scholarly journals The Preventive Effect of Endovascular Treatment for Recurrent Hemorrhage in Patients with Spinal Cord Arteriovenous Malformations

2015 ◽  
Vol 36 (9) ◽  
pp. 1763-1768 ◽  
Author(s):  
Y. Niimi ◽  
H. Matsukawa ◽  
N. Uchiyama ◽  
A. Berenstein
Keyword(s):  
Spinal Cord ◽  
Endovascular Treatment ◽  
Arteriovenous Malformations ◽  
Preventive Effect ◽  
Recurrent Hemorrhage

Spinal Cord Arteriovenous Malformations in a Pediatric Population Children below 15 Years of Age the Place of Endovascular Management

1995 ◽  
Vol 1 (1) ◽  
pp. 29-42 ◽  
Author(s):  
G. Rodesch ◽  
S. Pongpech ◽  
H. Alvarez ◽  
M. Zerah ◽  
M. Hurth ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Endovascular Treatment ◽  
Arteriovenous Malformations ◽  
Incidental Finding ◽  
Pediatric Population ◽  
Neurological Deficits ◽  
Male Population ◽  
Arteriovenous Shunts ◽  
Weak Points ◽  
Neurologically Normal

Among a global group of 164 spinal arteriovenous shunts, a series of 16 spinal cord arteriovenous malformations (SCAVMs) were diagnosed in a pediatric population below 15 years of age. The majority of the lesions affected the male population; 6 were located in the cervical spine and 10 at the thoracolumbar level. Hemorrhage was the most frequent symptom encountered (63%). Half of the bleeds occurred only in the subarachnoid spaces. Neurological deficits (acute or progressive) revealed the SCAVM in 31% of patients. The lesion was an incidental finding in one patient (6%). All the diagnoses (except one) were made by MRI. Selective angiography confirmed the diagnosis and identified the type of the lesion (nidus or fistula) and its angioarchitecture, stressing that the veins and their related features are the key point in the clinical eloquence of SCAVMs. All the treatments performed were endovascular; no patient was deemed a surgical candidate. Therapeutic abstention was decided in 37% of cases, mainly for anatomical reasons. All the patients in this group improved (50% being normal and 50% presenting slight non-handicapping deficits due to the initial accidents). Embolisation was indicated in 10 patients (63%) and was performed with fluid agents (histoacryl*) except in the first patient who had been treated with particles. Twelve percent of patients were cured (fistula), the remaining 88% having their lesion controlled to more than 50%. This partial treatment was always targetted towards the angioarchitectural weak points of the lesion. All patients improved after embolisation, 45% of them being neurologically normal. Follow-up in this group ranges from 1.5 to 13 Years. No complications occurred after embolisation. No bleed, rebleed or clinical worsening has occurred after endovascular treatment. The results in this series suggest that endovascular treatment (even partial but targetted) represents a safe and stable therapeutic alternative in the management of SCAVMs in this population.

scholarly journals Clinical and angiographic results of long-term follow-up of patients after endovascular treatment for spinal arteriovenous malformations

2020 ◽  
Vol 30 (4) ◽  
pp. 14-22
Author(s):  
D.V. Shchehlov ◽  
O.E. Svyrydiuk ◽  
A.V. Naida ◽  
Yu.M. Samonenko ◽  
O.V. Slobodian
Keyword(s):  
Spinal Cord ◽  
Endovascular Treatment ◽  
Neurological Deficit ◽  
Arteriovenous Malformations ◽  
Magnetic Resonance Tomography ◽  
Dynamic Monitoring ◽  
Long Term Results ◽  
Type I ◽  
Results Of Treatment

Objective – to evaluate long-term results of treatment of patients with arteriovenous malformations AVM of the spinal cord. Materials and methods. A retrospective analysis of clinical and angiographic data of the results of treatment of patients with spinal AVM for the period from 2005 to 2019 was conducted. In SO «Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine» 47 patients were operated on endovascular method. The age of patients ranged from 11 to 62 years (middle age is 45.3 years). There were 29 men (61.7 %), 18 women (38.3 %). Liquid cyanoacrylate embolizant was used for endovascular intervention. The operations were performed with transfemoral access. Accoding the classification proposed by Anson and Spetzler in 1992 patients with type I were 31 (65.9 %), with ІІ type – 8 (17.0 %), with ІIІ type – 5 (10.6 %), with IV type – 3 (6.4 %). Magnetic resonance tomography and spinal angiography were used for diagnostics AVM.Results. Total exclusion of AVM from the bloodstream was achieved in 22 (46.8 %) cases. Out of the 31 (65.9 %) patients with type I AVM, 17 (54.8 %) had an early transient deepening of the neurological deficit. In this group, complete dissection of arteriovenous fistula was achieved in 16 (51.6 %) patients. In 8 (17.0 %) patients with type II AVM, complete exclusion of AVM was achieved in 5 (62.5 %) cases. In this case, 6 (75.0 %) patients were observed early postoperative deepening of neurological symptoms. In 5 (10.6 %) patients with type III AVM, total exclusion was achieved in 1 (20.0 %) case. Transient deepening of neurological deficit was noted in 3 (60.0 %) patients. In 3 (75.0 %) patients with type IV AVM, total embolization was achieved in 1 (33.0 %) observation. Neurological impairment occurred in 1 (33.0 %) patient. In all groups there were no fatalities.Conclusions. Angiography is the gold standard of diagnosis and dynamic monitoring of patients with spinal cord AVM. The use of endovascular treatment of AVM can stop the further progression of neurological deficits, which, however, is not always associated with the total exclusion of AVM. The best neurological improvement and total exclusion were achieved in patients with type I AVM. Radicality, efficacy and deepening of neurological deficiency depend on angioarchitectonics of AVM. The main condition for carrying out embolization is to achieve a safe level of catheterization of the afferent.

