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Ji ZL, Xiang SS, Li JW, Xu J, Yu JX, Qi JW, Li GL, Zhang HQ. The Efficacy and Disadvantages of Endovascular Therapy for Deep-Seated Cerebral Arteriovenous Malformations: A Long-Term Follow-Up Study. J Craniofac Surg 2025:00001665-990000000-02735. [PMID: 40378007 DOI: 10.1097/scs.0000000000011486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2025] [Accepted: 04/13/2025] [Indexed: 05/18/2025] Open
Abstract
Arteriovenous malformations (AVMs) in the basal ganglia, the thalamus, and the insular lobe of the brain are rare and difficult-to-treat diseases that require integrated multimodal management. This study aimed to determine the safety and disadvantages of embolization as an independent therapy for deep-seated AVMs. The authors reviewed 76 patients from a single center with cerebral deep-seated AVMs from 2010 to 2020. Clinical hemorrhage refers to the initial clinical presentation with bleeding, the first occurrence of bleeding, and delayed postoperative hemorrhage refers to subsequent bleeding following the initial hemorrhage. After interventional therapy, 8 patients experienced delayed postoperative hemorrhage during the total follow-up of 94,631 person-years, with an annual postoperative hemorrhage rate of 3.1%. Compared with the overall clinical hemorrhage rate before treatment (15.9%/person-year), 11 patients experienced clinical hemorrhage during 25,238 person-years, indicating a significantly decreased risk of clinical hemorrhage after treatment. A total of 28.9% (22/76) of patients achieved angiographic obliteration. Multivariate analysis showed that pretreatment limb weakness and a high Spetzler-Martin grade predicted poor clinical outcomes (P = 0.043 and 0.005). Fewer feeding arteries predicted AVMs' obliteration (P = 0.048). Endovascular procedure-related complications, mortality, and morbidity were, respectively, reported in 7.9% (6/76), 1.3% (1/76), and 14.8% (8/54) of patients. Endovascular embolization significantly lowered the risk of clinical deterioration and delayed hemorrhage, indicating it to be a safe and effective therapy for deep-seated AVMs. Lesions with a simple angioarchitecture were more likely to be completely obliterated.
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Affiliation(s)
- Zhen-Long Ji
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, Beijing
- Department of Neurosurgery, The Affiliated Hospital of Northwest University, Xi'an No.3 Hospital, Xi'an
| | - Si-Shi Xiang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, Beijing
| | - Jing-Wei Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, Beijing
| | - Jin Xu
- Department of Library, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jia-Xing Yu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, Beijing
| | - Jia-Wei Qi
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, Beijing
| | - Gui-Lin Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, Beijing
| | - Hong-Qi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, China International Neuroscience Institute, Beijing
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Brunozzi D, Alaraj A. Unruptured brain arteriovenous malformation risk stratification. J Neurointerv Surg 2025:jnis-2024-022779. [PMID: 40274404 DOI: 10.1136/jnis-2024-022779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2025] [Accepted: 04/12/2025] [Indexed: 04/26/2025]
Abstract
Cerebral arteriovenous malformations (AVMs) are an uncommon type of central nervous system vascular anomaly that have the potential to rupture and cause intracranial hemorrhage. AVM hemorrhagic risk assessment has been mainly based on anatomical features derived from imaging; the most recent focus on AVM hemodynamics, vessel wall imaging, and molecular analysis of the inflammatory response, provide new insights into the hemorrhagic risk stratification. The greater data availability provided by innovative imaging techniques and biological analysis of biomarkers and genetic polymorphism further demonstrates the existence of a complex interaction between anatomically altered vasculature, non-physiological hemodynamics, and inflammatory molecular activity. The accurate prediction of cerebral AVM rupture, essential to guide the management decision by comparing the risk of observation to the risk of intervention, has yet to be solved. This review of several studies aims to summarize the current evidence on brain AVM rupture risk stratification.
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Affiliation(s)
- Denise Brunozzi
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
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Davison M, McCune M, Thiyagarajah N, Kashkoush A, Achey R, Shost M, Toth G, Bain M, Moore N. The incidence of infratentorial arteriovenous malformation-associated aneurysms: an institutional case series and systematic literature review. J Neurointerv Surg 2025:jnis-2024-022003. [PMID: 38937081 DOI: 10.1136/jnis-2024-022003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/13/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Arteriovenous malformation (AVM)-associated aneurysms represent a high-risk feature predisposing them to rupture. Infratentorial AVMs have been shown to have a greater incidence of associated aneurysms, however the existing data is outdated and biased. The aim of our research was to compare the incidence of supratentorial vs infratentorial AVM-associated aneurysms. METHODS Patients were identified from our institutional AVM registry, which includes all patients with an intracranial AVM diagnosis since 2000, regardless of treatment. Records were reviewed for clinical details, AVM characteristics, nidus location (supratentorial or infratentorial), and presence of associated aneurysms. Statistical comparisons were made using Fisher's exact or Wilcoxon rank sum tests as appropriate. Multivariable logistic regression analysis determined independent predictors of AVM-associated aneurysms. As a secondary analysis, a systematic literature review was performed, where studies documenting the incidence of AVM-associated aneurysms stratified by location were of interest. RESULTS From 2000-2024, 706 patients with 720 AVMs were identified, of which 152 (21.1%) were infratentorial. Intracranial hemorrhage was the most common AVM presentation (42.1%). The incidence of associated aneurysms was greater in infratentorial AVMs compared with supratentorial cases (45.4% vs 20.1%; P<0.0001). Multivariable logistic regression demonstrated that infratentorial nidus location was the singular predictor of an associated aneurysm, odds ratio: 2.9 (P<0.0001). Systematic literature review identified eight studies satisfying inclusion criteria. Aggregate analysis indicated infratentorial AVMs were more likely to harbor an associated aneurysm (OR 1.7) and present as ruptured (OR 3.9), P<0.0001. CONCLUSIONS In this modern consecutive patient series, infratentorial nidus location was a significant predictor of an associated aneurysm and hemorrhagic presentation.
