Complications of embolization of arteriovenous malformations of the brain

2006 ◽  
Vol 104 (2) ◽  
pp. 226-232 ◽  
Author(s):  
Charles S. Haw ◽  
Karel terBrugge ◽  
Robert Willinsky ◽  
George Tomlinson
Keyword(s):  
Vascular Malformation ◽  
Neurological Deficit ◽  
Arteriovenous Malformations ◽  
Study Group ◽  
Mortality And Morbidity ◽  
University Of Toronto ◽  
The University ◽  
The Brain

Object The goal of this study was to determine the rates of mortality and morbidity associated with the embolization of arteriovenous malformations (AVMs) of the brain and to analyze the factors related to embolization-related complications. Methods The University of Toronto Brain Vascular Malformation Study Group database was reviewed. Three hundred six patients underwent 513 embolization sessions between November 1984 and September 2002. The combined rate of death and any permanent disabling neurological deficit was 3.9% per patient. Location of the AVM in an eloquent part of the brain, presence of a fistula, and a venous deposition of glue were related to complications. A clinically important reduction in the rate of death and disabling morbidity occurred in the second half of the study period. Conclusions Embolization of AVMs in the brain is associated with low overall rates of mortality and disabling morbidity.

scholarly journals Involvement of Microglia in the Pathophysiology of Intracranial Aneurysms and Vascular Malformations—A Short Overview

2021 ◽  
Vol 22 (11) ◽  
pp. 6141
Author(s):  
Teodora Larisa Timis ◽  
Ioan Alexandru Florian ◽  
Sergiu Susman ◽  
Ioan Stefan Florian
Keyword(s):  
Immune Cells ◽  
Arteriovenous Malformations ◽  
Intracranial Aneurysms ◽  
Immune Cell ◽  
Vascular Malformations ◽  
Cerebral Injury ◽  
Future Research ◽  
Mortality And Morbidity ◽  
The Central Nervous System ◽  
The Brain

Aneurysms and vascular malformations of the brain represent an important source of intracranial hemorrhage and subsequent mortality and morbidity. We are only beginning to discern the involvement of microglia, the resident immune cell of the central nervous system, in these pathologies and their outcomes. Recent evidence suggests that activated proinflammatory microglia are implicated in the expansion of brain injury following subarachnoid hemorrhage (SAH) in both the acute and chronic phases, being also a main actor in vasospasm, considerably the most severe complication of SAH. On the other hand, anti-inflammatory microglia may be involved in the resolution of cerebral injury and hemorrhage. These immune cells have also been observed in high numbers in brain arteriovenous malformations (bAVM) and cerebral cavernomas (CCM), although their roles in these lesions are currently incompletely ascertained. The following review aims to shed a light on the most significant findings related to microglia and their roles in intracranial aneurysms and vascular malformations, as well as possibly establish the course for future research.

Single-hole, ruptured parenchymal arteriovenous fistula of the mesencephalon : Not known vascular malformation of the brain or a posthemorrhagic entity?

2021 ◽  
Vol 74 (3-4) ◽  
pp. 126-128
Author(s):  
Zsolt Kulcsár ◽  
Paolo Machi ◽  
Maria Isabel Vargas ◽  
Karl Schaller ◽  
Karl Olof Lovblad
Keyword(s):  
Arteriovenous Fistula ◽  
Vascular Malformation ◽  
Arteriovenous Malformations ◽  
Red Nucleus ◽  
Brain Parenchyma ◽  
Pial Surface ◽  
Single Hole ◽  
Pseudo Aneurysm ◽  
The Brain ◽  
Spontaneous Haemorrhage

The subtypes of brain arteriovenous malformations, with direct, single-hole fistulas without co-existing nidus are not described as existing entities inside the brain parenchyma but on the pial surface. True parenchymal arteriovenous malformations present with nidal structure, even if they are small, whereas surface lesions may present a direct fistulous configuration. In this case of midbrain haemorrhage a direct arteriovenous fistula was detected at the level of the red nucleus between a paramedian midbrain perforator artery and a paramedian parenchymal vein, with pseudo-aneurysm formation at the fistulous connection, without signs of adjacent nidus structure. The hypothesis whether a pre-existing arteriovenous fistula ruptured or a spontaneous haemorrhage has caused the fistulous connection is discussed.

