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Journal articles on the topic 'Cerebral arteriovenous malformations – Treatment'

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Author: Grafiati

Published: 10 December 2022

Last updated: 29 January 2023

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1

Heros, Roberto C. "Multimodality Treatment of Cerebral Arteriovenous Malformations: Modern Treatment of Cerebral Arteriovenous Malformations." World Neurosurgery 82, no. 1-2 (July 2014): 46–48. http://dx.doi.org/10.1016/j.wneu.2013.03.025.

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Aguiar, Paulo Henrique, Marco Antonio Stefani, Gustavo Rassier Isolan, Carlos Alexandre Zicarelli, and Apio Claudio Martins Antunes. "Cerebral Arteriovenous Malformations." JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA 23, no. 4 (March 29, 2018): 301–15. http://dx.doi.org/10.22290/jbnc.v23i4.1215.

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A significant improvement of central nervous system arteriovenous vascular malformations (AVM) outcome has been observed due to the advances in all modalities of diagnosis and treatment. The authors report the advances in diagnosis and integrated global treatment of AVM`s.

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3

Janicijevic, Milos. "Surgery of the arteriovenous cerebral malformations." Acta chirurgica Iugoslavica 55, no. 2 (2008): 11–16. http://dx.doi.org/10.2298/aci0802011j.

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According to the present technical possibilities modalities of the treatment of the arteriovenous cerebral malformations (surgery, embolization, radiosurgery) for direct neurosurgical excision of malformations remains of cases. Decision to operate is made separately for each malformation and is based on anticipation of the natural course of the illness, precise estimate of the risk from operation and on the estimate of the condition of the patient. Surgical technique is also chosen for each malformation separately, depending on its size, angioarchitecture, hemodynamic characteristics and localization. The following techniques are used: resection of the malformation "en blocque", coagulation of the lesion in situ, gradual marginal coagulation in the lesion cleavage, "backword technique", perivenous approach and excision of the complex malformations in several acts. The safety of the surgical excision is increased by preoperative and perioperative actions already described. Intraoperative problems and postoperative complications (brain edema, uncontrolled hemorrhage, intracerebral hematoma and others) were discussed.

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4

Fahed, Robert, Tim E. Darsaut, Charbel Mounayer, René Chapot, Michel Piotin, Raphaël Blanc, Vitor Mendes Pereira, et al. "Transvenous Approach for the Treatment of cerebral Arteriovenous Malformations (TATAM): Study protocol of a randomised controlled trial." Interventional Neuroradiology 25, no. 3 (February 4, 2019): 305–9. http://dx.doi.org/10.1177/1591019918821738.

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Background Transvenous embolisation is a promising technique but the benefits remain uncertain. We hypothesised that transvenous embolisation leads to a higher rate of arteriovenous malformation angiographic occlusion than transarterial embolisation. Methods The Transvenous Approach for the Treatment of cerebral Arteriovenous Malformations (TATAM) is an investigator initiated, multicentre, prospective, phase 2, randomised controlled clinical trial. To test the hypothesis that transvenous embolisation is superior to transarterial embolisation for arteriovenous malformation obliteration, 76 patients with arteriovenous malformations considered curable by up to two sessions of endovascular therapy will be randomly allocated 1:1 to treatment with either transvenous embolisation (with or without transarterial embolisation) (experimental arm) or transarterial embolisation alone (control arm). The primary endpoint of the trial is complete arteriovenous malformation occlusion, assessed by catheter cerebral angiography. Complete occlusions will be confirmed at 3 months, while incompletely occluded arteriovenous malformations, considered treatment failures, will then be eligible for complementary treatments by surgery, radiation therapy, or even transvenous embolisation. Standard procedural safety outcomes will also be assessed. Patient selection will be validated by a case selection committee, and participating centres with limited experience in transvenous embolisation will be proctored. Discussion The TATAM trial is a transparent research framework designed to offer a promising but still unvalidated treatment to selected arteriovenous malformation patients. Clinical Trial Registration-URL: http://www.clinicaltrials.gov . Unique identifier: NCT03691870.

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5

Jervis, S., and D. Skinner. "Screening for arteriovenous malformations in hereditary haemorrhagic telangiectasia." Journal of Laryngology & Otology 130, no. 8 (July 5, 2016): 734–42. http://dx.doi.org/10.1017/s0022215116008422.

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AbstractObjective:To determine whether patients with hereditary haemorrhagic telangiectasia were being screened according to international guidelines, and to review recent evidence in order to provide up-to-date guidelines for the initial systemic management of hereditary haemorrhagic telangiectasia.Methods:A retrospective case note analysis was conducted, assessing patients in terms of screening for: genetics, cerebral arteriovenous malformations, pulmonary and hepatic arteriovenous malformations, and gastrointestinal telangiectasia. Databases searched included Medline, the Cumulative Index to Nursing and Allied Health Literature, and Embase.Results:Screening investigations were most frequently performed for hepatic arteriovenous malformations and least frequently for genetics. Recent data suggest avoiding routine genetic and cerebral arteriovenous malformation screening because of treatment morbidities; performing high-resolution chest computed tomography for pulmonary arteriovenous malformation screening; using capsule endoscopy (if possible) to reduce complications from upper gastrointestinal endoscopy; and omitting routine liver enzyme testing in favour of Doppler ultrasound.Conclusion:Opportunities for systemic arteriovenous malformation screening are frequently overlooked. This review highlights the need for screening and considers the form in which it should be undertaken.