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Affiliation(s)
- Mark Davison
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Maximos McCune
- Cerebrovascular Center, CCF, Cleveland Heights, Ohio, USA
| | | | - Ahmed Kashkoush
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rebecca Achey
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Michael Shost
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Gabor Toth
- Cerebrovascular Center, CCF, Cleveland Heights, Ohio, USA
| | - Mark Bain
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cerebrovascular Center, CCF, Cleveland Heights, Ohio, USA
| | - Nina Moore
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cerebrovascular Center, CCF, Cleveland Heights, Ohio, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland, OH, USA
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Das S, Kasher P, Waqar M, Parry-Jones A, Patel H. Reporting of angiographic studies in patients diagnosed with a cerebral arteriovenous malformation: a systematic review. F1000Res 2024; 12:1252. [PMID: 39931157 PMCID: PMC11809685 DOI: 10.12688/f1000research.139256.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2024] [Indexed: 02/13/2025] Open
Abstract
A cerebral arteriovenous malformation (cAVM) is an abnormal tangle of cerebral blood vessels. The consensus document by the Joint Writing Group (JWG) highlighted which cAVM features should be recorded. Subsequent publications have reported cAVM angioarchitecture, but it is unknown if all followed the JWG recommendations. The aim of this systematic review was to describe use of the JWG guidelines. A database search, using the PRISMA checklist, was performed. We describe the proportion of publications that used JWG reporting standards, which standards were used, whether the definitions used differed from the JWG, or if any additional angiographic features were reported. Out of 4306 articles identified, 105 were selected, and a further 114 from other sources. Thirty-three studies (33/219; 15%) specifically referred to using JWG standards. Since the JWG publication, few studies have used their standards to report cAVMs. This implies that the angioarchitecture of cAVMs are not routinely fully described.
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Affiliation(s)
- Suparna Das
- The University of Manchester, Manchester, England, UK
| | - Paul Kasher
- The University of Manchester, Manchester, England, UK
| | - Mueez Waqar
- The University of Manchester, Manchester, England, UK
| | | | - Hiren Patel
- The University of Manchester, Manchester, England, UK
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Miron I, Prună VM, Visarion D, Giovani A, Sandu AM, Brehar FM, Petrescu GED, Gorgan RM. Clinical outcomes of posterior fossa arteriovenous malformations: a single center experience. Acta Neurochir (Wien) 2024; 166:215. [PMID: 38744729 PMCID: PMC11093870 DOI: 10.1007/s00701-024-06116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/05/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Posterior fossa arterio-venous malformations (pfAVMs) are challenging lesions due to the anatomical particularities of the posterior fossa, and the high incidence of hemorrhagic presentation. The two most important goals when treating AVMs are preserving neurological function and preventing rupture, or a second hemorrhage. The aim of this study was to analyze the clinical and imaging features of pfAVMs to identify the factors that influence the prognosis of these patients. METHODS We conducted a single-center retrospective observational study that included patients treated at our institution with pfAVMs between January 1997 and December 2021. RESULTS A total of 48 patients were included. A good modified Rankin score (mRS) was observed in 33 cases (69%) at presentation. Thirty-four patients (71%) presented with a ruptured AVM. Out of these, 19 patients (40%) had intraventricular hemorrhage. Microsurgical resection was performed in 33 cases (69%), while in the other cases, the patients opted for conservative management (7 cases, 15%), stereotactic radiosurgery (SRS) (6 cases, 12%), or endovascular treatment (2 cases, 4%). Patients ≤ 30 years old were more prone to hemorrhagic presentation (OR: 5.23; 95% CI: 1.42-17.19; p = 0.024) and this remained an independent risk factor for rupture after multivariate analysis as well (OR: 4.81; 95% CI: 1.07-21.53; p = 0.040). Following multivariate analysis, the only factor independently associated with poor prognosis in the surgically treated subgroup was a poor clinical status (mRS 3-5) at admission (OR: 96.14; 95% CI: 5.15-1793.9; p = 0.002). CONCLUSIONS Management of posterior fossa AVMs is challenging, and patients who present with ruptured AVMs often have a poor clinical status at admission leading to a poor prognosis. Therefore, proper and timely management of these patients is essential.
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Affiliation(s)
- Ioana Miron
- Department of Neurosurgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Neurosurgery, Bagdasar-Arseni Clinical Emergency Hospital, Bucharest, Romania
| | - Viorel M Prună
- Department of Neurosurgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Neurosurgery, Bagdasar-Arseni Clinical Emergency Hospital, Bucharest, Romania
| | - Dan Visarion
- Department of Neurosurgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Neurosurgery, Bagdasar-Arseni Clinical Emergency Hospital, Bucharest, Romania
| | - Andrei Giovani
- Department of Neurosurgery, Bagdasar-Arseni Clinical Emergency Hospital, Bucharest, Romania
| | - Aurelia M Sandu
- Department of Neurosurgery, Bagdasar-Arseni Clinical Emergency Hospital, Bucharest, Romania
| | - Felix M Brehar
- Department of Neurosurgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Neurosurgery, Bagdasar-Arseni Clinical Emergency Hospital, Bucharest, Romania
| | - George E D Petrescu
- Department of Neurosurgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
- Department of Neurosurgery, Bagdasar-Arseni Clinical Emergency Hospital, Bucharest, Romania.