Long term follow-up of endovascular management of spinal cord arteriovenous malformations with emphasis on particle embolization

2018 ◽  
Vol 10 (12) ◽  
pp. 1183-1186 ◽  
Author(s):  
Adrien Collin ◽  
Marc-Antoine Labeyrie ◽  
Stephanie Lenck ◽  
Akli Zetchi ◽  
Armand Aymard ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Endovascular Treatment ◽  
Arteriovenous Malformations ◽  
Median Number ◽  
Injection Technique ◽  
Imaging Data ◽  
Independent Observer ◽  
Neurological Improvement

ObjectiveTo determine long term safety and efficacy of endovascular treatment of spinal cord arteriovenous malformations (AVMs), with calibrated particle embolization as a firstline approach.MethodsWe reviewed clinical and imaging data of consecutive patients who underwent endovascular treatment for both nidal and fistulous type spinal cord AVMs in our center, from 1990 to 2015. Outcome at the last follow-up was assessed by an independent observer.ResultsEmbolization of spinal cord AVMs was performed in 61 patients, including 46 (75%) with particles (exclusively in 29 patients), 30 (49%) with cyanoacrylate, and 6 (10%) with combined surgical treatments. Particle embolizations were iterative in 33 patients (median number of sessions 5 (range 3–6)). Neurological deterioration after treatment occurred in 5 patients (cyanoacrylate=4, surgery=1, particles=0; P<0.001). At a median follow-up of 6 years (range 3–13 years), angiographic cure was obtained in 11/61 (18%) patients (nidal type=6/53 (11%), fistulous type=5/8 (63%)). In progressive forms, neurological improvement occurred in 16/28 (57%) patients, stabilized in 9/28 (31%), and worsened in 3/28 (12%). In hemorrhagic forms, the rebleeding rate was 4/14 patient years without standard treatment, 0/322 patient years in partial iterative treatment, and 0/15 patient years in angiographically cured lesions (P=0.001).ConclusionOur study suggests that particle embolization as a firstline therapy to treat spinal cord AVMs is safe and offers long term efficacy, especially for those with small, distal, and multiple shunts. Partial occlusion of the AVM may be sufficient to prevent rebleeding, without the potential risks of complete occlusion. Particle calibration and injection technique, ‘one by one’, are critical to safety. Cyanoacrylate embolization or surgery remains necessary if particle embolization fails to occlude large shunts.

scholarly journals Symptoms, Vascular Anatomy and Endovascular Treatment of Spinal Cord Arteriovenous Malformations

2000 ◽  
Vol 6 (1_suppl) ◽  
pp. 199-202 ◽  
Author(s):  
Y. Niimi ◽  
A. Berenstein ◽  
A. Setton ◽  
J. Pryor
Keyword(s):  
Spinal Cord ◽  
Endovascular Treatment ◽  
Retrospective Analysis ◽  
Arteriovenous Malformations ◽  
Vascular Anatomy ◽  
Provocative Test ◽  
First Choice ◽  
Complete Obliteration ◽  
Choice Of Treatment

The purpose of this study is to evaluate the symptoms, anatomy and efficacy of embolization of spinal cord AVMs (SCAVMs). We performed retrospective analysis of 108 SCAVMs consisting of 38 pediatric and 70 adult cases. They included 81 nidus (26 pediatric) and 27 fistulous (12 pediatric) AVMs. Hemorrhage occurred in 74% of pediatric and 62% of adult cases with multiple hemorrhages in 54% of pediatric and 42% of adult cases. Fistulous AVMs hemorrhaged more frequently in children than adults (75% vs. 13%). 75 cases were treated with embolization alone, 10 with surgery and embolization, 2 with embolization following radiation and 12 with surgery alone. 9 patients received no treatment. In 79 of 87 embolized patients, acrylic was utilized either alone (49) or in combination (30) with other materials. Embolization was attempted 156 times in 93 patients. Complete obliteration by embolization was obtained in 17 cases. If complete obliteration was not possible, partial targeted embolization was performed, aiming at dangerous anatomic structures such as aneurysms. During the follow-up period (mean: 34 months), hemorrhage was observed in only 2 cases. Although technical complications such as dissection or vasospasm occurred on 19 occasions, only 4 resulted in aggravation of neurological symptoms. Of the 21 sessions in which worsening of symptoms occurred after embolization, 10 resulted in permanent deficits and eight of these occurred prior to 1990. SCAVMs have a poor functional prognosis due to frequent hemorrhage if untreated. Embolization with acrylic is feasible as the first choice of treatment. Provocative test and electrophysiological monitoring have improved safety. Partial targeted embolization is effective in preventing hemorrhage.