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6

Shchehlov, D. V., O. Ye Svyrydiuk, S. V. Chebanyuk, and M. B. Vyval. "Endovascular embolization of cerebral arteriovenous malformations." Ukrainian Interventional Neuroradiology and Surgery 37, no. 3 (February 3, 2022): 69–76. http://dx.doi.org/10.26683/2786-4855-2021-3(37)-69-76.

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Endovascular embolization is a critical component in the treatment of cerebral arteriovenous malformations. It can be used as an independent treatment modality or as an adjunct to microurgery or radiosurgery. The published literature in the PubMed database until September 2021 was reviewed with reference to the results of cerebral arteriovenous malformations embolization using liquid embolic agents. More scientific data reporting about total embolization of the cerebral arteriovenous malformations with a final cure. Although complications and mortality after arteriovenous malformations embolization have decreased significantly, but they still exist, and decisions about it usage should be weighed against its benefits during the planning phase. Treatment of arteriovenous malformations of the brain requires a multidisciplinary approach involving vascular neurosurgeons, endovascular interventionists and radiation oncologists, with a deep understanding of the natural course and combination of risks of multimodal treatment. Only such approach can increase the likelihood of a positive outcome of the cerebral arteriovenous malformations treatment.

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7

Eliahu, Karen, Florence Hofman, and Steven Giannotta. "A Systematic Review of Cerebral Arteriovenous Malformation Management." International Journal of Medical Students 5, no. 2 (August 31, 2017): 74–80. http://dx.doi.org/10.5195/ijms.2017.13.

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Cerebral Arteriovenous Malformation is a neurovascular lesion characterized by an abnormal connection between arterial and venous systems, resulting in a tangle of blood vessels lacking intervening capillaries. The goal of treatment is to prevent catastrophic hemorrhage, neurological injury, or death. Despite the availability of multiple cutting-edge treatment options there is little consensus on the most promising approaches for treatment due to the novelty of each Arteriovenous Malformation case. This analysis will link the various angioarchitectural characteristics and associated presentations of Arteriovenous Malformation to treatment modalities. In the era of personalized medicine, genomics-driven research to normalize by drawing parallels between Cerebral Cavernous Malformation and Arteriovenous Malformation, both of which are characterized by hemorrhage-prone vascular malformations, may provide insight for the development of pharmacological therapy. Understanding the underlying mechanisms and genes responsible for the symptoms will allow us to better treat patients in a non-invasive manner and paves future directions in Arteriovenous Malformation treatment.

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8

NAKAI, Yasunobu, Yoshiro ITO, Masayuki SATO, Kazuhiro NAKAMURA, Masanari SHIIGAI, Tomoji TAKIGAWA, Kensuke SUZUKI, et al. "Multimodality Treatment for Cerebral Arteriovenous Malformations." Neurologia medico-chirurgica 52, no. 12 (2012): 859–64. http://dx.doi.org/10.2176/nmc.52.859.

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9

Lee, Liang Shong. "Surgical Treatment of Cerebral Arteriovenous Malformations." Nosotchu 18, no. 6 (1996): 440. http://dx.doi.org/10.3995/jstroke.18.440.

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10

Gailloud, Philippe. "Endovascular Treatment of Cerebral Arteriovenous Malformations." Techniques in Vascular and Interventional Radiology 8, no. 3 (September 2005): 118–28. http://dx.doi.org/10.1053/j.tvir.2005.10.003.

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11

Deruty, R., I. Pelissou-Cuyotat, D. Amat, C. Mottolese, Y. Bascoulergue, F. Turjman, and J. P. Gerard. "Multidisciplinary treatment of cerebral arteriovenous malformations." Neurological Research 17, no. 3 (June 1995): 169–77. http://dx.doi.org/10.1080/01616412.1995.11740307.

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12

Kalani, Mohammad Yashar Sorena, Felipe C. Albuquerque, David Fiorella, and Cameron G. McDougall. "Endovascular Treatment of Cerebral Arteriovenous Malformations." Neuroimaging Clinics of North America 23, no. 4 (November 2013): 605–24. http://dx.doi.org/10.1016/j.nic.2013.03.009.

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13

Nataraj, Andrew, M. Bahgaat Mohamed, Anil Gholkar, Ramon Vivar, Laurence Watkins, Robert Aspoas, Barbara Gregson, Patrick Mitchell, and A. David Mendelow. "Multimodality Treatment of Cerebral Arteriovenous Malformations." World Neurosurgery 82, no. 1-2 (July 2014): 149–59. http://dx.doi.org/10.1016/j.wneu.2013.02.064.

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14

Lasjaunias, Pierre, Claude Manelfe, Karel Terbrugge, and Luis Lopez Ibor. "Endovascular treatment of cerebral arteriovenous malformations." Neurosurgical Review 9, no. 4 (December 1986): 265–75. http://dx.doi.org/10.1007/bf01743633.

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15

Aminoff, M. J. "Treatment of unruptured cerebral arteriovenous malformations." Neurology 37, no. 5 (May 1, 1987): 815. http://dx.doi.org/10.1212/wnl.37.5.815.

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16

Utiger, Robert D., Roberto C. Heros, and Kazuyoshi Korosue. "Radiation Treatment of Cerebral Arteriovenous Malformations." New England Journal of Medicine 323, no. 2 (July 12, 1990): 127–29. http://dx.doi.org/10.1056/nejm199007123230211.