| | - Radu M Gorgan
- Department of Neurosurgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Neurosurgery, Bagdasar-Arseni Clinical Emergency Hospital, Bucharest, Romania
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Lin CJ, Chen KK, Hu YS, Yang HC, Lin CF, Chang FC. Quantified flow and angioarchitecture show similar associations with hemorrhagic presentation of brain arteriovenous malformations. J Neuroradiol 2023; 50:79-85. [PMID: 35120975 DOI: 10.1016/j.neurad.2022.01.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The purpose of our study was to elucidate the impact of brain arteriovenous malformation (BAVM) flow and wall shear stress (WSS) on angioarchitecture and to evaluate their association with hemorrhagic presentations. MATERIALS AND METHODS Forty-one patients with BAVMs were evaluated by phase-contrast MR angiography. Volume flow rate and WSS were quantified. Angioarchitectural features such as location, angiogenesis, venous stenosis, venous ectasia, venous phlebitis, venous rerouting, exclusive deep vein and venous sac were evaluated by two neuroradiologists. The correlation between BAVM flow and size was evaluated with Spearman correlation coefficients. Differences of size, flow, and WSS between the hemorrhagic and non-hemorrhagic groups, the seizure and non-seizure groups, and between the different groups based on angioarchitecture were evaluated with Mann-Whitney U tests. Accuracy in predicting hemorrhage was evaluated with receiver operating characteristic curves. RESULT BAVM flow was highly correlated with volume (ρ = 0.77). Higher flow was more commonly associated with angiogenesis, venous ectasia, venous rerouting, and venous phlebitis. Flow and angioarchitecture showed similar efficacy in differentiating hemorrhagic from non-hemorrhagic BAVMs. WSS did not demonstrate differences across any clinical groups. CONCLUSION Flow quantification and angioarchitecture analysis of BAVMs showed similar efficacy as evaluated by associations with hemorrhagic presentation. High flow affects both arterial and venous angioarchitecture, reflecting the nature of low vascular resistance in BAVMs.
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Affiliation(s)
- Chung-Jung Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Ko-Kung Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yong-Sin Hu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Radiology, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan
| | - Huai-Che Yang
- Department of Radiology, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chun-Fu Lin
- Department of Radiology, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan; Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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De Leacy R, Ansari SA, Schirmer CM, Cooke DL, Prestigiacomo CJ, Bulsara KR, Hetts SW. Endovascular treatment in the multimodality management of brain arteriovenous malformations: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee. J Neurointerv Surg 2022; 14:1118-1124. [PMID: 35414599 DOI: 10.1136/neurintsurg-2021-018632] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/07/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The purpose of this review is to summarize the data available for the role of angiography and embolization in the comprehensive multidisciplinary management of brain arteriovenous malformations (AVMs METHODS: We performed a structured literature review for studies examining the indications, efficacy, and outcomes for patients undergoing endovascular therapy in the context of brain AVM management. We graded the quality of the evidence. Recommendations were arrived at through a consensus conference of the authors, then with additional input from the full Society of NeuroInterventional Surgery (SNIS) Standards and Guidelines Committee and the SNIS Board of Directors. RESULTS The multidisciplinary evaluation and treatment of brain AVMs continues to evolve. Recommendations include: (1) Digital subtraction catheter cerebral angiography (DSA)-including 2D, 3D, and reformatted cross-sectional views when appropriate-is recommended in the pre-treatment assessment of cerebral AVMs. (I, B-NR) . (2) It is recommended that endovascular embolization of cerebral arteriovenous malformations be performed in the context of a complete multidisciplinary treatment plan aiming for obliteration of the AVM and cure. (I, B-NR) . (3) Embolization of brain AVMs before surgical resection can be useful to reduce intraoperative blood loss, morbidity, and surgical complexity. (IIa, B-NR) . (4) The role of primary curative embolization of cerebral arteriovenous malformations is uncertain, particularly as compared with microsurgery and radiosurgery with or without adjunctive embolization. Further research is needed, particularly with regard to risk for AVM recurrence. (III equivocal, C-LD) . (5) Targeted embolization of high-risk features of ruptured brain AVMs may be considered to reduce the risk for recurrent hemorrhage. (IIb, C-LD) . (6) Palliative embolization may be useful to treat symptomatic AVMs in which curative therapy is otherwise not possible. (IIb, B-NR) . (7) The role of AVM embolization as an adjunct to radiosurgery is not well-established. Further research is needed. (III equivocal, C-LD) . (8) Imaging follow-up after apparent cure of brain AVMs is recommended to assess for recurrence. Although non-invasive imaging may be used for longitudinal follow-up, DSA remains the gold standard for residual or recurrent AVM detection in patients with concerning imaging and/or clinical findings. (I, C-LD) . (9) Improved national and international reporting of patients of all ages with brain AVMs, their treatments, side effects from treatment, and their long-term outcomes would enhance the ability to perform clinical trials and improve the rigor of research into this rare condition. (I, C-EO) . CONCLUSIONS Although the quality of evidence is lower than for more common conditions subjected to multiple randomized controlled trials, endovascular therapy has an important role in the management of brain AVMs. Prospective studies are needed to strengthen the data supporting these recommendations.
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Affiliation(s)
- Reade De Leacy
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sameer A Ansari
- Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Daniel L Cooke
- Radiology and Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | | | - Ketan R Bulsara
- Division of Neurosurgery, University of Connecticut, Farmington, Connecticut, USA
| | - Steven W Hetts
- Radiology and Biomedical Imaging, University California San Francisco, San Francisco, California, USA
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Rozhchenko LV, Petrov AE, Goroshchenko SA, Bobinov VV, Samochernykh KA. [Endovascular treatment of aneurysms associated with cerebral arteriovenous malformations]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2022; 86:25-35. [PMID: 35412710 DOI: 10.17116/neiro20228602125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED There are proximal, distal and intranidal AVM-associated aneurysms (G. Redekop, 1998). OBJECTIVE To evaluate treatment outcomes in 120 patients with AVM-associated aneurysms. MATERIAL AND METHODS We analyzed treatment outcomes in 639 patients with cerebral AVM who underwent 1992 endovascular procedures between 2010 and 2019. AVM-associated aneurysms were found in 120 (18.8%) cases: 81 (67.5%) patients with 69 proximal and 29 distal aneurysms, 33 (27.5%) AVMs with intranidal aneurysms and 6 (5%) aneurysms without hemodynamic connection with AVM. One hundred and one malformations (16.9%) out of 596 supratentorial AVMs and 19 (44.2%) out of 43 subtentorial AVMs were associated with aneurysms. RESULTS Intracranial hemorrhage occurred in 349 (53.3%) out of 639 patients with AVM: 97 (80.8%) out of 120 patients with AVM-associated aneurysms and 252 (48.6%) out of 519 ones with AVM and no aneurysms. All 33 patients with intranidal aneurysms in the AVM structure and 18 (94.7%) out of 19 patients with AVM-associated aneurysms and AVM in posterior cranial fossa had intracranial hemorrhage. There were 98 aneurysms in 81 patients with AVM-associated aneurysms. Eighty-nine (90.8%) ones underwent endovascular treatment, 6 (6.1%) patients with proximal aneurysms required microsurgery. Three distal aneurysms were not repaired. Thirty-four aneurysms were embolized with spirals. Embolization with spirals and balloon assistance was performed for 41 aneurysms, spirals with stent-assistance - for 9 aneurysms (including 1 distal MCA aneurysm in hemorrhagic period). Implantation of a flow-diverting stent was performed for 5 aneurysms (1 distal and 4 proximal aneurysms). There were 8 (8.9%) complications after embolization of 89 AVM-associated aneurysms (5 thromboembolic and 3 hemorrhagic events). CONCLUSION According to our data, intranidal aneurysms require exclusion of the parent AVM segment due to high risk of hemorrhage. Treatment of proximal AVM-associated aneurysms should be carried out prior to AVM embolization. Distal aneurysms do not regress after definitive AVM treatment and should be operated on after total AVM embolization.
