scholarly journals Surgical Treatment for High-grade Arteriovenous Malformation: Efficacy of Microsurgical Resection Utilizing Preoperative Embolization and Intraoperative Monitoring

2008 ◽  
Vol 36 (1) ◽  
pp. 24-28 ◽  
Author(s):  
Hisashi NAGASHIMA ◽  
Kazuhiro HONGO ◽  
Toshiki TAKEMAE ◽  
Fusakazu OYA ◽  
Jun-ichi KOYAMA ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Arteriovenous Malformation ◽  
Intraoperative Monitoring ◽  
Preoperative Embolization ◽  
High Grade ◽  
Microsurgical Resection

scholarly journals Embolization of Arteriovenous Malformation

2004 ◽  
Vol 10 (2_suppl) ◽  
pp. 54-58 ◽  
Author(s):  
H. Nagashima ◽  
K. Hongo ◽  
S. Kobayashi ◽  
T. Takamae ◽  
H. Okudera ◽  
...  
Keyword(s):  
Arteriovenous Malformation ◽  
Removal Rate ◽  
Postoperative Bleeding ◽  
University Hospital ◽  
Neurological Deficits ◽  
Preoperative Embolization ◽  
Surgical Removal ◽  
High Grade ◽  
Previously Treated ◽  
Microsurgical Resection

Treatment options for cerebral arteriovenous malformation (AVM) are still controversial due to the recent result of stereotactic radiosurgery and the improved result of microsurgical resection. We investigated previously treated AVM cases and discussed the efficacy and safety of preoperative embolization especially for microsurgical resection of high-grade AVM in the Spetzler-Martin grading. Efficacy of preoperative embolization was evaluated based on 126 previously treated AVM cases at Shinshu University Hospital during the last 25 years. The safety of embolization was evaluated based on our previously-embolized 58 AVM cases (91 procedures) in the last 11 years after introduction of preoperative embolization for AVM. In all 126 cases, 82 were treated before introduction of embolization and 44 were treated after introduction of embolization. In 82 cases of the pre-embolization era, 63 lesions were removed totally in 63 AVMs (77%), partially resected in 11 (13%) and untreated in eight (10%). In 74 surgically removed cases, 11 (15%) cases showed severe intra/postoperative bleeding. In 44 cases of the embolization era, lesions were removed totally in 29 AVMs (66%), disappeared only with embolization in one (2%), disappeared with radiosurgery in seven (16%) and were untreated in five (11%). In 32 surgically removed cases, only one (2%) case showed severe intra/postoperative bleeding. In all 58 embolized cases, 44 were surgically removed, six were treated with radiosurgery, one was eliminated with embolization alone and six were partially obliterated and followed up for their location. In 91 procedures for 58 cases, two haemorrhagic and three ischemic complications occurred, three were transient and two remained having neurological deficits. The introduction of preoperative embolization improved the total removal rate and reduced the intra/postoperative bleeding rate in surgical removal of AVM. The total risk of embolization is low and well-designed preoperative embolization makes surgical resection safer even in high-grade AVM in the Spetzler-Martin grading.

Localization and Microsurgical Resection of Left Postcentral Gyrus Spetzler-Martin Grade 3 Arteriovenous Malformation by Intraoperative Neuronavigation and Tracing of Subcortical Draining Vein: 3-Dimensional Operative Video

2019 ◽  
Vol 19 (2) ◽  
pp. E185-E186
Author(s):  
Qazi Zeeshan ◽  
Juan P Carrasco Hernandez ◽  
Laligam N Sekhar
Keyword(s):  
Arteriovenous Malformation ◽  
Blood Clot ◽  
Preoperative Embolization ◽  
Facial Weakness ◽  
Cortical Vein ◽  
3 Dimensional ◽  
Postcentral Gyrus ◽  
Microsurgical Resection ◽  
Martin Grade ◽  
Grade 3

Abstract This 42-yr-old man presented with a history of sudden right-sided facial and right arm weakness and dysarthria. Head computed tomography showed a left frontal-parietal blood clot. An intra-arterial digital subtraction angiography demonstrated a left subcortical postcentral, Spetzler-Martin Grade 3 arteriovenous malformation (AVM) with a diffuse nidus, measuring 2.1 × 1.5 cm, supplied by branches of the left MCA, and draining into a cortical vein and a deep vein, which was going toward the ventricle. Preoperative embolization was not possible.  The patient underwent left frontal-parietal craniotomy with intraoperative motor and sensory mapping. No arterialized veins were visible on the cortical surface. Neuronavigation localized the AVM in the subcortical postcentral gyrus. Through an incision in the postcentral sulcus, microdissection led to a yellowish gliotic plane. The large cortical vein was in the gliotic area and traced to the AVM. Circumferential microdissection was performed around the AVM. It had a very diffuse nidus; the arterial feeders were cauterized and divided, and the superior superficial and inferior deep draining veins were finally occluded, and AVM was removed.  Postoperative angiogram showed total removal of the AVM. At discharge, his right arm weakness had improved (power 5/5), and facial weakness and dysarthria were improving (modified Rankin Scale (mRS) 2). At 1-yr follow-up, facial weakness and dysarthria had improved considerably, and patient returned to work (mRS 1).  This video shows microsurgical resection of an AVM by neuronavigation and tracing of the subcortical draining vein. The technique of cauterizing the perforating arteries after temporary clipping with flow arrest is shown in the video. Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

