Clipping of Basilar Perforator Pure Arterial Malformation Aneurysm: 2-Dimensional Operative Video

2018 ◽  
Vol 17 (2) ◽  
pp. E67-E67 ◽  
Author(s):  
Stephan A Munich ◽  
Marie Christine Brunet ◽  
Robert M Starke ◽  
Jacques J Morcos
Keyword(s):  
Arteriovenous Malformations ◽  
Correct Identification ◽  
Microsurgical Clipping ◽  
Intracranial Lesions ◽  
History Of ◽  
Offending Artery ◽  
Arterial Malformation ◽  
Rare Instance ◽  
Perforating Arteries

Abstract Pure arterial malformations are rarely-encountered intracranial lesions, often mistaken for arteriovenous malformations. A minority of these lesions may harbor associated aneurysms. In a recent series of 12 patients with pure arterial malformations, 3 patients had associated aneurysms.1 As the authors describe, the presentation and natural history of pure arterial malformations generally are considered benign. In over 85% of cases reported in the literature, they are discovered incidentally and in cases with documented follow-up the angio-architecture tends to remain stable.1  However, here we present the case of an aneurysm associated with a pure arterial malformation managed with microsurgical clipping. The patient presented to us with the development of hemorrhage within and/or around the lesion and the development of a partial CN III palsy. Using a cranio-orbital approach, we successfully performed clipping of the offending vessel in the region of the basilar apex. Critical to the successful treatment of this lesion were: the correct identification of the offending vessel, recognition of the presence of perforating arteries, and clipping of the offending artery distal to the origin of the perforating arteries. This case represents a rare instance of a symptomatic pure arterial malformation with associated aneurysm.  Verbal consent was provided by the patient for reproduction and publication of her case.

Radiation Therapy for Arteriovenous Malformations: A Review

Neurosurgery ◽  
1990 ◽  
Vol 26 (5) ◽  
pp. 725-735 ◽  
Author(s):  
Christopher S. Ogilvy
Keyword(s):  
Proton Beam ◽  
Gamma Knife ◽  
Linear Accelerator ◽  
Arteriovenous Malformations ◽  
Proton Beam Therapy ◽  
Recurrent Hemorrhage ◽  
Brain Irradiation ◽  
History Of ◽  
Gamma Knife Therapy

Abstract There have been numerous case reports and series of patients treated with partial brain irradiation, linear accelerator-based radiosurgery, gamma knife radiosurgery, and Bragg peak therapy for inoperable arteriovenous malformations (AVMs). These cases are summarized and compared. There is convincing evidence that radiation therapy does have a role in obliterating carefully chosen inoperable lesions. The changes that occur in vessel walls after radiation are reviewed. Data about x-ray and gamma radiation are mostly historical and difficult to evaluate because of the techniques of partial brain irradiation. There is a lack of data about the volume of AVM treated and the minimum dose delivered to the AVM nidus. For gamma knife, heavy particle, and linear accelerator therapy, more complete data are available. The incidence of hemorrhage during the first 2 years after treatment, when radiation-induced vascular changes are proposed to occur, is approximately 2.6% per year for gamma knife therapy, 2% per year for proton beam therapy, 2.3% per year for helium beam therapy, and 2.3% per year for linear accelerator therapy. These rates are similar to the recurrence rate for hemorrhage of 2.2 to 3% per year expected based on the natural history of untreated AVMs. If AVM obliteration after therapy is not achieved, the incidence of recurrent hemorrhage remains between 2% per year after treatment with gamma knife therapy. The incidence of hemorrhage for all patients treated was reported as 0.15% per year in one study and 20% over 8 years in a follow-up study using proton beam therapy. Mortality from hemorrhage after treatment was 0.6% after gamma knife therapy, 2.3% after helium beam therapy, and 2 to 5% after proton beam therapy. These figures for mortality are all lower than the 11% observed for the natural history of untreated AVMs. Permanent neurological deficits experienced as a complication of radiation occurred in 2 to 3% of patients treated with gamma knife therapy, 4% of patients treated with helium beam therapy, 1.7% of patients treated with proton beam therapy, and 3% of patients treated with stereotactic linear accelerator therapy. Proton beam therapy has been used for both small and large lesions. The majority of lesions in patients treated with gamma knife, helium beam, and linear accelerator therapy have been small (usually less than 3.0 cm average diameter) lesions. In these patients with small inoperable lesions treated with accurately directed fields of isocentric radiation, the greatest incidence of AVM obliteration has been observed on follow-up angiograms. Larger lesions may undergo vascular wall thickening with subsequent protection from recurrent hemorrhage, but more data are needed to support this hypothesis.