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Affiliation(s)
- L V Rozhchenko
- Polenov Russian Research Institute of Neurosurgery, St. Petersburg, Russia
| | - A E Petrov
- Polenov Russian Research Institute of Neurosurgery, St. Petersburg, Russia
| | - S A Goroshchenko
- Polenov Russian Research Institute of Neurosurgery, St. Petersburg, Russia
| | - V V Bobinov
- Polenov Russian Research Institute of Neurosurgery, St. Petersburg, Russia
| | - K A Samochernykh
- Polenov Russian Research Institute of Neurosurgery, St. Petersburg, Russia
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Piao J, Luan T, Wang Y, Yu J. Imaging characteristics and endovascular treatment strategy for cerebellar arteriovenous malformations. MEDICINE INTERNATIONAL 2021; 1:5. [PMID: 36698869 PMCID: PMC9855278 DOI: 10.3892/mi.2021.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/22/2021] [Indexed: 01/28/2023]
Abstract
Cerebellar arteriovenous malformations (CAVMs) have increased probabilities of rupture and bleeding compared with arteriovenous malformations (AVMs) in other locations of the brain. Endovascular treatment (EVT) for CAVMs is difficult; as the angioarchitecture of CAVMs is complex, EVT may be associated with complications, due to the involvement of crucial structures, such as the brainstem. The present study aimed to determine the efficacy of EVT for CAVMS. For this purpose, 33 cases of CAVMs treated with EVT from January, 2015 to January, 2020 were retrospectively analyzed. The 33 patients were aged 8 to 73 years (mean age, 40.4±17.8 years) and 21 were female (63%, 21/33). Rupture and bleeding occurred in 29 patients (87.9%, 29/33). Among the 33 CAVM cases, 15 (45.5%, 15/33) were fed by a single artery, and 18 (54.5%, 18/33) were fed by multiple arteries. In total, 27 patients (81.8%, 27/33) had superficial vein drainage alone. Among the 33 cases, 15 were complicated by 16 aneurysms, including 14 prenidal aneurysms and 2 intranidal aneurysms. Among the 33 cases, the nidus of the CAVM (87.9%, 29/33) was treated with Onyx™ casting in 29 patients: 8 cases (27.6%, 8/29) had an embolization volume of <1/3 of the nidus, 11 cases had a volume of 1/3-2/3 of the nidus (37.9%, 11/29) and 10 cases had a volume >2/3 of the nidus (34.5%, 10/29). Among the EVT complications, there were 3 cases (9.1%, 3/33) of intraoperative and post-operative bleeding, which resulted in two deaths (on the 1st and 7th days). The length of hospital stay was 10.7±5.4 days. In total, 27 patients (81.7%, 27/33) had a Glasgow Outcome Scale (GOS) score of 5 at discharge. On the whole, the present study demonstrates that overall, EVT is a feasible treatment for CAVM and may be used to obtain acceptable therapeutic effects.
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Affiliation(s)
- Jianmin Piao
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Tengfei Luan
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yiheng Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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Yu JX, He C, Ye M, Li GL, Bian LS, Yang F, Zhai XD, Ling F, Zhang HQ, Hong T. The efficacy and deficiency of contemporary treatment for spinal cord arteriovenous shunts. Brain 2021; 144:3381-3391. [PMID: 34156437 DOI: 10.1093/brain/awab237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/15/2021] [Accepted: 06/03/2021] [Indexed: 11/12/2022] Open
Abstract
Contemporary treatments for spinal cord arteriovenous shunts are only based on clinicians' treatment experiences and expertise due to its rarity. We reviewed the clinical course of the largest multi-cantered cohort to evaluate the efficacy and deficiency of contemporary interventional treatments for spinal cord arteriovenous shunts. The clinical features, treatment results and clinical outcomes of 463 spinal cord arteriovenous shunts patients were retrospectively assessed. The main outcome was the neurological deterioration that was evaluated based on the modified Aminoff and Logue scale. According to post-treatment DSA, complete obliteration was defined as disappearance of the intradural lesion, whereas partial obliteration was defined as any residual intradural lesion remaining visible and was further categorized as shunt-reduction obliteration (the nidus or shunt points was reduced) or palliative obliteration (only obliterated aneurysms or feeders). Cure rate was 40.6% for whole cohort, 58.5% after microsurgery, and 26.4% after embolization. The curative resection was associated with non-metameric lesions, lesions with a maximum diameter < 3 cm and lesions without anterior sulcal artery supply. The curative embolization was associated with fistula-type lesions, non-metameric lesions, and main drainage diameter < 1.5 mm. Permanent treatment-related neurological deficits rate was 11.2% for the whole cohort, 16.1% after microsurgery, and 5.6% after embolization. The pre-treatment clinical deterioration rate was 32.5%/year, which decreased to 9.3%/year after clinical interventions. After partial treatment, the long-term acute and gradual deterioration rate were 5.3%/year and 3.6%/year, respectively. The acute deteriorations were associated with metameric lesions, craniocervical lesions, lesions with a maximum diameter ≥2 cm and residual aneurysm. Residual aneurysm was the only predictor of acute deterioration for non-metameric spinal cord arteriovenous shunts. The gradual deteriorations were associated with palliative obliteration, absence of pre-treatment acute deterioration and intact main drainage. Although clinical risks of spinal cord arteriovenous shunts were reduced after clinical interventions, contemporary treatments for spinal cord arteriovenous shunt remains associated with considerable risks and incomplete efficacy. Individualized treatment plans should be adopted according to the angioarchitectural features and major clinical risks of specific lesions. There is a higher opportunity for complete obliteration for lesions with simple angioarchitecture. However, regarding most of spinal cord arteriovenous shunts with complex vascular anatomy, partial treatment is the only choice. For these patients, palliative obliteration targeting the aneurysms is recommended for reducing hemorrhagic risk, whereas shunt-reduction obliteration is necessary for non-haemorrhagic myelopathy. Contemporary treatment is ineffective in reducing hemorrhagic risk of incurable metameric spinal cord arteriovenous shunts.
