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Tao W, Li S, Zeng C, Chen Z, Huang Z, Chen F. Machine Learning Models for Brain Arteriovenous Malformations Presenting with Hemorrhage Based on Clinical and Angioarchitectural Characteristics. Acad Radiol 2024; 31:1583-1593. [PMID: 37783607 DOI: 10.1016/j.acra.2023.08.023] [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: 07/16/2023] [Revised: 08/13/2023] [Accepted: 08/19/2023] [Indexed: 10/04/2023]
Abstract
RATIONALE AND OBJECTIVES This study aims to develop the best diagnostic model for brain arteriovenous malformations (bAVMs) rupture by using machine learning (ML) algorithms. MATERIALS AND METHODS We retrospectively included 353 adult patients with ruptured and unruptured bAVMs. The clinical and radiological data on patients were collected. The significant variables were selected using univariable logistic regression. We constructed and compared the predictive models using five supervised ML algorithms, multivariable logistic regression, and R2eDAVM scoring system. A complementary systematic review and meta-analysis of studies was aggregated to explore the potential predictors for bAVMs rupture. RESULTS We found that a small nidus size of <3 cm, deep and infratentorial location, longer filling time, and deep and single venous drainage were associated with a higher risk of bAVMs rupture. The multilayer perceptron model showed the best performance with an area under the curve value of 0.736 (95% CI 0.67-0.801) and 0.713 (95% CI 0.647-0.779) in the training and test dataset, respectively. In our pooled analysis, we also found that the male sex, a single feeding artery, hypertension, non-White race, low Spetzler-Martin grade, and coexisting aneurysms are risk factors for bAVMs rupture. CONCLUSION This study further demonstrated the clinical and angioarchitectural characteristics in predicting bAVMs hemorrhage.
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Affiliation(s)
- Wengui Tao
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Street, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.); National Clinical Research Center for Geriatric Disorders, Central South University, 87 Xiangya Street, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.); Hypothalamic-Pituitary Research Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.)
| | - Shifu Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Street, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.); National Clinical Research Center for Geriatric Disorders, Central South University, 87 Xiangya Street, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.); Hypothalamic-Pituitary Research Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.)
| | - Chudai Zeng
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Street, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.); National Clinical Research Center for Geriatric Disorders, Central South University, 87 Xiangya Street, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.); Hypothalamic-Pituitary Research Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.)
| | - Zhou Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Street, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.); National Clinical Research Center for Geriatric Disorders, Central South University, 87 Xiangya Street, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.); Hypothalamic-Pituitary Research Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.)
| | - Zheng Huang
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Street, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.); National Clinical Research Center for Geriatric Disorders, Central South University, 87 Xiangya Street, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.); Hypothalamic-Pituitary Research Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.)
| | - Fenghua Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, 87 Xiangya Street, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.); National Clinical Research Center for Geriatric Disorders, Central South University, 87 Xiangya Street, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.); Hypothalamic-Pituitary Research Center, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan 410008, China (W.T., S.L., C.Z., Z.C., Z.H., F.C.).
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Lim J, Kuo CC, Waqas M, Cappuzzo JM, Monteiro A, Baig AA, Snyder KV, Davies JM, Levy EI, Siddiqui AH. A Systematic Review of Non-Galenic Pial Arteriovenous Fistulas. World Neurosurg 2023; 170:226-235.e3. [PMID: 36087909 DOI: 10.1016/j.wneu.2022.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Non-galenic pial arteriovenous fistulas (NGPAVFs) are rare cerebrovascular pathologies accounting for only 1.6%-4.8% of all brain vascular malformations. We performed a comprehensive review of NGPAVF cases reported in the literature to further characterize their clinical patterns of presentation, angiographic features, management, clinical outcomes, and complications. METHODS We searched PubMed, Google Scholar, and Embase from each database's earliest records to April 2022 for all relevant English language articles. A total of 3280 articles were screened to identify those that met prespecified inclusion criteria. Differences in clinical outcomes between children (≤18 years old) and adults (>18 years old) and those articles in which NGPAVFs were associated with the presence of a varix or a hemorrhage were statistically examined. RESULTS A total of 242 patients in 86 articles were included. The mean patient age was 18.51 ± 18.80 years. The male-to-female ratio was 1.44:1. Headache was the most common initial presentation (42.6%) in the study cohort. Hemorrhage occurred at a significantly higher frequency in adults (P = 0.004), whereas more children presented with congestive heart failure (P < 0.001). Surgical, endovascular, and combination therapy led to comparable rates of complete NGPAVF obliteration (86.8%, 85.2%, and 88.5%, respectively). Fifty-nine patients (24.4%) experienced a complication, ranging from minor neurological deficit to severe hemorrhage. The mortality rate for the overall cohort was 3.3%, and all deceased patients had a varix associated with their fistulas. CONCLUSIONS To our knowledge, we report the largest literature review describing the clinical course and characteristics of NGPAVFs. All treatment approaches resulted in favorable obliteration rates and overall patient outcomes.
