scholarly journals Cerebral arteriovenous malformation radiosurgery after intracranial hemorrhage: A case report and literature review

2017 ◽  
Vol 70 (7-8) ◽  
pp. 241-244
Author(s):  
Bojan Jelaca ◽  
Tomislav Cigic ◽  
Vladimir Papic ◽  
Mladen Karan ◽  
Jagos Golubovic ◽  
...  
Keyword(s):  
Case Report ◽  
Arteriovenous Malformation ◽  
Gamma Knife ◽  
Intracranial Hemorrhage ◽  
Good Condition ◽  
Gamma Knife Radiosurgery ◽  
Treatment Modalities ◽  
Temporal Region ◽  
Surgical Morbidity

Introduction. Treatment of cerebral arteriovenous malformations is very challenging and controversial in spite of current recommendations. Surgery is recommended in patients with hemorrhagic stroke, but in patients with good neurological status, when symptoms improve rapidly, the risk of surgical morbidity may be much higher than the risk of rebleeding. Case report. We report a case of a patient with an intracranial hemorrhage due to a ruptured arteriovenous malformation located in the right temporal region of the brain. Because of angiographic and anatomical features of the arteriovenous malformation (deep location and deep venous drainage, but also small arteriovenous malformation nidus size), radiosurgery was the preferred treatment modality. The patient was treated conservatively in the acute stage, and the arteriovenous malformation was subsequently completely eradicated with gamma knife radiosurgery. During the 3-year imaging follow-up, no sings of rebleeding were found. Also, angiography demonstrated that the arteriovenous malformation was completely excluded from the cerebral circulation. The patient was in a good condition and presented without neurological deficits or seizures during the follow-up period. Conclusion. All treatment modalities carry a risk of neurological compromise, but gamma knife radiosurgery may be a good option, even in cases with hemorrhagic presentation. It needs to be mentioned that complete obliteration takes approximately 1 to 3 years after the treatment, and in some cases it cannot be obtained.

scholarly journals A challenging entity of endovascular embolization with ONYX for brainstem arteriovenous malformation: Experience from 13 cases

2017 ◽  
Vol 23 (5) ◽  
pp. 497-503 ◽  
Author(s):  
Hengwei Jin ◽  
Zhan Liu ◽  
Qing Chang ◽  
Chang Chen ◽  
Huijian Ge ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Intracranial Hemorrhage ◽  
Arteriovenous Malformations ◽  
Clinical Presentation ◽  
Gamma Knife Radiosurgery ◽  
Endovascular Embolization ◽  
Treatment Modalities ◽  
Patient Demographics ◽  
Partially Occluded

Objective Brainstem arteriovenous malformations (AVMs) are rare lesions with a high risk of intracranial hemorrhage and are challenging to treat. We present our experience of endovascular embolization with Onyx in these aggressive lesions. Materials and methods Between 2007 and 2016, 13 patients with brainstem AVMs were embolized with Onyx at our center. Twelve patients presented with intracranial hemorrhage and one with headache. Retrospective examinations of patient demographics, clinical presentation, angiographic features, treatment modalities, postoperative complications and outcomes were carried out. Results The AVMs were in the midbrain in 10 patients (one anterior and nine posterior or dorsal), in the posterior pons in two and pontomedullary in one. Complete occlusion was achieved in three patients. Gamma knife radiosurgery was performed in six patients who were near-completely or partially embolized. Postoperative complications, including five cases of ischemia and one case of hemorrhage, resulted in four cases of neurological deterioration and two deaths. Clinical follow-up was obtained in 10 patients at a mean period of 45.2 months (range 3 to 93 months). During the follow-up, good clinical outcomes were observed in seven patients with posterior or dorsal midbrain AVMs, and one patient with a posterior pons AVM that was partially occluded died of intracranial hemorrhage. Conclusion Endovascular embolization for brainstem AVM with Onyx is a technical challenge and the reflux of Onyx may cause severe complications. Individualized treatment is needed based on the specific subtype of brainstem AVM.

scholarly journals Short Term Effectiveness of Gamma Knife Radiosurgery in the Management of Brain Arteriovenous Malformation