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Affiliation(s)
- Jia-Xing Yu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Chuan He
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Ming Ye
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Gui-Lin Li
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Li-Song Bian
- Department of Neurosurgery, Beijing Haidian Hospital, Beijing, China
| | - Fan Yang
- Department of Neurosurgery, Beijing United Family Hospital, Beijing, China
| | - Xiao-Dong Zhai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Hong-Qi Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
| | - Tao Hong
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.,International Neuroscience Institute (China-INI), Beijing, China
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11
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Kato Y, Dong VH, Chaddad F, Takizawa K, Izumo T, Fukuda H, Hara T, Kikuta K, Nakai Y, Endo T, Kurita H, Xu B, Beneš V, Christian R, Pavesi G, Hodaie M, Sharma RK, Agarwal H, Mohan K, Liew BS. Expert Consensus on the Management of Brain Arteriovenous Malformations. Asian J Neurosurg 2019; 14:1074-1081. [PMID: 31903343 PMCID: PMC6896626 DOI: 10.4103/ajns.ajns_234_19] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Brain arteriovenous malformations (bAVMs) are complex, heterogeneous, and uncommon intracranial lesions. They can be treated by one or a combination of the following treatment modalities, namely embolization, radiosurgery, or microsurgical resection. In Spetzler-Martin Grade 4 and 5 arteriovenous malformations (AVMs), conservative management may be the best option. A group of experts in the management of AVMs of different disciplines gathered in January 2019 in Hanoi to compile the “Expert Consensus on the Management of Brain Arteriovenous Malformations”.
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Affiliation(s)
- Yoko Kato
- Department of Neurosurgery, Fujita Health University Bantane Hospital, Nagoya, Japan
| | - Van He Dong
- Department of Neurosurgery, VietDuc University Hospital, Hoan Kiem, Hanoi, Vietnam
| | - Feres Chaddad
- Department of Neurosurgery, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Katsumi Takizawa
- Department of Neurosurgery, Japanese Red Cross Asahikawa Hospital, Asahikawa, Japan
| | - Tsuyoshi Izumo
- Department of Neurosurgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan
| | - Hitoshi Fukuda
- Department of Neurosurgery, Kochi University Hospital, Nankoku, Kochi, Japan
| | - Takayuki Hara
- Department of Neurosurgery, Toranomon Hospital, MinatoKu, Tokyo, Japan
| | | | - Yasunobu Nakai
- Department of Neurosurgery, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryo Aoba, Sendai, Japan
| | - Hiroki Kurita
- Department of Cerebrovascular Surgery, International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Bin Xu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Vladimír Beneš
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University, Military University Hospital, Prague, Czech Republic
| | - Raftopoulos Christian
- Department of Neurosurgery, Cliniques Universitaires SaintLuc Bruxelles, Brussels, Belgium
| | - Giacomo Pavesi
- Department of Neurosurgery, Sant'Agostino Estense Hospital, Modena, Italy
| | - Mojgan Hodaie
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Rajan Kumar Sharma
- Department of Neurosurgery, Bir Hospital, National Academy of Medical Sciences, Kathmandu, Nepal
| | | | - Krishna Mohan
- Department of Neurosurgery, SVIMS, Tirupathi, Andhra Pradesh, India
| | - Boon Seng Liew
- Department of Neurosurgery, Hospital Sungai Buloh, Selangor, Malaysia
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12
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Brunozzi D, Hussein AE, Shakur SF, Linninger A, Hsu CY, Charbel FT, Alaraj A. Contrast Time-Density Time on Digital Subtraction Angiography Correlates With Cerebral Arteriovenous Malformation Flow Measured by Quantitative Magnetic Resonance Angiography, Angioarchitecture, and Hemorrhage. Neurosurgery 2019; 83:210-216. [PMID: 29106647 DOI: 10.1093/neuros/nyx351] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/24/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Digital subtraction angiography (DSA) currently provides angioarchitectural features of cerebral arteriovenous malformations (AVMs) but its role in the hemodynamic evaluation of AVMs is poorly understood. OBJECTIVE To assess contrast time-density time (TT) on DSA relative to AVM flow measured using quantitative magnetic resonance angiography (QMRA). METHODS Patients seen at our institution between 2007 and 2014 with a supratentorial AVM and DSA and QMRA obtained prior to any treatment were retrospectively reviewed. Regions of interest were selected on the draining veins at the point closest to the nidus. TT on DSA was defined as time needed for contrast to change image intensity from 10% to 100%, 100% to 10%, and 25% to 25%. TT was correlated to AVM total flow, angioarchitectural features, and hemorrhage. RESULTS Twenty-eight patients (mean age 35.6 yr) were included. Six patients presented with hemorrhage. Mean AVM volume was 11.42 mL (range 0.3-57.7 mL). Higher total AVM flow significantly correlated with shorter TT100%-10% and TT25%-25% (P = .02, .02, respectively). Presence of venous stenosis correlated significantly with shorter TT100%-10% (P = .04) and TT25%-25% (P = .04). AVMs with a single draining vein exhibited longer TT25%-25% compared to those with multiple draining veins (P = .04). Ruptured AVMs had significantly shorter TT10%-100% compared to unruptured AVMs (P = .05). CONCLUSION TT on DSA correlates with cerebral AVM flow measured using QMRA and with AVM angioarchitecture and hemorrhagic presentation. Thus, TT may be used to indirectly estimate AVM flow during angiography in real-time and may also be an indicator of important AVM characteristics associated with outflow resistance and increased rupture risk, such as venous stenosis.