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Affiliation(s)
- Jaims Lim
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Cathleen C Kuo
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Muhammad Waqas
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Justin M Cappuzzo
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Andre Monteiro
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Ammad A Baig
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA
| | - Jason M Davies
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
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Raj Sharma M, Sedain G, Kafle P, Rajbhandari B, Bahadur Pradhanang A, Kumar Shrestha D, Singh Karki A, Chiluwal A. Clinical characteristics and outcome of patients with brain arteriovenous malformations from a university hospital in nepal. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Xie F, Huang L, Ye Y, Hao J, Lv J, Richard SA. Hybrid operation for arteriovenous malformations with associated multiple intracranial aneurysms and subarachnoid hemorrhage: Case report. Medicine (Baltimore) 2022; 101:e28944. [PMID: 35212302 PMCID: PMC8878828 DOI: 10.1097/md.0000000000028944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/09/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE The hybrid surgical concept for the treatment of brain arteriovenous malformations (AVMs) with associated intracranial aneurysms (IAs) is still not widely practiced. Concomitant occurrence of AVMs with IAs is common. Subarachnoid hemorrhage (SAH) as a result of AVM or IA rupture is often associated with these dual pathological phenomena. We present a case of concomitant occurrence of AVMs and IAs that was successfully treated using the hybrid operation concept. PATIENT CONCERNS A 62-year-old man presented with sudden onset of severe headache, dizziness, nausea, and vomiting for 4 hours. DIAGNOSIS Computed tomography revealed SAH and a hematoma in the right frontal lobe. A computed tomographic angiogram also revealed a right frontal AVM with 3 IAs. INTERVENTIONS We used a hybrid operating room to successfully treat both AVMs and IAs. OUTCOMES Two years of follow-up showed that the patients were well and performed their daily duties. LESSONS The hybrid operating room is an innovative, safe, and effective method for the treatment of AVMs with associated IAs, particularly high-grade AVMs and IAs with hemorrhage or SAH. Patients with concomitant AVMs and IAs have the highest chance of hemorrhage compared with those with AVM or IAs alone.
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Affiliation(s)
- Fei Xie
- Department of Neurosurgery, The First People's Hospital of Ziyang, No. 66, Rende west road, Ziyang, Sichuan, PR China
| | - Lin Huang
- Department of Cardiology, The First People's Hospital of Ziyang, No. 66, Rende west road, Ziyang, Sichuan, PR China
| | - Yongqiang Ye
- Department of Neurosurgery, The First People's Hospital of Ziyang, No. 66, Rende west road, Ziyang, Sichuan, PR China
| | - Jianqiang Hao
- Department of Neurosurgery, The First People's Hospital of Ziyang, No. 66, Rende west road, Ziyang, Sichuan, PR China
| | - Janwei Lv
- Department of Neurosurgery, The First People's Hospital of Ziyang, No. 66, Rende west road, Ziyang, Sichuan, PR China
| | - Seidu A. Richard
- Department of Medicine, Princefield University, Ho-Volta Region, Ghana, West Africa
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Hou K, Lv X, Yu J. Endovascular Treatment of Posterior Cerebral Artery Trunk Aneurysm: The Status Quo and Dilemma. Front Neurol 2022; 12:746525. [PMID: 35069405 PMCID: PMC8778581 DOI: 10.3389/fneur.2021.746525] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 12/08/2021] [Indexed: 02/05/2023] Open
Abstract
The posterior cerebral artery (PCA) is an important artery that can be divided into four segments (P1-4): segments P1-2 are proximal segments, and segments P3-4 are distal segments. Various aneurysms can occur along the PCA trunk. True saccular aneurysms are rare, and most PCA trunk aneurysms are dissecting. Sometimes, the PCA trunk can give rise to flow-related aneurysms in association with high-flow arteriovenous shunt diseases or moyamoya disease and internal carotid artery occlusion. Some PCA trunk aneurysms require treatment, especially ruptured or large/giant aneurysms. Recently, endovascular treatment (EVT) has become the mainstream treatment for PCA trunk aneurysms, and it mainly involves reconstructive or deconstructive techniques. Traditional EVT includes selective coiling with/without stent or balloon assistance and parent artery occlusion (PAO). For proximal aneurysms, the PCA should be preserved. For distal aneurysms, PAO can be performed. However, during EVT, preservation of the PCA must naturally be the prime objective. Recently, flow-diverting stents have been used and are a revolutionary treatment for unruptured dissecting aneurysms of the PCA trunk. Despite the associated complications, EVT remains an effective method for treating PCA trunk aneurysms and can result in a good prognosis.