Microsurgical Resection of Ruptured Large Left Temporo-Occipital Arteriovenous Malformation: 3-Dimensional Operative Video

2018 ◽  
Vol 15 (6) ◽  
pp. E86-E86
Author(s):  
Chun-Yu Cheng ◽  
Rakshith Shetty ◽  
Laligam N Sekhar
Keyword(s):  
Arteriovenous Malformation ◽  
Cerebral Artery ◽  
Speech Therapy ◽  
Venous Drainage ◽  
Sigmoid Sinus ◽  
Preoperative Embolization ◽  
3 Dimensional ◽  
Vein Of Labbé ◽  
Microsurgical Resection ◽  
Martin Grade

Abstract A 59-yr-old man presented with intraventricular hemorrhage and was found to have a large temporo-occipital arteriovenous malformation (AVM), Spetzler–Martin grade 4. The preoperative intra-arterial digital subtraction angiography (IADSA) showed the AVM was 4 × 4 cm2, had superficial and deep venous drainage, and was fed by multiple branches of the posterior cerebral artery and middle cerebral artery. Preoperative embolization was done in 4 stages.  He underwent a left temporo-occipital craniotomy, mastoidectomy, and retrosigmoid craniotomy with a posterior temporal approach. Intraoperatively, there was a large draining vein draining into the sigmoid sinus in the location of the vein of Labbe, and multiple other feeding arteries and draining veins, including periventricular vessels. Circumferential dissection of the AVM was done from posteriorly, superiorly, anteriorly, and then inferiorly. The technique of temporary clipping and cauterizing the perforating arteries, and then sectioning them after flow arrest is shown in the video. Large arterial feeders were cauterized and divided. Three permanent aneurysm clips were left to control bleeding from the vessels of the trigone of the lateral ventricle. After the large draining vein into the sigmoid sinus was occluded, the AVM was completely removed. The patient had acute nonfluent aphasia postoperatively but improved after speech therapy. The postoperative IADSA demonstrated total resection. At 3-mo follow-up, he had recovered completely (mRS0).  This 3-D video shows the technical nuances of microsurgical resection of a complex large AVM.  Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

scholarly journals Microsurgical resection of a high-grade occipital arteriovenous malformation after staged embolization

2017 ◽  
Vol 43 (videosuppl1) ◽  
pp. V11 ◽  
Author(s):  
Liyong Sun ◽  
Hongqi Zhang ◽  
Jian Ren
Keyword(s):  
Visual Field ◽  
Arteriovenous Malformation ◽  
High Grade ◽  
Final Time ◽  
Grade 5 ◽  
Patient Reported ◽  
Venous Ectasia ◽  
Microsurgical Resection ◽  
Field Defect ◽  
Grade Iii

The authors demonstrate the case of a 16-year-old girl with a large symptomatic occipital arteriovenous malformation (AVM). The staged embolization was performed to downgrade the AVM from Spetzler-Martin (S-M) Grade IV (Supplementary S-M Grade 7) to Grade III (Supplementary S-M Grade 5). The patient developed a subacute progressive visual field defect after the final time of embolization. MRI revealed an enlarged draining venous ectasia of the AVM compressing the visual cortex. Postoperatively, good radiological results were achieved, and the patient reported an improvement in her symptoms. The detailed operative technique and surgical nuances (including the surgical features of the AVM postembolization) of the marginal dissection and removal are illustrated in this video atlas.The video can be found here: https://youtu.be/2MZq5patcJI.

scholarly journals Usefulness of the middle cerebellar peduncle approach for microsurgical resection of lateral pontine arteriovenous malformation

2021 ◽  
Vol 4 (1) ◽  
pp. V11
Author(s):  
Shinsuke Tominaga ◽  
Miyahito Kugai ◽  
Kou Matsuda ◽  
Keisho Yamazato ◽  
Toshihiko Inui ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Arteriovenous Malformation ◽  
Surgical Management ◽  
Neurological Deficits ◽  
Review Of The Literature ◽  
Treatment Results ◽  
Total Resection ◽  
Middle Cerebellar Peduncle ◽  
Microsurgical Resection ◽  
Cerebellar Peduncle