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17

Prirodov, A. V., E. Yu Bakharev, R. M. Kozlova, M. Yu Sinkin, and A. A. Grin. "Case report: Surgical treatment of combined dural arteriovenous fistula and angiographically occult arteriovenous malformation complicated by intracerebral hemorrhage." Russian journal of neurosurgery 24, no. 4 (December 27, 2022): 85–94. http://dx.doi.org/10.17650/1683-3295-2022-24-4-85-94.

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Background. Cerebral arteriovenous malformations and dural arteriovenous fistulas are relatively rare pathologies with frequency of 1–1.5 and 0.1–0.2 cases per 100 000 people per year, respectively. Probability of a combination of these pathologies in a single patient is extremely low. The authors were not able to find publications describing a combination of these pathologies of the cerebral vasculature.Aim. To present a clinical case of successful surgical treatment of combined cerebral pathology – dural arteriovenous fistula and angiographically occult arteriovenous malformation – in a patient with intracranial hemorrhage.Materials and methods. Analysis of the results of treatment of patient with dural arteriovenous fistula with hemorrhagic disease course at the N.V. Sklifosovsky Research Institute of Emergency Medicine (Moscow) was performed. The patient underwent osteoplastic cranial trepanation, resection of the dural arteriovenous fistula. Intraoperatively an angiographically occult arteriovenous malformation was detected which caused the hemorrhage.Results. Surgical treatment allowed to achieve a satisfactory outcome. Intraoperatively diagnosed angiographically occult arteriovenous malformation was confirmed histologically.Conclusions. The presented clinical observation shows the necessity of careful revision of hematoma cavity in the presence of isolated intraparenchymal hemorrhage from dural arteriovenous fistula.

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18

Rodríguez-Hernández, Ana, Helen Kim, Tony Pourmohamad, William L. Young, and Michael T. Lawton. "Cerebellar Arteriovenous Malformations." Neurosurgery 71, no. 6 (September 24, 2012): 1111–24. http://dx.doi.org/10.1227/neu.0b013e318271c081.

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ABSTRACT BACKGROUND: Anatomic diversity among cerebellar arteriovenous malformations (AVMs) calls for a classification that is intuitive and surgically informative. Selection tools like the Spetzler-Martin grading system are designed to work best with cerebral AVMs but have shortcomings with cerebellar AVMs. OBJECTIVE: To define subtypes of cerebellar AVMs that clarify anatomy and surgical management, to determine results according to subtypes, and to compare predictive accuracies of the Spetzler-Martin and supplementary systems. METHODS: From a consecutive surgical series of 500 patients, 60 had cerebellar AVMs, 39 had brainstem AVMs and were excluded, and 401 had cerebral AVMs. RESULTS: Cerebellar AVM subtypes were as follows: 18 vermian, 13 suboccipital, 12 tentorial, 12 petrosal, and 5 tonsillar. Patients with tonsillar and tentorial AVMs fared best. Cerebellar AVMs presented with hemorrhage more than cerebral AVMs (P < .001). Cerebellar AVMs were more likely to drain deep (P = .04) and less likely to be eloquent (P < .001). The predictive accuracy of the supplementary grade was better than that of the Spetzler-Martin grade with cerebellar AVMs (areas under the receiver-operating characteristic curve, 0.74 and 0.59, respectively). The predictive accuracy of the supplementary system was consistent for cerebral and cerebellar AVMs, whereas that of the Spetzler-Martin system was greater with cerebral AVMs. CONCLUSION: Patients with cerebellar AVMs present with hemorrhage more often than patients with cerebral AVMs, justifying an aggressive treatment posture. The supplementary system is better than the Spetzler-Martin system at predicting outcomes after cerebellar AVM resection. Key components of the Spetzler-Martin system such as venous drainage and eloquence are distorted by cerebellar anatomy in ways that components of the supplementary system are not.

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Tanaka, M., and A. Valavanis. "Role of Superselective Angiography in the Detection and Endovascular Treatment of Ruptured Occult Arteriovenous Malformations." Interventional Neuroradiology 7, no. 4 (December 2001): 303–11. http://dx.doi.org/10.1177/159101990100700404.

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Three cases of occult micro-arteriovenous malformations not identified by cerebral angiography or other imaging modalities were detected by superselective angiography. The first case had a small intracerebral hemorrhage in the superior colliculus, the second had a perimesencephalic subarachnoid hemorrhage, and the third presented with intracerebral hemorrhage combined with massive intraventricular hematoma. While repeated selective cerebral angiography (four-vessel study) was negative, superselective angiography clearly demonstrated each lesion with small early venous filling in accordance with the location of hematoma. Successful superselective embolization with polyvinyl alcohol particles was performed in each micro-arteriovenous malformation by flow-guided microcatheter without postoperative complications. Our experience suggests that superselective angiography is necessary to visualize micro-arteriovenous malformations in patients with cerebral hemorrhage and negative four-vessel angiography. Furthermore, the superselective endovascular approach has the advantage of offering immediate obliteration of the micro-shunt, thereby reducing or eliminating the risk of further hemorrhage.

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Sirakov, Stanimir S., Alexander Sirakov, Krasimir Minkin, Hristo Hristov, Kristian Ninov, Marin Penkov, Vasil Karakostov, et al. "Initial experience with precipitating hydrophobic injectable liquid in cerebral arteriovenous malformations." Interventional Neuroradiology 25, no. 1 (September 17, 2018): 58–65. http://dx.doi.org/10.1177/1591019918798808.