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Affiliation(s)
- Kun Hou
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Xianli Lv
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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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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Tsuei YS, Luo CB, Fay LY, Yang HC, Guo WY, Wu HM, Chung WY, Teng MMH. Morphologic Change of Flow-Related Aneurysms in Brain Arteriovenous Malformations after Stereotactic Radiosurgery. AJNR Am J Neuroradiol 2019; 40:675-680. [PMID: 30948381 DOI: 10.3174/ajnr.a6018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 01/25/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The natural history of flow-related aneurysms after obliteration of brain arteriovenous malformations is poorly understood. The purpose of this study was to evaluate the angioarchitecture and morphologic change in flow-related aneurysms after gamma knife surgery of brain arteriovenous malformations. MATERIALS AND METHODS During a 12-year period, 823 patients with brain arteriovenous malformations underwent gamma knife surgery at our institution with complete peritherapeutic angiographic evaluation. From this population, a series of 72 patients (8.8%) with 111 flow-related aneurysms were enrolled (1.5 aneurysms per patient). There were 43 men and 29 women; ages ranged from 18 to 72 years (mean, 43 years). The morphologic change of flow-related aneurysms was longitudinally evaluated before and after obliteration of brain arteriovenous malformations. After gamma knife surgery, angiographic follow-up varied from 26 to 130 months (mean, 58 months). RESULTS All flow-related aneurysms were small (mean, 4.1 mm; range, 2-9 mm). There were 72 proximal flow-related aneurysms (mean size, 4.3 mm) and 39 distal flow-related aneurysms (mean size, 3.7 mm). Spontaneous thrombosis occurred more frequently in distal flow-related aneurysms than in proximal flow-related aneurysms (P < .001). Smaller flow-related aneurysms (<5 mm) tended to spontaneously occlude after obliteration of brain arteriovenous malformations (P = .036). Two patients had ruptures of proximal flow-related aneurysms at 27- and 54-month follow-ups, respectively. CONCLUSIONS Spontaneous thrombosis occurred more frequently in distal flow-related aneurysms due to occlusion or normalization of distal feeders. Smaller flow-related aneurysms also tended to spontaneously thrombose after obliteration of brain arteriovenous malformations. The rate of flow-related aneurysm rupture in our series was similar to that of natural intradural aneurysms.
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Affiliation(s)
- Y-S Tsuei
- From the Department of Neurosurgery (Y.-S.T.), Taichung Veterans General Hospital, Taichung, Taiwan.,Departments of Neurosugery (Y.-S.T.)
| | - C-B Luo
- Radiology (C.-B.L.), Tri-Service General Hospital, National Defenses Medical Center, Taipei, Taiwan .,Departments of Radiology (C.-B.L., W.-Y.G., H.-M.W., M.M.H.T.)
| | - L-Y Fay
- Neurosurgery (L.-Y.F., H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - H-C Yang
- Neurosurgery (L.-Y.F., H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - W-Y Guo
- Departments of Radiology (C.-B.L., W.-Y.G., H.-M.W., M.M.H.T.)
| | - H-M Wu
- Departments of Radiology (C.-B.L., W.-Y.G., H.-M.W., M.M.H.T.)
