiving some form of hormone replacement therapy, their endocrine status was stably controllable. Conclusions. In the authors' experience, the frontobasal interhemispheric approach, even made through a small craniotomy window, is a valid choice for the removal of craniopharyngiomas extending outside the sellar—suprasellar region. Via this approach, tumors can be removed without significant sequelae related to the surgical method, due to ease of preservation of the pituitary stalk, hypothalamic structures, and perforating vessels. This approach offers a safe and minimally invasive means of treating craniopharyngiomas.

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