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Background Precipitating hydrophobic injectable liquid is a newly introduced liquid embolic agent for endovascular embolization with some technical advantages over other liquid embolic agents. We present our initial experience with precipitating hydrophobic injectable liquid in the endovascular treatment of cerebral arteriovenous malformations. Methods From October 2015 to January 2018, 27 patients harboring cerebral arteriovenous malformations underwent endovascular embolization with precipitating hydrophobic injectable liquid 25. Clinical features, angiographic results, procedural details, complications, and follow-up details were retrospectively analyzed. Results Twenty-seven patients with cerebral arteriovenous malformations were included. Total obliteration in one endovascular session was confirmed for 14/27 (52%) patients. Partial embolization was attained in 13 patients (48%) in whom staged treatment with following radiosurgery or surgery was planned. No mortality was recorded in this series. Complications during or after the embolization occurred in six of 27 (22.2%) patients. Conclusion In our initial experience, precipitating hydrophobic injectable liquid has acceptable clinical outcome comparable to other liquid embolic agents. Although this is the largest reported study in arteriovenous malformation treatment with precipitating hydrophobic injectable liquid, further studies are needed to validate its safety and efficacy.

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Lv, Xianli, Wei Li, Hongwei He, Chuhan Jiang, and Youxiang Li. "Known and unknown cerebral arteriovenous malformations in pregnancies: haemorrhage risk and influence on obstetric management." Neuroradiology Journal 30, no. 5 (June 21, 2017): 437–41. http://dx.doi.org/10.1177/1971400917712264.

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Objective The objective of this study was to evaluate the haemorrhage risk of known and unknown cerebral arteriovenous malformations and their obstetric management. Methods A retrospective review was performed and analysed 67 consecutive cases of arteriovenous malformation with pregnancy history. Results Sixty-seven cases of arteriovenous malformation with pregnancy histories were identified. In 14 cases (20.9%) of arteriovenous malformation diagnosed before pregnancy, 11 cases were treated (10 embolisation and one surgery), there was no haemorrhage in 14 pregnancies, 14 healthy babies were delivered by caesarean section in 12 pregnancies (85.7%) and vaginal delivery in two pregnancies (14.3%). In 53 cases (89.1%) of arteriovenous malformation diagnosed during/after pregnancy, there was one (1.6%) case of subarachnoid haemorrhage at 38 weeks’ gestation in 64 pregnancies, 64 healthy babies were delivered by caesarean section in 11 pregnancies (17.2%) and vaginal delivery in 53 pregnancies (82.8%). This resulted in 1.6% (95% confidence interval 0–4.6%) haemorrhage rate per pregnancy in unknown arteriovenous malformations. Known arteriovenous malformation gravida was prone to caesarean section; however, vaginal delivery did not increase the haemorrhage risk in unknown arteriovenous malformation gravidas (1.8% vs. 0%, P = 1.000). Conclusion Prior treatment for ruptured arteriovenous malformation could prevent its haemorrhage during pregnancy and the haemorrhage risk of unruptured arteriovenous malformation in pregnancies is low. Although known arteriovenous malformation gravida is prone to caesarean section, vaginal delivery seems not to increase the haemorrhage risk in unknown arteriovenous malformation gravidas.

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Hashimoto, Nobuo, Kazuhiko Nozaki, Yasushi Takagi, Ken-ichiro Kikuta, and Nobuhiro Mikuni. "SURGERY OF CEREBRAL ARTERIOVENOUS MALFORMATIONS." Neurosurgery 61, suppl_1 (July 1, 2007): SHC—375—SHC—389. http://dx.doi.org/10.1227/01.neu.0000255491.95944.eb.

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Abstract Despite remarkable progress, the microsurgical extirpation of cerebral arteriovenous malformations (AVMs) even by experienced neurosurgeons is not always easy or safe. This article focuses on how to render AVM surgery safer, and offers strategies and tactics for avoiding perilous bleeding and preserving postoperative neurological function. Our treatment strategies and surgical techniques are offered from the operating surgeon's perspective. An understanding of pathophysiology of cerebral AVMs is important for their appropriate surgical treatment. Sophisticated neuroimaging techniques and scrupulous neurophysiological examinations alert to possible complications, and improved surgical approaches help to minimize the sequelae of unanticipated complications. At the early stage of cerebral AVM surgery, extensive dissection of the sulci, fissures, and subarachnoid cistern should be performed to expose feeders, nidus, and drainers. Problems with the surgery of large and/or deep-seated lesions are exacerbated when arterial bleeding from the nidus continues even after all major feeders are thought to have been occluded. We routinely place catheters for angiography at the surgery of complex AVMs to find missing feeding arteries or to identify the real-time hemodynamic status of the lesion. Temporary clip application on feeders and less coagulation of the nidus is necessary to control intranidal pressure and to avoid uncontrollable bleeding from the nidus and adjacent brain. Intraoperative navigation images superimposed on tractography images can provide us with valuable information to minimize neurological deficits. Deeper insight into AVM nature and into events that occur during AVM surgery as well as the inclusion of molecular biological approaches will open new horizons for the safe and effective treatment of AVMs.

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Coffey, Robert J., Douglas A. Nichols, and Edward G. Shaw. "Stereotactic Radiosurgical Treatment of Cerebral Arteriovenous Malformations." Mayo Clinic Proceedings 70, no. 3 (March 1995): 214–22. http://dx.doi.org/10.4065/70.3.214.