| | - W-Y Chung
- Neurosurgery (L.-Y.F., H.-C.Y., W.-Y.C.), Taipei Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - M M H Teng
- Departments of Radiology (C.-B.L., W.-Y.G., H.-M.W., M.M.H.T.).,Department of Radiology (M.M.H.T.), Cheng-Hsin General Hospital, Taipei, Taiwan
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Yang WY, Luo CB, Tsuei YS, Guo WY, Wu HM, Chung WY. A single-institution study of predisposing factors of patients with BAVMs to flow-related aneurysm. J Formos Med Assoc 2019; 118:707-712. [DOI: 10.1016/j.jfma.2018.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 08/11/2018] [Accepted: 08/17/2018] [Indexed: 10/28/2022] Open
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Eliava S, Dmitriev A, Shekhtman O, Yakovlev S, Kheireddin A, Pilipenko Y. Treatment of Brain Arteriovenous Malformations with Hemodynamic Aneurysms: A Series of 131 Consecutive Cases. World Neurosurg 2018; 110:e917-e927. [DOI: 10.1016/j.wneu.2017.11.114] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 11/29/2022]
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Critical review of brain AVM surgery, surgical results and natural history in 2017. Acta Neurochir (Wien) 2017; 159:1457-1478. [PMID: 28555270 DOI: 10.1007/s00701-017-3217-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 05/09/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND An understanding of the present standing of surgery, surgical results and the role in altering the future morbidity and mortality of untreated brain arteriovenous malformations (bAVMs) is appropriate considering the myriad alternative management pathways (including radiosurgery, embolization or some combination of treatments), varying risks and selection biases that have contributed to confusion regarding management. The purpose of this review is to clarify the link between the incidence of adverse outcomes that are reported from a management pathway of either surgery or no intervention with the projected risks of surgery or no intervention. METHODS A critical review of the literature was performed on the outcomes of surgery and non-intervention for bAVM. An analysis of the biases and how these may have influenced the outcomes was included to attempt to identify reasonable estimates of risks. RESULTS In the absence of treatment, the cumulative risk of future hemorrhage is approximately 16% and 29% at 10 and 20 years after diagnosis of bAVM without hemorrhage and 35% and 45% at 10 and 20 years when presenting with hemorrhage (annualized, this risk would be approximately 1.8% for unruptured bAVMs and 4.7% for 8 years for bAVMs presenting with hemorrhage followed by the unruptured bAVM rate). The cumulative outcome of these hemorrhages depends upon whether the patient remains untreated and is allowed to have a further hemorrhage or is treated at this time. Overall, approximately 42% will develop a new permanent neurological deficit or death from a hemorrhagic event. The presence of an associated proximal intracranial aneurysm (APIA) and restriction of venous outflow may increase the risk for subsequent hemorrhage. Other risks for increased risk of hemorrhage (age, pregnancy, female) were examined, and their purported association with hemorrhage is difficult to support. Both the Spetzler-Martin grading system (and its compaction into the Spetzler-Ponce tiers) and Lawton-Young supplementary grading system are excellent in predicting the risk of surgery. The 8-year risk of unfavorable outcome from surgery (complication leading to a permanent new neurological deficit with a modified Rankin Scale score of greater than one, residual bAVM or recurrence) is dependent on bAVM size, the presence of deep venous drainage (DVD) and location in critical brain (eloquent location). For patients with bAVMs who have neither a DVD nor eloquent location, the 8-year risk for an unfavorable outcome increases with size (increasing from 1 cm to 6 cm) from 1% to 9%. For patients with bAVM who have either a DVD or eloquent location (but not both), the 8-year risk for an unfavorable outcome increases with the size (increasing from 1 cm to 6 cm) from 4% to 35%. For patients with bAVM who have both a DVD and eloquent location, the 8-year risk for unfavorable outcome increases with size (increasing from 1 cm to 3 cm) from 12% to 38%. CONCLUSION Patients with a Spetzler-Ponce A bAVM expecting a good quality of life for the next 8 years are likely to do better with surgery in expert centers than remaining untreated. Ongoing research is urgently required on the outcome of management pathways for bAVM.
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Kilburg C, Taussky P, Kalani MYS, Park MS. Novel use of flow diversion for the treatment of aneurysms associated with arteriovenous malformations. Neurosurg Focus 2017; 42:E7. [PMID: 28565984 DOI: 10.3171/2017.2.focus1755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The use of flow-diverting stents for intracranial aneurysms has become more prevalent, and flow diverters are now routinely used beyond their initial scope of approval at the proximal internal carotid artery. Although flow diversion for the treatment of cerebral aneurysms is becoming more commonplace, there have been no reports of its use to treat flow-related cerebral aneurysms associated with arteriovenous malformations (AVMs). The authors report the cases of 2 patients whose AVM-associated aneurysms were managed with flow diversion. A 40-year-old woman presented with a history of headaches that led to the identification of an unruptured Spetzler-Martin Grade V, right parietooccipital AVM associated with 3 aneurysms of the ipsilateral internal carotid artery. Initial attempts at balloon-assisted coil embolization of the aneurysms were unsuccessful. The patient underwent placement of a flow-diverting stent across the diseased vessel; a 6-month follow-up angiogram demonstrated complete occlusion of the aneurysms. In the second case, a 57-year-old man presented with new-onset seizures, and an unruptured Spetzler-Martin Grade V, right frontal AVM associated with an irregular, wide-necked anterior communicating artery aneurysm was identified. The patient underwent placement of a flow-diverting stent, and complete occlusion of the aneurysm was observed on a 7-month follow-up angiogram. These 2 cases illustrate the potential for use of flow diversion as a treatment strategy for feeding artery aneurysms associated with AVMs. Because of the need for dual antiplatelet medications after flow diversion in this patient population, however, this strategy should be used judiciously.