scholarly journals Fatal Hemorrhage in Cerebral Proliferative Angiopathy

2012 ◽  
Vol 18 (3) ◽  
pp. 309-313 ◽  
Author(s):  
H. Maekawa ◽  
M. Tanaka ◽  
H. Hadeishi
Keyword(s):  
Lower Risk ◽  
Arteriovenous Malformations ◽  
Brain Parenchyma ◽  
High Flow ◽  
Remarkable Change ◽  
Vascular Abnormality ◽  
Fatal Hemorrhage ◽  
History Of ◽  
Brain Avms

Cerebral proliferative angiopathy (CPA) is a rare vascular abnormality with several angiomorphological features that are distinct from brain arteriovenous malformations (AVMs). The natural history of CPAs indicates a lower risk for hemorrhage compared to brain AVMs. A 62-year-old woman presented with gait instability and dysarthria. MRI and angiography revealed a diffuse vascular network involving the tectum and cerebellar vermis with intermingled brain parenchyma. This lesion had no dominant feeder, high-flow arteriovenous shunt, flow-related aneurysm or highly dilated veins on angiogram. These findings were consistent with a diagnosis of CPA. During follow-up, she developed progressive gait instability and eye movement abnormalities, but no remarkable change was detected on the repeated MRI and angiography. Nine years later, she died of mesencephalic hemorrhage originating from the CPA. To the best of our knowledge, this is the first description of a patient with CPA who died as a result of the initial hemorrhage. It is important to recognize that a part of CPAs is aggressive and can be more vulnerable to critical hemorrhage.

scholarly journals Natural history of brain arteriovenous malformations: a systematic review

2014 ◽  
Vol 37 (3) ◽  
pp. E7 ◽  
Author(s):  
Isaac Josh Abecassis ◽  
David S. Xu ◽  
H. Hunt Batjer ◽  
Bernard R. Bendok
Keyword(s):  
Natural History ◽  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Cerebral Arteriovenous Malformations ◽  
Brain Arteriovenous Malformations ◽  
Increased Risk ◽  
Risk Of Rupture ◽  
History Of ◽  
Arterial Aneurysms

Object The authors aimed to systematically review the literature to clarify the natural history of brain arteriovenous malformations (BAVMs). Methods The authors searched PubMed for one or more of the following terms: natural history, brain arteriovenous malformations, cerebral arteriovenous malformations, and risk of rupture. They included studies that reported annual rates of hemorrhage and that included either 100 patients or 5 years of treatment-free follow-up. Results The incidence of BAVMs is 1.12–1.42 cases per 100,000 person-years; 38%–68% of new cases are first-ever hemorrhage. The overall annual rates of hemorrhage for patients with untreated BAVMs range from 2.10% to 4.12%. Consistently implicated in subsequent hemorrhage are initial hemorrhagic presentation, exclusively deep venous drainage, and deep and infrantentorial brain location. The risk for rupture seems to be increased by large nidus size and concurrent arterial aneurysms, although these factors have not been studied as thoroughly. Venous stenosis has not been implicated in increased risk for rupture. Conclusions For patients with BAVMs, although the overall risk for hemorrhage seems to be 2.10%–4.12% per year, calculating an accurate risk profile for decision making involves clinical attention and accounting for specific features of the malformation.

scholarly journals A Rare Case of Calcifying Pseudoneoplasms of the Neural Axis in Lumbar Spine

2021 ◽  
Author(s):  
Venkatesan Ravi ◽  
Pammi Srinath
Keyword(s):  
Histopathological Examination ◽  
Previous History ◽  
Neural Axis ◽  
Intracranial Lesions ◽  
History Of ◽  
The Central Nervous System ◽  
Radicular Symptoms ◽  
The Right ◽  
Weighted Sequences

AbstractCalcified pseudoneoplasm of the neural axis (CAPNON) is a very rare, non-neoplastic, calcified pathological entity occurring anywhere in the central nervous system (CNS). Overall, less than 100 cases were reported, of which less than 50% were from the spine. We present a case of a 53-year-old lady with a history of L4–L5 radiculopathy, known case of rheumatoid arthritis, and with no previous history of trauma, tumor or infection. MRI showed calcified intradural mass, extending into the right lateral recess, which was isointense on T1- and T2-weighted sequences. Fenestration on right side along with complete resection of the lesion was done. Mass was found adherent around the dura, extending in to right L5 nerve root foramen, and histopathological examination confirmed the diagnosis of CAPNON. At 6 months follow-up, the patient is pain-free with no radicular symptoms. This entity should be taken in as differential in cases of calcified intraspinal and intracranial lesions. Surgical resection is the treatment of choice.