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Sure, Ulrich, Nick Butz, Adrian M. Siegel, Hans D. Mennel, Siegfried Bien, and Helmut Bertalanffy. "Treatment-induced neoangiogenesis in cerebral arteriovenous malformations." Clinical Neurology and Neurosurgery 103, no. 1 (April 2001): 29–32. http://dx.doi.org/10.1016/s0303-8467(01)00112-3.

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25

Schumacher, M., and J. A. Horton. "Treatment of cerebral arteriovenous malformations with PVA." Neuroradiology 33, no. 2 (1991): 101–5. http://dx.doi.org/10.1007/bf00588243.

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Mansmann, Ulrich, Pierre Lasjaunias, and Hans Jörg Meisel. "Treatment of Patients with Cerebral Arteriovenous Malformations." Radiology 223, no. 3 (June 2002): 879–81. http://dx.doi.org/10.1148/radiol.2233011657.

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Batjer, Hunt H., Phillip D. Purdy, Cole A. Giller, and Duke S. Samson. "Evidence of Redistribution of Cerebral Blood Flow during Treatment for an Intracranial Arteriovenous Malformation." Neurosurgery 25, no. 4 (October 1, 1989): 599–605. http://dx.doi.org/10.1227/00006123-198910000-00014.

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Abstract The presence of an intracranial arteriovenous malformation has a dramatic impact on local circulatory dynamics. Treatment of some arteriovenous malformations can result in disastrous hyperemic states caused by redistribution of previously shunted blood. This report describes serial hemodynamic measurements of both cerebral blood flow and flow velocity in 3 patients during treatment for arteriovenous malformations. Measurements of cerebral blood flow were made by computed tomographic scan employing the stable xenon inhalation technique; flow velocity, including autoregulatory characteristics, was measured by transcranial Doppler ultrasonogram. Substantial hyperemia developed in one patient (Case 1) after resection and in another (Case 3) after embolization. Embolization resulted in restoration of normal regional cerebral blood flow in a patient who demonstrated hypoperfusion before treatment (Case 2). In Patient 1, postoperative hyperemia was associated with persistently elevated flow velocities, and may have been accompanied by hemispheric neurological deficits. Sequential hemodynamic measurements may predict patients at risk of perioperative complications, and may become useful clinical guidelines for the extent and timing of embolization and for the timing of surgery after intracranial hemorrhage or preoperative embolization procedures.

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Wikholm, G., C. Lundqvist, and P. Svendsen. "Transarterial Embolisation of Cerebral Arteriovenous Malformations." Interventional Neuroradiology 3, no. 2 (June 1997): 119–23. http://dx.doi.org/10.1177/159101999700300203.

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Arteriovenous malformations of the brain are rare disorders. Embolisation has emerged as an effective treatment with an acceptable, low complication rate. Previously presented results are completed with results from 1994 to 1996. Ninety-six percent of the patients were treated with no or very minor sequelae resulting in total obliteration in 32% and supplementary stereotactic radiation in 49%. Ninety percent of all patients are in excellent or good health at follow up. These results may be jeopardised by the ongoing proliferation of endovascular treatment for AVMs.

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Shchehlov, D. V., O. E. Svyrydiuk, S. V. Chebanyuk, O. V. Slobodian, and M. B. Vyval. "Spontaneous occlusion of the cerebral arteriovenous malformations." Ukrainian Interventional Neuroradiology and Surgery 39, no. 1 (September 27, 2022): 34–39. http://dx.doi.org/10.26683/2786-4855-2022-1(39)-34-39.

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Spontaneous occlusion of arteriovenous malformations (AVM), characterized by complete disappearance of the AVM nidus and early venous drainage, and is a rare. The frequency of this phenomenon varied from 0.1 to 1.3 %.We analyzed two cases of spontaneous occlusion of cerebral AVMs with a non-hemorrhagic debut after 3 and 13 years in women aged 28 and 40 years, respectively. In both cases AVM was diagnosed during routine neuroimaging because of headache. Both patients had superficial small malformations. After discussing the risks of surgical treatment, both patients refused to perform any intervention. Scheduled angiography was performed 3 years after the diagnosis to follow-up the course of the disease and revealed complete disappearance of the AVM. Another patient noted persistent regression of headache after 3 years. Follow-up angiography was performed 13 years after diagnosis and confirmed spontaneous occlusion of the AVM. Given the data on the recurrence of the disease after spontaneous occlusion, such patients require long-term follow-up.When an AVM ruptures, hemodynamic changes may explain the thrombosis of the malformation, but the mechanisms of spontaneous occlusion in non-ruptured AVM remain unclear.

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Colombo, Federico, Antonio Benedetti, Franco Pozza, Cristina Marchetti, and Giorgio Chierego. "Linear Accelerator Radiosurgery of Cerebral Arteriovenous Malformations." Neurosurgery 24, no. 6 (June 1, 1989): 833–40. http://dx.doi.org/10.1227/00006123-198906000-00008.