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Affiliation(s)
- Craig Kilburg
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Philipp Taussky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - M Yashar S Kalani
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Min S Park
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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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: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [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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Yu J, Shi L, Lv X, Wu Z, Yang H. Intracranial non-galenic pial arteriovenous fistula: A review of the literature. Interv Neuroradiol 2016; 22:557-68. [PMID: 27388601 PMCID: PMC5072213 DOI: 10.1177/1591019916653934] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/15/2016] [Indexed: 02/05/2023] Open
Abstract
An intracranial non-galenic pial arteriovenous fistula (NGPAVF) is a direct connection between the intracranial artery and vein without a nidus. NGPAVFs are clinically rare, and the current understanding of NGPAVFs is limited. This study searched PubMed for the currently available literature, and a review of the relevant publications revealed that NGPAVFs require aggressive treatment, spontaneous occlusion is uncommon, and the prognosis following conservative treatment is poor. NGPAVFs can be divided into congenital and traumatic (including iatrogenic) types. Clinically, NGPAVFs are characterized by congestive heart failure, epilepsy, hemorrhage, mass effects, and nerve function deficits. For the imaging examination of NGPAVFs, digital subtraction angiography (DSA) is still the gold standard for diagnosis, although magnetic resonance DSA (MRDSA) and 4D computed tomography angiography (CTA) can also provide hemodynamic data in a non-invasive manner. Current treatments for NGPAVFs include surgical resection and endovascular embolization, both of which can yield clinical improvements. However, potential postoperative complications should be addressed, such as fatal bleeding due to rupture and deep vein thrombosis. Some studies recommend postoperative anticoagulation to reduce postoperative thrombotic complications.
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Affiliation(s)
- Jinlu Yu
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Lei Shi
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
| | - Xianli Lv
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China
| | - Zhongxue Wu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Beijing, China
| | - Hongfa Yang
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, China
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Rammos SK, Gardenghi B, Bortolotti C, Cloft HJ, Lanzino G. Aneurysms Associated with Brain Arteriovenous Malformations. AJNR Am J Neuroradiol 2016; 37:1966-1971. [PMID: 27339951 DOI: 10.3174/ajnr.a4869] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Brain arteriovenous malformations are frequently associated with the presence of intracranial aneurysms at a higher-than-expected incidence based on the frequency of each lesion individually. The identification of intracranial aneurysms in association with AVMs has increased due to improvement in diagnostic techniques, particularly 3D and superselective conventional angiography. Intracranial aneurysms may confer a higher risk of hemorrhage at presentation and of rehemorrhage in patients with AVMs and therefore may be associated with a more unfavorable natural history. The association of AVMs and intracranial aneurysms poses important therapeutic challenges for practicing neurosurgeons, neurologists, and neurointerventional radiologists. In this report, we review the classification and radiology of AVM-associated intracranial aneurysms and discuss their clinical significance and implications for treatment.
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Affiliation(s)
- S K Rammos
- From the Department of Neurosurgery (S.K.R.), Arkansas Neuroscience Institute, Little Rock, Arkansas
| | - B Gardenghi
- Institute of Neurosurgery (B.G.), University Hospital of Verona, Verona, Italy
| | - C Bortolotti
- Department of Neurosurgery (C.B.), Istituto Di Ricovero e Cura a Carattere Scientifico, Institute of Neurological Science of Bologna, Bologna, Italy
| | - H J Cloft
- Departments of Radiology (H.J.C., G.L.)
| | - G Lanzino
- Departments of Radiology (H.J.C., G.L.) .,Neurosurgery (G.L.), Mayo Clinic, Rochester, Minnesota
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