A Conjunctival Vascular Malformation as a Rare Presenting Sign of Wyburn–Mason Syndrome

2017 ◽  
Vol 16 (04) ◽  
pp. 239-242
Author(s):  
Gunnar Buyse ◽  
Lieven Lagae ◽  
Philippe Demaerel ◽  
Frank Kesteloot ◽  
Ingele Casteels ◽  
...  
Keyword(s):  
Vascular Malformation ◽  
Arteriovenous Malformations ◽  
Brain Magnetic Resonance Imaging ◽  
Rare Condition ◽  
Vascular Lesion ◽  
Facial Skin ◽  
Sudden Appearance ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
The Brain

AbstractWyburn–Mason syndrome is a rare condition that is characterized by ipsilateral arteriovenous malformations affecting the eye, brain, and facial skin. A conjunctival vascular dilation can be a rare ocular presenting sign. We report a 6-year-old boy who attended the hospital because of the sudden appearance of a conjunctival vascular lesion in his right eye. Inspection of his facial skin showed a subtle discoloration along the right trigeminal nerve and a vascular structure of the conjunctiva. Fundoscopy showed dilated and tortuous retinal vessels. Brain magnetic resonance imaging (MRI) revealed a large arteriovenous malformation involving the thalamus and perimesencephalic area. Ophthalmologic and neuroradiologic findings were consistent with the diagnosis of Wyburn–Mason syndrome. The sudden emergence of a vascular malformation in the conjunctiva should alert the clinician to perform an ophthalmoscopy, and in our patient, this finding was the clue to diagnosis of Wyburn–Mason syndrome. Because of the association between retinal and intracranial arteriovenous malformations, an MRI of the brain is strongly recommended in all patients with ocular arteriovenous malformations.

HIV-Associated Lymphoma of the Gastrointestinal Tract: The University of Toronto AIDS-Lymphoma Study Group Experience

1995 ◽  
Vol 16 (3-4) ◽  
pp. 343-349 ◽  
Author(s):  
Kevin R. Imrie ◽  
Carol A. Sawka ◽  
George Kutas ◽  
Joseph Brandwein ◽  
Ellen Warner ◽  
...  
Keyword(s):  
Gastrointestinal Tract ◽  
Study Group ◽  
University Of Toronto ◽  
Lymphoma Study Group ◽  
The University ◽  
Group Experience

Cerebral arteriovenous malformations

1984 ◽  
Vol 60 (1) ◽  
pp. 14-22 ◽  
Author(s):  
Alfred J. Luessenhop ◽  
Louis Rosa
Keyword(s):  
Arteriovenous Malformations ◽  
Neurological Dysfunction ◽  
Cerebral Arteriovenous Malformations ◽  
Natural Risk ◽  
Surgical Risk ◽  
Content Type ◽  
Mortality And Morbidity ◽  
The Brain ◽  
Fine Print

✓ To address the problems of surgical risk versus natural risk associated with cerebral arteriovenous malformations (AVM's), and the role of the intravascular operative approach, the authors have assessed a 20-year experience with 450 patients. Results of direct surgery in 90 patients indicate that for the smaller AVM's (Grades I and II), mortality and morbidity rates are lower than a reasonably projected natural risk. Hence, these patients are candidates for surgery in most instances. However, for more extensive AVM's (Grades III and IV), consideration of anticipated future years of exposure to natural risk and the location of the AVM in the brain are necessary for determining operability. In general, neither seizures nor incipient focal neurological dysfunction alone are indications for surgery, and the risks of disability or death from hemorrhage after the fifth decade of life are probably less than the surgical risks by present operative techniques. Considering the usual age of patients at the time of diagnosis, it is estimated that surgical risk is currently less than the natural risk for about 65% to 70% of all AVM patients. The categories of AVM's in which the angiographic effectiveness of the intravascular approach is the greatest correspond to the same categories of AVM's that can be surgically removed with low risk. The intravascular approach is most useful for management of large AVM's causing progressive neurological dysfunction or as a preliminary step to surgery in selected cases in which access to major feeding arteries is difficult. The authors believe that the future of the intravascular approach should be directed toward transforming large inoperable AVM's into operable ones, but that the overall capability for this with acceptable risk is uncertain at present.

Radiosurgical treatment for rolandic arteriovenous malformations

2006 ◽  
Vol 105 (5) ◽  
pp. 689-697 ◽  
Author(s):  
Yuri M. Andrade-Souza ◽  
Meera Ramani ◽  
Daryl Scora ◽  
May N. Tsao ◽  
Karel terBrugge ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Latency Period ◽  
Obliteration Rate ◽  
University Of Toronto ◽  
First Choice ◽  
Study Population ◽  
Radiation Induced ◽  
Risk Of Hemorrhage ◽  
The University