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Abstract A technique for linear accelerator radiosurgery has been used in clinical practice since 1982. The technique is based on multiple intersecting arc irradiations focused on a stereotactic target. From November 1984 to October 1988, 97 patients with cerebral arteriovenous malformations have been treated. Seventy-nine patients suffered one or more than one hemorrhage. Four patients had progressive neurological symptoms. In 14 patients, epilepsy was the principal complaint. Stereotactic localization was performed by stereotactic angiography. Lesion dimensions varied from 4 to 40 mm in diameter. Doses from 18.7 to 40 Gy were delivered in one or two sessions. Mean follow-up is 17.1 months (from 1 to 49). Four instances of minor rebleeding were observed after treatment: 3 patients complained of transient neurological deterioration. Of 56 patients who were followed longer than 1 year, 50 underwent 12-month follow-up angiography. In 26 patients complete obliteration of the malformation was demonstrated (52%), in 12 patients subtotal obliteration was obtained (24%), in 11 patients the obliteration was evident but not significant (22%), and in 1 patient the AVM was unchanged. Other angiographic features in incompletely obliterated cases were a significant reduction of flow velocity through the malformation together with a reduction in diameter of both feeding arteries and draining veins.

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Jelaca, Bojan, Tomislav Cigic, Vladimir Papic, Mladen Karan, Jagos Golubovic, and Petar Vulekovic. "Cerebral arteriovenous malformation radiosurgery after intracranial hemorrhage: A case report and literature review." Medical review 70, no. 7-8 (2017): 241–44. http://dx.doi.org/10.2298/mpns1708241j.

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

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Gallina, Pasquale, Pasquale Gallina, Louis Merienne, Meder Jean-François, Michel Schlienger, Dimitri Lefkopoulos, and Merland Jean-Jacques. "Failure in Radiosurgery Treatment of Cerebral Arteriovenous Malformations." Neurosurgery 42, no. 5 (May 1, 1998): 996–1002. http://dx.doi.org/10.1097/00006123-199805000-00024.

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Alexander, Eben. "Failure in Radiosurgery Treatment of Cerebral Arteriovenous Malformations." Neurosurgery 42, no. 5 (May 1, 1998): 1002–3. http://dx.doi.org/10.1097/00006123-199805000-00025.

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Lunsford, L. Dade. "Failure in Radiosurgery Treatment of Cerebral Arteriovenous Malformations." Neurosurgery 42, no. 5 (May 1, 1998): 1004. http://dx.doi.org/10.1097/00006123-199805000-00026.

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Friedman, William A. "Failure in Radiosurgery Treatment of Cerebral Arteriovenous Malformations." Neurosurgery 42, no. 5 (May 1, 1998): 1004. http://dx.doi.org/10.1097/00006123-199805000-00027.

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Steinberg, Gary K., and Steven D. Chang. "Failure in Radiosurgery Treatment of Cerebral Arteriovenous Malformations." Neurosurgery 42, no. 5 (May 1, 1998): 1004. http://dx.doi.org/10.1097/00006123-199805000-00028.

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Gorozhanin, V. A., Yu V. Pilipenko, O. B. Belousova, and Sh Sh Eliava. "Microsurgical treatment of non-bleeding cerebral arteriovenous malformations." Voprosy neirokhirurgii imeni N.N. Burdenko 82, no. 5 (2018): 119. http://dx.doi.org/10.17116/neiro201882051119.

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Deruty, R., I. Pelissou-Guyotat, D. Amat, C. Mottolese, Y. Bascoulergue, F. Turjman, and J. P. Gerard. "Complications after multidisciplinary treatment of cerebral arteriovenous malformations." Acta Neurochirurgica 138, no. 2 (February 1996): 119–31. http://dx.doi.org/10.1007/bf01411350.

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Hoi Sang, U., Charles W. Kerber, and Michael M. Todd. "Multimodality treatment of deep periventricular cerebral arteriovenous malformations." Surgical Neurology 38, no. 3 (September 1992): 192–203. http://dx.doi.org/10.1016/0090-3019(92)90169-n.

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Nunes, André Freitas, Rafael Gomes dos Santos, Rodrigo Salmeron de Toledo Aguiar, José Carlos Esteves Veiga, Heitor Castelo Branco Rodrigues Alves, Mario Luiz Marques Conti, and Guilherme Brasileiro de Aguiar. "Cerebral proliferative angiopathy: a review / Angiopatia proliferativa cerebral: uma revisão." Arquivos Médicos dos Hospitais e da Faculdade de Ciências Médicas da Santa Casa de São Paulo 64, no. 1 (April 30, 2019): 55. http://dx.doi.org/10.26432/1809-3019.2019.64.1.055.