2019 ◽  
Vol 7 (19) ◽  
pp. 3221-3224
Author(s):  
Bassam Mahmood Flamerz Arkawazi ◽  
Moneer K. Faraj ◽  
Zaid Al-Attar ◽  
Hayder Ali A. Hussien
Keyword(s):  
Arteriovenous Malformation ◽  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Clinical Symptoms ◽  
Gamma Knife Radiosurgery ◽  
Signs And Symptoms ◽  
Brain Arteriovenous Malformation ◽  
Short Term ◽  
Brain Malformations

AIM: To evaluate the short-term effectiveness of Gamma knife radiosurgery as a modality of treatment of brain arteriovenous malformation. METHODS: Sixty-three patients with arteriovenous brain malformations underwent Gamma knife radiosurgery included in this prospective study between April 2017 and September 2018 with clinical and radiological with MRI follow up was done at three months and six months post-Gamma knife radiosurgery. By the end of the 12th-month post-Gamma knife radiosurgery, the patients were re-evaluated using digital subtraction angiography co-registered with M.R.I. During the 12 months follow up, CT scan or MRI was done at any time if any one of the patients᾽ condition deteriorated or developed signs and symptoms of complications. The mean volume of the arteriovenous malformations treated was 26.0 ± 5 cm3 (range 12.5–39.5 cm3) in The Neurosciences Hospital, Baghdad/Iraq. RESULTS: By the end of the 12th month of follow up, the overall obliteration of the arteriovenous malformations was seen in six patients only (9.5%), while shrinkage was noticed in 57 patients (90.5%). Improvement or clinical stability was found in 24 out of 39 patients (61.5%) presented with epilepsy as a chief complaint before Gamma knife radiosurgery and 21 out of 24 patients (87.0%) complained of a headache before Gamma knife radiosurgery. Post-Gamma knife radiosurgery bleeding was found in only three patients (5.0%). CONCLUSION: Even with the short term follow up, Gamma knife radiosurgery has an excellent clinical outcome in most patients with arteriovenous brain malformations. The clinical symptoms like headache and seizure were either diminished or controlled with the same medical treatment dose before Gamma knife radiosurgery. Long term clinical and radiological follow up is recommended.

SUNCT syndrome successfully treated by gamma knife radiosurgery: Case report

Cephalalgia ◽  
2011 ◽  
Vol 31 (7) ◽  
pp. 870-873 ◽  
Author(s):  
Khaled Effendi ◽  
Samir Jarjoura ◽  
David Mathieu
Keyword(s):  
Adverse Effect ◽  
Case Report ◽  
Gamma Knife ◽  
Maximum Dose ◽  
Gamma Knife Radiosurgery ◽  
Sphenopalatine Ganglion ◽  
Conjunctival Injection ◽  
Sunct Syndrome ◽  
First Case

Background: The SUNCT syndrome (short-unilateral neuralgiform headache with conjunctival injection and tearing) can be very disabling for affected patients and is often refractory to medical management. We report the first case of SUNCT with a successful response to stereotactic radiosurgery without any adverse effect. Case: After failing optimal medical treatment, a 82-year old male patient suffering from SUNCT syndrome was treated with Gamma knife radiosurgery. The trigeminal nerve and sphenopalatine ganglion were targeted with a maximum dose of 80 Gy each. The patient had complete pain cessation 2 weeks after the treatment, and remains pain-free with no medication at the latest follow-up 39 months after radiosurgery. He did not have any side effect from the procedure. Conclusion: Gamma knife radiosurgery is an option for medically refractory SUNCT patients.

scholarly journals Brain Edema after Repeat Gamma Knife Radiosurgery for a Large Arteriovenous Malformation: A Case Report

2016 ◽  
Vol 25 (4) ◽  
pp. 191-196 ◽  
Author(s):  
Joo Whan Kim ◽  
Hyun-Tai Chung ◽  
Moon Hee Han ◽  
Dong Gyu Kim ◽  
Sun Ha Paek
Keyword(s):  
Case Report ◽  
Arteriovenous Malformation ◽  
Brain Edema ◽  
Gamma Knife ◽  
Gamma Knife Radiosurgery

Marked Growth of a Cerebral Arteriovenous Malformation: Case Report and Review of the Literature