Multisession CyberKnife Radiosurgery for Intramedullary Spinal Cord Arteriovenous Malformations

Neurosurgery ◽  
2006 ◽  
Vol 58 (6) ◽  
pp. 1081-1089 ◽  
Author(s):  
John Sinclair ◽  
Steven D. Chang ◽  
Iris C. Gibbs ◽  
John R. Adler
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Arteriovenous Malformations ◽  
Conus Medullaris ◽  
Spinal Angiography ◽  
Resonance Imaging ◽  
Intramedullary Spinal Cord ◽  
Cyberknife Radiosurgery

Abstract OBJECTIVE: Intramedullary spinal cord arteriovenous malformations (AVMs) have an unfavorable natural history that characteristically involves myelopathy secondary to progressive ischemia and/or recurrent hemorrhage. Although some lesions can be managed successfully with embolization and surgery, AVM size, location, and angioarchitecture precludes treatment in many circumstances. Given the poor outlook for such patients, and building on the successful experience with radiosurgical ablation of cerebral AVMs, our group at Stanford University has used CyberKnife (Accuray, Inc., Sunnyvale, CA) stereotactic radiosurgery (SRS) to treat selected spinal cord AVMs since 1997. In this article, we retrospectively analyze our preliminary experience with this technique. METHODS: Fifteen patients with intramedullary spinal cord AVMs (nine cervical, three thoracic, and three conus medullaris) were treated by image-guided SRS between 1997 and 2005. SRS was delivered in two to five sessions with an average marginal dose of 20.5 Gy. The biologically effective dose used in individual patients was escalated gradually over the course of this study. Clinical and magnetic resonance imaging follow-up were carried out annually, and spinal angiography was repeated at 3 years. RESULTS: After a mean follow-up period of 27.9 months (range, 3–59 mo), six of the seven patients who were more than 3 years from SRS had significant reductions in AVM volumes on interim magnetic resonance imaging examinations. In four of the five patients who underwent postoperative spinal angiography, persistent AVM was confirmed, albeit reduced in size. One patient demonstrated complete angiographic obliteration of a conus medullaris AVM 26 months after radiosurgery. There was no evidence of further hemorrhage after CyberKnife treatment or neurological deterioration attributable to SRS. CONCLUSION: This description of CyberKnife radiosurgical ablation demonstrates its feasibility and apparent safety for selected intramedullary spinal cord AVMs. Additional experience is necessary to ascertain the optimal radiosurgical dose and ultimate efficacy of this technique.

scholarly journals Emergency endovascular treatment for ruptured abdominal aortic aneurysm and the risk of spinal cord ischemia

2005 ◽  
Vol 42 (4) ◽  
pp. 608-614 ◽  
Author(s):  
Noud Peppelenbosch ◽  
Philippe W.M. Cuypers ◽  
Anco C. Vahl ◽  
Frank Vermassen ◽  
Jacob Buth
Keyword(s):  
Spinal Cord ◽  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Endovascular Treatment ◽  
Spinal Cord Ischemia ◽  
Ruptured Abdominal Aortic Aneurysm ◽  
Abdominal Aortic

The endovascular treatment of arteriovenous malformations

2001 ◽  
Vol 1 (1) ◽  
pp. 64-82
Author(s):  
Christopher Ian MacKay ◽  
Cameron G. McDougall
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Malformations

Characteristics of Brain Arteriovenous Malformations Presenting with Seizures without Acute or Remote Hemorrhage

2011 ◽  
Vol 24 (6) ◽  
pp. 886-888 ◽  
Author(s):  
P. Jiang ◽  
X. Lv ◽  
Z. Wu ◽  
Y. Li ◽  
C. Jiang ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Brain Arteriovenous Malformations ◽  
Male Sex

We report on the predictors of seizure presention in unruptured brain arteriovenous malformations (AVMs). Between 1999 and 2008, 302 consecutive patients with AVMs were referred to our institution for endovascular treatment. Seventy-four patients (24.5%) experienced seizures without hemorrhage before treatment. We tested for statistical associations between angioarchitectural characteristics and seizure presentation. When we compared the 74 patients with seizures without hemorrhage with the 228 patients who did not experience seizures initially (total of 302 patients), male sex, cortical AVM location, AVM size of more than 3 cm, superficial venous drainage and presence of varices in the venous drainage were statistically associated with seizures (P=0.016, P=0.002, P=0.022, P=0.005, and P=0.022, respectively). Posterior fossa and deep locations and coexisting aneurysms were statistically associated with no seizures. The angioarchitectural characteristics of AVM associated with seizure presentation include male sex, cortical AVM location, AVM size of more than 3 cm, superficial venous drainage and presence of varices in the venous drainage.

Sign in / Sign up

Export Citation Format

Share Document