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Affiliation(s)
- Denise Brunozzi
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Ahmed E Hussein
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Sophia F Shakur
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Andreas Linninger
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.,Department of Bioengineering, Univers-ity of Illinois at Chicago, Chicago, Illinois
| | - Chih-Yang Hsu
- Department of Bioengineering, Univers-ity of Illinois at Chicago, Chicago, Illinois
| | - Fady T Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.,Department of Bioengineering, Univers-ity of Illinois at Chicago, Chicago, Illinois
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13
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Shotar E, Sourour NA, Premat K, Haffaf I, Ghazanfari S, Jacquens A, Nouet A, Lenck S, Chiras J, Degos V, Clarençon F. Acute Subdural Hematomas in Ruptured Brain Arteriovenous Malformations: Association with Distal Flow-Related Aneurysms. Clin Neuroradiol 2019; 30:305-312. [PMID: 30868256 DOI: 10.1007/s00062-019-00771-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 02/25/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Non-traumatic acute subdural hematomas (SDH) are rare and have seldom been reported in ruptured brain arteriovenous malformations (BAVM). The aim of this study was to report the frequency of acute SDH in BAVM-related hemorrhage and to determine the relationship of SDHs with BAVM angioarchitectural features. METHODS This was a retrospective monocentric study of patients admitted for BAVM rupture between 2003 and 2017. Patients with rupture complicating or closely following partial embolization procedures were excluded. Univariate followed by multivariate logistic regression analysis was used to determine factors significantly and independently associated with SDHs and distal flow-related aneurysms. RESULTS A total of 181 patients with 188 BAVM ruptures admitted during the study period were included, eleven cases of acute SDH were identified (6%) and 2 cases of isolated SDH were found. The presence of a distal flow-related aneurysm was the only feature independently and significantly associated with SDH (odds ratio [OR] 8.1, 95% confidence interval, CI 1.9-34.5, P = 0.003). Distal flow-related aneurysms were associated with proximal flow-related aneurysms (OR 28, 95%CI 4.9-163.8, P < 0.001), were more frequent in infratentorial BAVMs (OR 3.7, 95%CI 1.3-10.2, P = 0.01) and more often found in cases of acute SDH (OR 16.9, 95%CI 3.6-79.6, P < 0.001) and subarachnoid hemorrhage (SAH) (OR 4.5, 95%CI 1.7-12.2, P = 0.003). CONCLUSION Ruptured BAVMs can rarely present with acute SDH and SDH in ruptured BAVMs are often associated with distal flow-related aneurysms. This finding may impact acute management of ruptured BAVMs with SDH by eliciting an emergent and thorough imaging work-up to identify distal flow-related aneurysm(s), in turn leading to treatment.
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Affiliation(s)
- Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Boulevard de l'Hôpital, 75013, Paris, France.
| | - Nader-Antoine Sourour
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Kevin Premat
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne Université, Paris, France
| | - Idriss Haffaf
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Sam Ghazanfari
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Alice Jacquens
- Department of Neurosurgical Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Aurélien Nouet
- Department of Neurosurgery, Pitié-Salpêtrière Hospital, Paris, France
| | - Stéphanie Lenck
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Boulevard de l'Hôpital, 75013, Paris, France
| | - Jacques Chiras
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne Université, Paris, France
| | - Vincent Degos
- Sorbonne Université, Paris, France.,Department of Neurosurgical Anesthesiology and Critical Care, Pitié-Salpêtrière Hospital, Paris, France
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne Université, Paris, France
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14
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Dinc N, Won SY, Quick-Weller J, Berkefeld J, Seifert V, Marquardt G. Prognostic variables and outcome in relation to different bleeding patterns in arteriovenous malformations. Neurosurg Rev 2019; 42:731-736. [DOI: 10.1007/s10143-019-01091-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/12/2019] [Accepted: 02/25/2019] [Indexed: 12/27/2022]
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15
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Hung AL, Yang W, Jiang B, Garzon-Muvdi T, Caplan JM, Colby GP, Coon AL, Tamargo RJ, Huang J. The Effect of Flow-Related Aneurysms on Hemorrhagic Risk of Intracranial Arteriovenous Malformations. Neurosurgery 2018; 85:466-475. [DOI: 10.1093/neuros/nyy360] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 07/12/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Previous reports indicated an association between hemorrhagic presentation and flow-related aneurysms in arteriovenous malformation (AVM) patients. However, it remains unclear whether these flow-related aneurysms result in the hemorrhage of AVM.
OBJECTIVE
To characterize this hemorrhage risk using our institutional experience over 25 yr.
METHODS
We retrospectively reviewed records of patients at our institution diagnosed with AVM from 1990 to 2015. Patients without associated aneurysms (AVM only) and those with flow-related aneurysms (AVM-FA) were compared. Those with intranidal or unrelated aneurysms were excluded. Annual risk of AVM-related hemorrhage was calculated using the birth-to-treatment approach and compared using Poisson rate ratio test.