Surgical treatment of brainstem arteriovenous malformation (AVM) is challenging and associated with a higher risk of complications and a lower rate of gross-total resection. The authors present their experience with the surgical management of lateral pontine AVM using the middle cerebellar peduncle approach. All cases presented with neurological deficits that were caused by hemorrhage before surgery. In all cases, the AVM was not visualized on postoperative angiography, and there was no deterioration of neurological symptoms. In this video, the authors report the treatment results of one case and describe the technique with a review of the literature.The video can be found here: https://youtu.be/bFvEMtMnrKw

Combined Embolization and Surgical Treatment of Arteriovenous Malformation of the Orbit

1993 ◽  
Vol 116 (1) ◽  
pp. 17-25 ◽  
Author(s):  
Robert A. Goldberg ◽  
George H. Garcia ◽  
Gary R. Duckwiler
Keyword(s):  
Surgical Treatment ◽  
Arteriovenous Malformation

Radiosurgery as a microsurgical adjunct: outcomes after microsurgical resection of intracranial arteriovenous malformations previously treated with stereotactic radiosurgery

2021 ◽  
pp. 1-12
Author(s):  
Mark Bigder ◽  
Omar Choudhri ◽  
Mihir Gupta ◽  
Santosh Gummidipundi ◽  
Summer S. Han ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Perioperative Period ◽  
Low Grade ◽  
High Grade ◽  
Eligibility Criteria ◽  
Previously Treated ◽  
Microsurgical Resection ◽  
Cerebral Avms ◽  
Staged Treatment

OBJECTIVE Microsurgical resection of arteriovenous malformations (AVMs) can be aided by staged treatment consisting of stereotactic radiosurgery followed by resection in a delayed fashion. This approach is particularly useful for high Spetzler-Martin (SM) grade lesions because radiosurgery can reduce flow through the AVM, downgrade the SM rating, and induce histopathological changes that additively render the AVM more manageable for resection. The authors present their 28-year experience in managing AVMs with adjunctive radiosurgery followed by resection. METHODS The authors retrospectively reviewed records of patients treated for cerebral AVMs at their institution between January 1990 and August 2019. All patients who underwent stereotactic radiosurgery (with or without embolization), followed by resection, were included in the study. Of 1245 patients, 95 met the eligibility criteria. Univariate and multivariate regression analyses were performed to assess relationships between key variables and clinical outcomes. RESULTS The majority of lesions treated (53.9%) were high grade (SM grade IV–V), 31.5% were intermediate (SM grade III), and 16.6% were low grade (SM grade I–II). Hemorrhage was the initial presenting sign in half of all patients (49.5%). Complete resection was achieved among 84% of patients, whereas 16% had partial resection, the majority of whom received additional radiosurgery. Modified Rankin Scale (mRS) scores of 0–2 were achieved in 79.8% of patients, and 20.2% had poor (mRS scores 3–6) outcomes. Improved (44.8%) or stable (19%) mRS scores were observed among 63.8% of patients, whereas 36.2% had a decline in mRS scores. This includes 22 patients (23.4%) with AVM hemorrhage and 6 deaths (6.7%) outside the perioperative period but prior to AVM obliteration. CONCLUSIONS Stereotactic radiosurgery is a useful adjunct in the presurgical management of cerebral AVMs. Multimodal therapy allowed for high rates of AVM obliteration and acceptable morbidity rates, despite the predominance of high-grade lesions in this series of patients.

scholarly journals Navigation-guided transsylvian approach and microsurgical resection of a deep left temporal low-grade arteriovenous malformation

2017 ◽  
Vol 43 (videosuppl1) ◽  
pp. V6
Author(s):  
William T. Couldwell
Keyword(s):  
Arteriovenous Malformation ◽  
Superior Temporal Gyrus ◽  
Adolescent Male ◽  
Low Grade ◽  
Link Type ◽  
Transsylvian Approach ◽  
Grade Ii ◽  
Microsurgical Resection ◽  
Martin Grade

This video demonstrates stereotactic-guided resection of a ruptured diffuse left temporal arteriovenous malformation (AVM) in an adolescent male who presented with headache and speech difficulties. The diffuse nidus of the AVM, 25 mm in size, was located in the posterior superior temporal gyrus, with drainage into the sylvian veins (Spetzler-Martin Grade II). The AVM was located stereotactically, and resection was performed through a small corticectomy. The clot cavity was evacuated. Feeding branches to the AVM were identified during careful dissection, and parent M1 and M2 branches were preserved. The patient recovered well, with no residual speech deficit. Postoperative angiogram demonstrated complete AVM removal.The video can be found here: https://youtu.be/Sttc86H8jCw.

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