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AbstractIntroduction: Cerebral Arteriovenous Malformations (AVMs) are vascular lesions defined by arteriovenous shunting flowing through a nidus of coiled and tortuous vascular connections. Cerebral Proliferative Angiopathy (CPA) is a rare type of AVM with pathological, clinical, diagnostic features and treatment differences from a typical AVM. We aimed to summarize important features of CPA already described and identify important gaps of evidence. Methods: Data was selected by a search of PUBMED with the term “cerebral proliferative angiopathy”. The articles considered relevant were included in this review. We also screened article references and included them as needed. Discussion: CPA shows a diffuse nidus appearance, presence of transdural supply and stenosis of feeding arteries, without dominant feeders or flow-related aneurysms. There is intermingled brain between the vascular spaces. The usual clinical presentation is seizures, headaches, and progressive neurological deficits. Sound diagnosis can be made based on CT, MRI, Angiography and perfusion techniques, which are essential to treatment choices. Invasive treatment is seldom indicated, in order to preserve the normal brain parenchyma, and clinical control of symptoms, associated with a thorough follow-up, is the usual approach in most reported cases. Conclusion: Still much remains to be learned about CPA. Establishing more precise roles of various radiological assessing methods, how they affect the follow-up of patients, and safety and efficacy profiles of different treatment approaches will provide us the tools to give patients a more solid intervention and clearer follow-up.Keywords: Vascular malformations, Intracranial arteriovenous malformations, Brain diseases, Cerebrovascular disordersResumoIntrodução: As malformações arteriovenosas cerebrais (MAVs) são lesões vasculares definidas por comunicação arteriovenosa por meio de conexões vasculares tortuosas. A angiopatia cerebral proliferativa (ACP) é um tipo raro de MAV com características patológicas, clínicas, diagnósticas e de tratamento distintas das MAVs típicas. Objetivou-se resumir características importantes da ACP já descritas na literatura, e identificar lacunas importantes nas evidências. Métodos: Os dados foram selecionados através de busca na base de dados PUBMED, com o termo “cerebral proliferative angiopathy”. Os artigos considerados relevantes foram incluídos nessa revisão, assim como alguns outros artigos presentes nas referências. Discussão: A ACP apresenta-se como um nidus difuso, associada à presença de irrigação transdural, de estenose das artérias que a alimentam, sem suprimento arterial dominante ou aneurismas relacionados ao fluxo. Há parênquima cerebral normal entre os espaços vasculares. Comumente se apresenta com crises epilépticas, cefaleia e déficits neurológicos progressivos. O diagnóstico de certeza pode ser realizado através de TC, RM, angiografia e técnicas de perfusão, e é essencial para a escolha do tratamento. Abordagens invasivas são raramente indicadas a fim de preservar o parênquima cerebral normal. O controle clínico dos sintomas, associado a seguimento rigoroso, é a escolha terapêutica geralmente utilizada na maioria dos relatos. Conclusão: Ainda há muito que se aprender sobre a ACP. Estabelecer os benefícios de cada um dos diversos métodos imaginológicos, como eles influenciam o seguimento dos pacientes, e perfis de segurança e eficácia das diferentes terapêuticas fornecerá ferramentas para melhor decisão terapêutica.Descritores: Malformações vasculares, Malformações arteriovenosas intracranianas, encefalopatias, Transtornos cerebrovasculares

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Cohen-Gadol, Aaron A., and Dennis D. Spencer. "Harvey W. Cushing and cerebrovascular surgery: Part II, vascular malformations." Journal of Neurosurgery 101, no. 3 (September 2004): 553–59. http://dx.doi.org/10.3171/jns.2004.101.3.0553.

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✓ The surgical treatment of cerebrovascular malformations intrigued early neurosurgeons. Cushing defined vascular malformations as tumors arising from cerebral blood vessels. He successfully resected the first arteriovenous malformation 3 years after it had been irradiated. In the absence of angiography, the pathoanatomy of these lesions remained elusive and early techniques such as cortical vein ligation proved catastrophic. Cushing demonstrated the favorable results of radiation treatments on vascular malformations and advocated decompressive craniectomy followed by radiotherapy. He ligated cortical feeding vessels and external carotid arteries with an improved understanding of the angioarchitecture of vascular malformations. He stressed the importance of preoperative diagnosis because the radical resection of nonirradiated vascular malformations challenged the limitations of the available neurosurgical armamentarium.

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Puccinelli, Francesco, Minh Ngoc Thien Kim Tran Dong, Marta Iacobucci, Jean-Xavier Mazoit, Philippe Durand, Pierre Tissieres, and Guillaume Saliou. "Embolization of cerebral arteriovenous shunts in infants weighing less than 5 kg." Journal of Neurosurgery: Pediatrics 23, no. 5 (May 2019): 597–605. http://dx.doi.org/10.3171/2018.11.peds1865.

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OBJECTIVEEndovascular treatment in children, especially neonates, can be more challenging than analogous procedures in adults. This study aimed to describe the clinical and radiological findings, type and timing of endovascular treatment, and early outcomes in children who present with neurovascular malformations, who are treated with embolization, and who weigh less than 5 kg.METHODSThe authors carried out a retrospective review of all consecutively treated children weighing less than 5 kg with neurovascular arteriovenous malformations (AVMs) at a single institution over a 10-year period.RESULTSFifty-two patients were included in the study. Thirty-eight had a vein of Galen aneurysmal malformation, 3 a pial AVM, 6 a pial arteriovenous fistula, and 5 a dural sinus malformation. The endovascular treatment goals were control of cardiac failure or hydrocephalus in cases of nonhemorrhagic malformations or to prevent new bleeding in cases of previous hemorrhage. A hemorrhagic complication occurred in 12 procedures and an ischemic complication in 2. Both complication types were correlated with the age of the infant (age cutoff at 3 months) (p = of 0.015 and 0.049, respectively). No correlation was found with the weight of the infant or the duration of the procedure.CONCLUSIONSThe embolization of AVMs in these patients prevented adverse cardiac effects, hydrovenous disorders, and rebleeding. The risk of major cerebral complications seems mainly correlated with age, with a threshold at 3 months. A multidisciplinary team involved in the treatment of these children may help to improve treatment success and management.

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Crowley, R. Webster, Andrew F. Ducruet, Cameron G. McDougall, and Felipe C. Albuquerque. "Endovascular Advances for Brain Arteriovenous Malformations." Neurosurgery 74, suppl_1 (February 1, 2014): S74—S82. http://dx.doi.org/10.1227/neu.0000000000000176.