Microsurgery for Small Arteriovenous Malformations of the Brain: Results in 110 Consecutive Patients

Neurosurgery ◽  
2000 ◽  
Vol 47 (3) ◽  
pp. 571-577 ◽  
Author(s):  
Justin H. T. Pik ◽  
Michael K. Morgan
Keyword(s):  
Arteriovenous Malformations ◽  
Postoperative Outcome ◽  
Neurological Status ◽  
Acute Onset ◽  
Neurological Deficits ◽  
Vascular Lesions ◽  
History Of ◽  
The Brain ◽  
Results Of Surgery

ABSTRACT OBJECTIVE To examine the results of surgery in 110 consecutive patients with arteriovenous malformations (AVMs) smaller than 3 cm in diameter. These results are compared with the published results of other microsurgical series as well as with results for patients treated with focused irradiation. METHODS From January 1989 to November 1998, 121 patients with AVMs smaller than 3 cm were treated at our institution. One hundred ten patients underwent microsurgical removal of their AVMs. The presentation, preoperative neurological status, and postoperative outcome were recorded. Follow-up was complete for all surgical cases. RESULTS Of the 110 patients, 109 (99%) had angiographically confirmed obliteration of their AVMs. Two patients (1.8%) required reoperation for residual AVM. Two (4.3%) of 46 patients with AVMs in eloquent brain areas experienced worsening of their neurological status after surgery. One (1.6%) of 64 patients was worse neurologically after removal of an AVM in a noneloquent area. CONCLUSION Microsurgical removal is a safe and effective treatment for the majority of AVMs smaller than 3 cm in diameter. Although the treatment is accompanied by a risk of acute onset of neurological deficits, this tends to be transient in the majority of cases. Furthermore, microsurgical excision of small AVMs offers patients immediate protection from the natural history of their vascular lesions.

scholarly journals Focal fractionated radiotherapy for intramedullary spinal arteriovenous malformations: 10-year experience

2003 ◽  
Vol 99 (1) ◽  
pp. 34-38 ◽  
Author(s):  
Kazutoshi Hida ◽  
Hiroki Shirato ◽  
Toyohiko Isu ◽  
Toshitaka Seki ◽  
Rikiya Onimaru ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Arteriovenous Malformations ◽  
Therapeutic Option ◽  
Fractionated Radiotherapy ◽  
Contrast Enhanced ◽  
Complete Obliteration ◽  
History Of ◽  
Spinal Arteriovenous Malformations ◽  
Tomography Scanning

Object Radiosurgical treatment of spinal arteriovenous malformations (AVMs) is becoming a practical therapeutic option as methodology improves, but no comparative study has yet been published on focal fractionated radiotherapy. The authors report their experience with conventional and hypofractionated radiotherapy for spinal AVM. Methods Candidates for this study were patients who experienced symptoms due to an intramedullary AVM but were ineligible for embolization or surgery. Of 21 patients with spinal AVMs, 10 cases in a 10-year period met this criterion. Angiography and contrast-enhanced computerized tomography scanning were used for treatment planning in all cases. Fractionated radiotherapy was performed using a linear accelerator, extracranial immobilization system, and frequent orthogonal linacographic verification. The starting radiation dose was 32 Gy in two, 36 Gy in three, and 40 Gy in two patients, in a regimen involving 1.8 to 2—Gy daily fractions; this was recently changed to a hypofractionation schedule of 30 Gy (in eight sessions) in one and 20 Gy (in four sessions) in two patients. Results The follow-up period ranged from 26 to 124 months (median of 49 months). There were no hemorrhages nor any adverse reactions attributable to irradiation. Of the seven patients who consented to undergo follow-up angiography, the nidus size decreased in five, but complete obliteration did not occur in any patient. Conclusions Because no patient experienced adverse effects, the maximum tolerable radiation dose for the spinal cord associated with an AVM could not be identified, although it presumably is higher than those administered. The lack of rebleeding in patients in whom complete angiographic occlusion was absent suggests that the natural history of spinal AVMs may be less aggressive than previously reported.

scholarly journals Hemoptysis due to Pulmonary Arteriovenous Malformation after Coil Embolization during Long-Term Follow-Up

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Masashi Shimohira ◽  
Kenji Iwata ◽  
Kengo Ohta ◽  
Yusuke Sawada ◽  
Takeshi Hashimoto ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Coil Embolization ◽  
Arteriovenous Malformations ◽  
Bronchial Artery ◽  
Ground Glass Opacity ◽  
Pulmonary Arteriovenous Malformations ◽  
Long Term Follow Up ◽  
History Of

A 28-year-old man with a history of coil embolization of multiple pulmonary arteriovenous malformations presented with hemoptysis 11 years after initial embolization. A cavity lesion in the left upper lobe, which was accompanied by deformed coils and ground-glass opacity, was considered responsible for hemoptysis. Embolization of the bronchial artery was performed.