Neurosurgery ◽  
1991 ◽  
Vol 29 (6) ◽  
pp. 920-923 ◽  
Author(s):  
Shin-ichi Wakabayashi ◽  
Kikuo Ohno ◽  
Tsuneo Shishido ◽  
Masashi Tamaki ◽  
Yoshiharu Matsushima ◽  
...  
Keyword(s):  
Case Report ◽  
Arteriovenous Malformation ◽  
Intracranial Hemorrhage ◽  
Vascular Lesion ◽  
Cerebral Arteriovenous Malformation ◽  
Review Of The Literature

Abstract A case demonstrating the marked growth of an angiographically occult arteriovenous malformation is presented. A review of 58 cases in which an increase in the size of an arteriovenous malformation occurred suggested that the patient's initial age may have had an important role in such growth and that both the age and the duration of follow-up were related to the extent of growth. Follow-up neuroradiological examinations are thought to be necessary for patients who have had an episode of intracranial hemorrhage of unknown cause during childhood, even if the initial angiograms revealed no vascular lesion.

Radiosurgery for dural carotid-cavernous sinus fistulas: Gamma Knife compared with XKnife radiosurgery

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 9-20 ◽  
Author(s):  
Hung-Chuan Pan ◽  
Ming-Hsi Sun ◽  
Jason Sheehan ◽  
Meei-Ling Sheu ◽  
Clayton Chi-Chang Chen ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Gamma Knife ◽  
Temporal Lobe ◽  
Treatment Modalities ◽  
Conformity Index ◽  
Index Number ◽  
The Mean ◽  
Instrument Accuracy ◽  
Group 1

Object In the modern era, stereotactic radiosurgery is an important part of the multidisciplinary and multimodality approach used to treat dural carotid-cavernous fistulas (DCCFs). Based on the ease of performance of techniques to fuse cerebral angiography studies with MR images or CT scans during the radiosurgical procedure, the Gamma Knife and XKnife are 2 of the most popular radiosurgical instruments for patients with DCCF. In this study, the authors compared the efficacy, neurological results, and complications associated with these 2 radiosurgical devices when used for DCCF. Methods Records for 41 patients with DCCF (15 treated using the XKnife and 26 with Gamma Knife surgery [GKS]) were retrieved from a radiosurgical database encompassing the period of September 2000 to August 2008. Among these patients, at least 2 consecutive MR imaging or MR angiography studies obtained after radiosurgery were available for determining radiological outcome of the fistula. All patients received regular follow-up to evaluate the neurological and ophthalmological function at an interval of 1–3 months. The symptomatology, obliteration rate, radiation dose, instrument accuracy, and adverse effects were determined for each group and compared between 2 groups. The data were analyzed using the Student t-test. Results The mean age of the patients was 63 ± 2.6 years, and the mean follow-up period was 63.1 ± 4.4 months (mean ± SD). Thirty-seven patients (90%) achieved an obliteration of the DCCF (93% in the XKnife cohort and 88% for the GKS cohort). In 34 of 40 patients (85%) with chemosis and proptosis of the eyes, these symptoms were resolved after treatment (4 had residual fistula and 2 had arterializations of sclera). All 5 patients with high intraocular pressure demonstrated clinical improvement. Ten (71%) of 14 patients with cranial nerve palsy demonstrated improvement following radiosurgery. Significant discrepancies of treatment modalities existed between the XKnife and GKS groups, such as radiation volume, conformity index, number of isocenters, instrument accuracy, peripheral isodose line, and maximum dosage. The XKnife delivered significantly higher radiation dosage to the lens, optic nerve, optic chiasm, bilateral temporal lobe, and brainstem. Few adverse events occurred, but included 1 patient with optic neuritis (GKS group), 1 intracranial hemorrhage (XKnife group), 1 brainstem edema (XKnife), and 3 temporal lobe radiation edemas (XKnife). Conclusions Radiosurgery affords a substantial chance of radiological and clinical improvement in patients with DCCFs. The Gamma Knife and XKnife demonstrated similar efficacy in the obliteration of DCCFs. However, a slightly higher incidence of complications occurred in the XKnife group.

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