Object The authors reviewed the radiosurgical outcomes in patients with arteriovenous malformations (AVMs) located in the rolandic area, including the primary motor and sensory gyri. Methods The study population consisted of 38 patients with rolandic-area AVMs who underwent linear accelerator radiosurgery at the University of Toronto between 1989 and 2000. Obliteration rate, risk of hemorrhage during the latency period, radiation-induced complications, seizure control, and functional status were evaluated. Patients were also divided into two subgroups according to AVM volume (< 3 cm3 and ≥ 3 cm3). Patients were followed up for a median of 42.4 months (range 30–103 months), and the median age of the patients was 40 years (range 12–67 years). The median AVM volume was 8.1 cm3 (range 0.32–21, mean 8.32 cm3), and the median dose at the tumor margin was 15 Gy (range 15–22, mean 16.8 Gy). The risk of hemorrhage after radiosurgery was 5.3% for the 1st year, 2.6% for the 2nd, and 0% for the 3rd. Two patients (5.3%) sustained adverse effects related to radiation for more than 6 months. Complete nidus obliteration after a single radiosurgical treatment was achieved in 23 patients (60.5%). The obliteration rate for AVMs smaller than 3 cm3 was 83.3% (10 of 12) and that for AVMs larger than or equal to 3 cm3 was 50% (13 of 26). Among the patients who had seizures as the initial presentation, 51.8% were free of seizures after radiosurgery and the seizure pattern improved in 40.7% during the 3rd and last year of follow up. Overall, excellent results (obliteration and no new or worsening neurological deficit) can be achieved in approximately 60% of patients. This percentage varies according to the AVM size and can reach 83% in patients with AVMs smaller than 3 cm3. Conclusions Radiosurgery is a safe and effective treatment for people with rolandic AVMs. The low rate of morbidity associated with radiosurgery, compared with other treatments, indicates that this method may be the first choice for patients with AVMs located in this area.

Giant arteriovenous malformations of infancy and childhood

1974 ◽  
Vol 40 (3) ◽  
pp. 304-312 ◽  
Author(s):  
Donlin M. Long ◽  
Edward L. Seljeskog ◽  
Shelley N. Chou ◽  
Lyle A. French
Keyword(s):  
Surgical Therapy ◽  
Cardiac Failure ◽  
Neurological Deficit ◽  
Arteriovenous Malformations ◽  
Content Type ◽  
Infancy And Childhood ◽  
Clinical Triad ◽  
The Brain ◽  
Fine Print

✓ Twelve patients are presented with giant arteriovenous malformations of the brain requiring therapy in the neonatal or infant period. Eight patients were operated on, and six survived with no neurological deficit. Four patients were not operated on and all died. The diagnostic clinical triad of enlarged head, cranial bruit, and cardiac failure or enlargement is described, and angiographic characteristics and surgical therapy discussed.

scholarly journals Radiosurgery for Arteriovenous Malformations: the University of Toronto Experience

1997 ◽  
Vol 24 (2) ◽  
pp. 99-105 ◽  
Author(s):  
C. Young ◽  
R. Summerfield ◽  
M. Schwartz ◽  
P. O'Brien ◽  
R. Ramani
Keyword(s):  
Linear Accelerator ◽  
Normal Tissue ◽  
Arteriovenous Malformations ◽  
Ct Scanning ◽  
University Of Toronto ◽  
Enhanced Ct ◽  
The University ◽  
Dynamic Rotation ◽  
Explicit Derivation

ABSTRACT:Background:From July 1989 to February 1996, 130 patients underwent sterotactic radiosurgery. We report the results of the first 50 patients eligible for a minimum of three years of follow-up.Methods:Twenty women and 30 men, (mean age: 37.5 years) were treated by dynamic rotation on a 6 MV linear accelerator. Prior treatment was embolization in seventeen, surgery in three and embolization and surgery in six. All had DSA and enhanced CT scanning, while some had MRI. Forty-seven treatments used a single isodose. Restricting eloquent normal tissue to 15 Gy, margin doses (at 50 - 90% isodose) were 12 Gy (one patient); 15 Gy (sixteen patients); 20 Gy (31 patients); 25 Gy (two patients). Maximum diameters were: <1.5 cm (12 patients); < 2.0 cm (nine patients); < 2.5 cm (twelve patients); < 3.0 cm (thirteen patients; 3.0 cm (four patients).Results:Forty-five patients were evaluable at three years, with thirty-nine having angiography. Twenty-five had angiographically confirmed obliterations; two had parenchymal AVMs obliterated but with residual dural components; four had MRI evidence of obliteration (refused angiography). One patient acutely had a seizure; one patient (with hemorrhages, resection, and embolizations preceding two applications of radiosurgery, separated by 3.5 years) had worsening of memory.Conclusions:Our uncorrected (five patients unevaluable at three years) and corrected angiographically confirmed obliteration rates are 54% and 60% respectively. Our follow-up (98% accounting of cohort; 78% angiographic rate) and explicit derivation of denominators help delineate the efficacy of radiosurgery at these doses.

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