Growth and regression of arteriovenous malformations in a patient with hereditary hemorrhagic telangiectasia

2007 ◽  
Vol 106 (3) ◽  
pp. 470-477 ◽  
Author(s):  
Rose Du ◽  
Tomoki Hashimoto ◽  
Tarik Tihan ◽  
William L. Young ◽  
Victor Perry ◽  
...  
Keyword(s):  
Hereditary Hemorrhagic Telangiectasia ◽  
Arteriovenous Malformations ◽  
De Novo ◽  
Chromosome 9 ◽  
Single Patient ◽  
Surgical Specimen ◽  
Endothelial Proliferation ◽  
History Of ◽  
Underlying Pathophysiology

✓ Data on the growth, regression, and de novo formation of arteriovenous malformations (AVMs) suggest that some of these lesions are not formed and developed only during embryogenesis. Patients with hereditary hemorrhagic telangiectasia (HHT) have a genetic propensity to form AVMs. The authors report on the growth and regression of AVMs in a single patient with HHT. This 26-day-old boy with a family history of HHT1 and a mutation in ENG on chromosome 9 presented with a generalized seizure. Results of computed tomography revealed a left frontoparietal intra-parenchymal hemorrhage. Cerebral angiography revealed multiple AVMs. Follow-up angiograms obtained 5 months later showed both growth and regression of the AVMs. A craniotomy was performed for complete resection of the left parietal AVM. Histopathological features of the surgical specimen were examined. Active angiogenesis, as indicated by increased endothelial proliferation, might be a part of the underlying pathophysiology of the growth and regression of AVMs.

The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment

1990 ◽  
Vol 73 (3) ◽  
pp. 387-391 ◽  
Author(s):  
Stephen L. Ondra ◽  
Henry Troupp ◽  
Eugene D. George ◽  
Karen Schwab
Keyword(s):  
Mortality Rate ◽  
Arteriovenous Malformations ◽  
Original Population ◽  
Major Morbidity ◽  
Content Type ◽  
History Of ◽  
The Mean ◽  
The Brain ◽  
Fine Print

✓ The authors have updated a series of 166 prospectively followed unoperated symptomatic patients with arteriovenous malformations (AVM's) of the brain. Follow-up data were obtained for 160 (96%) of the original population, with a mean follow-up period of 23.7 years. The rate of major rebleeding was 4.0% per year, and the mortality rate was 1.0% per year. At follow-up review, 23% of the series were dead from AVM hemorrhage. The combined rate of major morbidity and mortality was 2.7% per year. These annual rates remained essentially constant over the entire period of the study. There was no difference in the incidence of rebleeding or death regardless of presentation with or without evidence of hemorrhage. The mean interval between initial presentation and subsequent hemorrhage was 7.7 years.

Surgical Excision of Cerebral Arteriovenous Malformations: Late Results

Neurosurgery ◽  
1990 ◽  
Vol 26 (4) ◽  
pp. 570-578 ◽  
Author(s):  
Roberto C. Heros ◽  
Kazuyoshi Korosue ◽  
Paula M. Diebold
Keyword(s):  
Arteriovenous Malformation ◽  
Arteriovenous Malformations ◽  
Surgical Excision ◽  
Late Results ◽  
Neurological Deficits ◽  
Clinical Event ◽  
Complete Excision ◽  
Late Morbidity ◽  
History Of

Abstract A follow-up study of 153 consecutive patients who underwent complete excision of an angiographically visualized intracerebral arteriovenous malformation was conducted. The follow-up period ranged from 0.5 to 10.6 years, with a mean of 3.8 years. The presenting clinical event was hemorrhage in about one-half of the patients and seizure in about one-third. There was a marked tendency for postoperative neurological deficits to improve with time, so that whereas the immediate postoperative rate of serious morbidity was 24.2%, only 7.8% of the patients were found to have serious morbidity at follow-up. An additional 3 patients had died. one of an unrelated carcinoma, making the mortality related to arteriovenous malformation 1.3%. The classification of Spetzler and Martin (43) was used retrospectively; the percentages of Grade I (easiest) through Grade V (most difficult) lesions were 7.8%, 22.9%, 28.8%, 26.8%, and 13.8%, respectively. The early result was well correlated to grade, with good or excellent results in 100%, 94.3%, 88.6%, 61%, and 28.6% of the patients in Grades I through V, respectively. At follow-up, 98.7% of the patients with arteriovenous malformations of Grades I, II, and III were in good or excellent condition. The late morbidity and mortality rates for the patients in Grades IV and V were 12.2% and 38.4%, respectively. Of the patients who did not have seizures before surgery, 8.2% had only one or two seizures during the immediate postoperative period, and 7.1% had late seizures that were well controlled with medication in all. Of the patients who had seizures before surgery, over half were either cured or greatly improved with respect to the seizures. In 32.7% there was no change in the frequency of the seizures, and in 12.7% the seizures were more frequent after surgery. There was no history of either proven or suspected intracranial hemorrhage in any of the patients during the entire follow-up period, which in the aggregate totalled 556.3 years.

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