RESULTS
Among 526 patients, there were 457 AVM only patients and 69 with flow-related aneurysms. AVM-FA patients were older (P = .005). AVMs with flow-related aneurysms were more likely located in the cerebellar vermis and hemispheres (P = .023 and .001, respectively). Presence of flow-related aneurysms increased the risk of presentation with subarachnoid hemorrhage (P < .001). Interestingly, no significant differences in presenting hemorrhage due to AVM rupture were found (P > .356). The majority of aneurysms were untreated (69.5%), and only 8 (9.8%) had ruptured presentation. At follow-up (mean = 5.3 yr), patients with flow-related aneurysms were less likely to develop seizures (P = .004). The annual risk of AVM hemorrhage was 1.33% and 1.05% for AVM only patients and AVM-FA patients, respectively (P = .248).
CONCLUSION
Despite increased risk of subarachnoid hemorrhage at presentation, there was no increased likelihood of rupture in AVMs with flow-related aneurysms. More studies are warranted, as clarifying the competing risks of AVM vs aneurysm rupture may be critical in determining optimal treatment strategy.
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Affiliation(s)
- Alice L Hung
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Wuyang Yang
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Bowen Jiang
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Tomas Garzon-Muvdi
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Justin M Caplan
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Geoffrey P Colby
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Alexander L Coon
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Rafael J Tamargo
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
| | - Judy Huang
- Department of Neurosurgery, The Johns Hopkins University, School of Medicine, Baltimore, Maryland
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16
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Shotar E, Pistocchi S, Haffaf I, Bartolini B, Jacquens A, Nouet A, Chiras J, Degos V, Sourour NA, Clarençon F. Early Rebleeding after Brain Arteriovenous Malformation Rupture, Clinical Impact and Predictive Factors: A Monocentric Retrospective Cohort Study. Cerebrovasc Dis 2017; 44:304-312. [DOI: 10.1159/000479120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 06/30/2017] [Indexed: 11/19/2022] Open
Abstract
Background: Brain arteriovenous malformations (BAVMs) are a leading cause of intracranial hemorrhage in young adults. This study aimed to identify individual predictive factors of early rebleeding after BAVM rupture and determine its impact on prognosis. Methods: Early rebleeding was defined as a spontaneous intracranial hemorrhage within 30 days of BAVM rupture in patients with nonobliterated BAVMs. One hundred fifty one patients with 158 BAVM hemorrhagic events admitted to a tertiary care center during 14 years were included. Univariate followed by multivariate logistic regression was performed to assess the impact of early rebleeding on in-hospital mortality and modified Rankin Scale (mRS) score beyond 3 months and to identify independent predictors of early rebleeding. Results: Eight early rebleeding events were observed, 6 of which occurred during the first 7 days. Early rebleeding was independently and significantly associated with poor outcome (mRS ≥3 beyond 3 months, p = 0.004) but not with in-hospital mortality (p = 0.9). Distal flow-related aneurysms (p = 0.009) and altered consciousness with a Glasgow coma scale score of 3 (p = 0.01) were independently associated with early rebleeding. Conclusions: Early rebleeding is a severe complication that can occur after BAVM-related hemorrhage. Distal flow-related aneurysms and initial altered consciousness are associated with early rebleeding.
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17
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Yilmaz U. [Vascular pathologies and vascular anatomical variants of the posterior cranial fossa]. Radiologe 2017; 56:983-989. [PMID: 27770146 DOI: 10.1007/s00117-016-0176-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
CLINICAL/METHODICAL ISSUE The posterior fossa is the location of some specific vascular pathologies and vascular anatomical variants that are important for radiologists to know and recognize. Vascular malformations that are also found in the supratentorial region have some divergent characteristics in the posterior fossa. PRACTICAL RECOMMENDATIONS Knowledge of the vascular anatomy of the posterior fossa and its variants is important for an understanding of vascular pathologies.
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Affiliation(s)
- Umut Yilmaz
- Klinik für Diagnostische und Interventionelle Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg/Saar, Deutschland.
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18
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Hung AL, Yang W, Braileanu M, Garzon-Muvdi T, Caplan JM, Colby GP, Coon AL, Tamargo RJ, Huang J. Risk Assessment of Hemorrhage of Posterior Inferior Cerebellar Artery Aneurysms in Posterior Fossa Arteriovenous Malformations. Oper Neurosurg (Hagerstown) 2017; 14:359-366. [DOI: 10.1093/ons/opx120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/18/2017] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Posterior fossa arteriovenous malformations (AVMs) are associated with increased risk of rupture and severe consequences from such rupture. The hemorrhagic risk of prenidal aneurysms (anr) on the posterior inferior cerebellar artery (PICA) may exceed that of the AVM in posterior fossa AVMs fed by PICA (PICA-AVM).
OBJECTIVE
To characterize the relative risks of aneurysm and AVM hemorrhage in patients with posterior fossa AVMs.
METHODS
We retrospectively reviewed patients diagnosed with AVM. Patients with posterior fossa AVMs were divided into 3 groups: PICA-AVM with prenidal aneurysm (PICA-AVM-anr group), PICA-AVM without prenidal aneurysm (PICA-AVM group), and AVMs without PICA feeder with/without aneurysm (AVM-only group). Patient and lesion characteristics and treatment outcomes were compared. ANOVA and chi squared tests were used for statistical analyses.
RESULTS
Our cohort included 85 patients. Mean age was 45.3 ± 18.1 yr, with 43(50.6%) female patients. Fifty-one patients (60.0%) had hemorrhagic presentation, and 27 (31.8%) experienced acute hydrocephalus. Patients in the PICA-AVM-anr group (n = 11) were more likely to present with aneurysmal subarachnoid hemorrhage (SAH; P = .005) and less likely to have AVM rupture (P < .001). Ten (90.9%) patients presented with hemorrhage, 6 (60.0%) of which resulted from aneurysm rupture. Of these 6, 5 (83.3%) had acute hydrocephalus. No patients with AVM rupture had hydrocephalus. Eight (72.7%) received aneurysm treatment prior to AVM treatment. There were no significant differences in post-treatment outcomes dependent on treatment order.
CONCLUSION
In addition to relatively higher risk of AVM rupture from infratentorial location and prenidal aneurysm, a higher risk of aneurysm rupture rather than AVM rupture was observed in patients with PICA-AVM-anr complex.
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Affiliation(s)
- Alice L Hung
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Wuyang Yang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Maria Braileanu
- Department of Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - Tomas Garzon-Muvdi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin M Caplan
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Geoffrey P Colby
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander L Coon
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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19
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Management of posterior inferior cerebellar artery aneurysms: What factors play the most important role in outcome? Acta Neurochir (Wien) 2017; 159:549-558. [PMID: 28066873 DOI: 10.1007/s00701-016-3058-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/14/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Posterior inferior cerebellar artery (PICA) aneurysms are an uncommon, heterogeneous group of aneurysms with poorer clinical outcomes compared to other intracranial aneurysms. We performed a multicenter retrospective study to analyze the outcome in a large series of patients treated with modern microsurgical and endovascular techniques. METHODS Records of 94 patients treated for PICA aneurysms between 2000 and 2015 at three large tertiary referral centers were retrospectively reviewed. RESULTS Eighty-three patients met inclusion criteria and of these, two died before treatment, leaving 81 treated patients (43 underwent endovascular and 38 surgical treatment). Among patients treated endovascularly, procedure-related complications occurred in four cases (11.8%). Six patients (19.4%) suffered from complications directly associated with surgery. Recurrences occurred in 0% of surgical and in 16.3% of endovascularly treated patients, requiring treatment. Patients with unruptured asymptomatic aneurysms had good outcomes. In the group of 67 ruptured aneurysms, 16 endovascularly (47.1%) and 15 surgically (48.4%) treated patients had modified Rankin scale (mRS) scores of 3-6. Of patients in poor neurological condition (Hunt & Hess (H&H) IV-V at admission), 84.6% suffered a poor clinical outcome. Fifty percent of patients with distal and 31.9% patients with proximal ruptured PICA aneurysms suffered a poor neurological outcome. CONCLUSIONS This study of PICA aneurysms demonstrates that results of both treatment modalities are comparable. However, endovascular treatment is associated with higher risks of recurrence, requiring additional treatment. Outcomes were mostly impacted by clinical state at admission.
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20
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Long-Term Outcomes of Single-Session Stereotactic Radiosurgery for Cerebellar Arteriovenous Malformation, with a Median Follow-Up of 10 Years. World Neurosurg 2017; 98:314-322. [DOI: 10.1016/j.wneu.2016.10.137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 11/20/2022]
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21
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Cagnazzo F, Brinjikji W, Lanzino G. Arterial aneurysms associated with arteriovenous malformations of the brain: classification, incidence, risk of hemorrhage, and treatment-a systematic review. Acta Neurochir (Wien) 2016; 158:2095-2104. [PMID: 27644700 DOI: 10.1007/s00701-016-2957-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Aneurysms associated with brain arteriovenous malformations (bAVMs) influence the natural history of these lesions and pose important therapeutic challenges. However, the epidemiology, natural history, and appropriate management of the aneurysms associated with bAVMs are not completely understood due to the paucity of large and uniform studies. We performed a systematic review of published series examining the association between aneurysms and bAVMs with the purpose of clarifying the prevalence, risk of hemorrhage, and appropriate management of these lesions. METHOD PRISMA/MOOSE guidelines were followed. We conducted a comprehensive literature search of three databases (PubMed, Ovid MEDLINE, and Ovid EMBASE) on aneurysms associated with bAVMs. Only studies examining consecutive case series of aneurysms associated with bAVMs were included. From the collected studies, we extracted data regarding prevalence of bAVM-associated aneurysms, risk of aneurysm rupture in relation to bAVM location and aneurysm characteristics, and treatment-related outcomes. RESULTS Our systematic review included 44 articles with a total of 10,093 bAVMs. The proportion of bAVMs with an associated aneurysm was 20.2 % (95 % CI = 19.4-20.9 %). Among ruptured bAVMs with associated aneurysms, the aneurysm was the source of hemorrhage in 49.2 % (95 % CI = 43.7-54.7 %) of cases. Flow-related aneurysms were the most common source of aneurysm rupture (78.5 %, 95 % CI = 70.6-84.9 %). Infratentorial bAVM-associated aneurysms presented a higher risk of rupture (60 %, 95 % CI = 47.4-71.9 %) when compared with supratentorial lesions (29 %, 95 % CI = 21.4-38.5 %). Endovascular treatment of aneurysms associated with bAVMs had a cure rate of 80.0 % (95 % CI = 73.3-85.3 %), complication rate of 8.7 % (95 % CI = 5.5-13.1 %), and a good neurological outcome rate of 78.8 % (95 % CI = 72.5-83.9 %). CONCLUSIONS Twenty percent of bAVMs harbored arterial aneurysms. The presence of aneurysm increases the risk of bleeding of the bAVM, especially when flow-related or infratentorially located. Aneurysms associated with bAVMs should be treated promptly. Selective endovascular treatment of bAVM-associated aneurysms appears safe and effective.
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Affiliation(s)
- Federico Cagnazzo
- Department of Neurologic Surgery, Mayo Medical School, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Medical School, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Neurologic Surgery, Mayo Medical School, Mayo Clinic, Rochester, MN, USA
- Department of Radiology, Mayo Medical School, Mayo Clinic, Rochester, MN, USA
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Medical School, Mayo Clinic, Rochester, MN, USA.
- Department of Radiology, Mayo Medical School, Mayo Clinic, Rochester, MN, USA.
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22
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Shakur SF, Liesse K, Amin-Hanjani S, Carlson AP, Aletich VA, Charbel FT, Alaraj A. Relationship of Cerebral Arteriovenous Malformation Hemodynamics to Clinical Presentation, Angioarchitectural Features, and Hemorrhage. Neurosurgery 2016; 63 Suppl 1:136-140. [DOI: 10.1227/neu.0000000000001285] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sophia F. Shakur
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Kelly Liesse
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Sepideh Amin-Hanjani
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Andrew P. Carlson
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Victor A. Aletich
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Fady T. Charbel
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Ali Alaraj
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
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