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Abstract Arteriovenous malformations (AVMs) of the brain represent unique challenges for treating physicians. Although these lesions have traditionally been treated with surgical resection alone, advancements in endovascular and radiosurgical therapies have greatly expanded the treatment options for patients harboring brain AVMs. Perhaps no subspecialty within neurosurgery has seen as many advancements over a relatively short period of time as the endovascular field. A number of these endovascular innovations have been designed primarily for cerebral AVMs, and even those advancements that are not particular to AVMs have resulted in substantial changes to the way cerebral AVMs are treated. These advancements have enabled the embolization of cerebral AVMs to be performed either as a stand-alone treatment, or in conjunction with surgery or radiosurgery. Perhaps nothing has impacted the treatment of brain AVMs as substantially as the development of liquid embolics, most notably Onyx and n-butyl cyanoacrylate. However, of near-equal impact has been the innovations seen in the catheters that help deliver the liquid embolics to the AVMs. These developments include flow-directed catheters, balloon-tipped catheters, detachable-tipped catheters, and distal access catheters. This article aims to review some of the more substantial advancements in the endovascular treatment of brain AVMs and to discuss the literature surrounding the expanding indications for endovascular treatment of these lesions.

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Chen, Ching-Jen, Dale Ding, Colin P. Derdeyn, Giuseppe Lanzino, Robert M. Friedlander, Andrew M. Southerland, Michael T. Lawton, and Jason P. Sheehan. "Brain arteriovenous malformations." Neurology 95, no. 20 (October 1, 2020): 917–27. http://dx.doi.org/10.1212/wnl.0000000000010968.

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Brain arteriovenous malformations (AVMs) are anomalous direct shunts between cerebral arteries and veins that convalesce into a vascular nidus. The treatment strategies for AVMs are challenging and variable. Intracranial hemorrhage and seizures comprise the most common presentations of AVMs. However, incidental AVMs are being diagnosed with increasing frequency due to widespread use of noninvasive neuroimaging. The balance between the estimated cumulative lifetime hemorrhage risk vs the risk of intervention is often the major determinant for treatment. Current management options include surgical resection, embolization, stereotactic radiosurgery (SRS), and observation. Complete nidal obliteration is the goal of AVM intervention. The risks and benefits of interventions vary and can be used in a combinatorial fashion. Resection of the AVM nidus affords high rates of immediate obliteration, but it is invasive and carries a moderate risk of neurologic morbidity. AVM embolization is minimally invasive, but cure can only be achieved in a minority of lesions. SRS is also minimally invasive and has little immediate morbidity, but AVM obliteration occurs in a delayed fashion, so the patient remains at risk of hemorrhage during the latency period. Whether obliteration can be achieved in unruptured AVMs with a lower risk of stroke or death compared with the natural history of AVMs remains controversial. Over the past 5 years, multicenter prospective and retrospective studies describing AVM natural history and treatment outcomes have been published. This review provides a contemporary and comprehensive discussion of the natural history, pathobiology, and interventions for brain AVMs.

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Golovin, S. V., A. K. Khe, and K. A. Gadylshina. "Hydraulic model of cerebral arteriovenous malformations." Journal of Fluid Mechanics 797 (May 16, 2016): 110–29. http://dx.doi.org/10.1017/jfm.2016.245.

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The paper presents a model of a cerebral vascular system including two types of vessel networks (arterial and venous) joined by a porous medium as a substitute to a microcapillary system. The aim of the paper is to reproduce numerically experimental data on endovascular measurements of fluid velocity and pressure in the afferent artery and the efferent vein of the arteriovenous malformation (AVM). The suggested model qualitatively simulates all the main features of the experimental $vp$-diagrams: presence of the time shift between velocity and pressure waves, semicircular shape of the diagram, difference in the direction of circulation in the arterial and venous parts and upper-left drift of the diagram during the embolisation of the AVM. The velocity–pressure time shift is analysed on the modelling example of pulsation flow within a vessel in a cylindrical porous medium. The demonstrated adequacy of the model allows its further use for simulation of various strategies of AVM treatment, haemorrhage risk estimations, etc.

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YOSHIMOTO, Tetsuyuki, Takeshi KASHIWABA, Kiyohiro HOUKIN, and Hiroshi ABE. "Spontaneous Disappearance of Arteriovenous Malformation during Staged Treatment of Multiple Cerebral Arteriovenous Malformations —Case Report—." Neurologia medico-chirurgica 36, no. 11 (1996): 812–14. http://dx.doi.org/10.2176/nmc.36.812.

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Hashimoto, Tomoki, and William L. Young. "Anesthesia-related considerations for cerebral arteriovenous malformations." Neurosurgical Focus 11, no. 5 (November 2001): 1–6. http://dx.doi.org/10.3171/foc.2001.11.5.6.

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In the optimum anesthetic management of patients with cerebral arteriovenous malformations (AVMs), the anesthesiologist should be familiar with the general pathophysiology of these lesions and various strategies for treatment. In this review, the authors outline these issues with special attention to cerebral hemodynamic changes induced by AVMs and their resection.

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Fiorella, David, Felipe C. Albuquerque, Henry H. Woo, Cameron G. McDougall, and Peter A. Rasmussen. "The Role of Neuroendovascular Therapy for the Treatment of Brain Arteriovenous Malformations." Neurosurgery 59, suppl_5 (November 1, 2006): S3–163—S3–177. http://dx.doi.org/10.1227/01.neu.0000237544.20452.47.

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Abstract NEUROENDOVASCULAR EMBOLIZATION REPRESENTS a critical component of the multidisciplinary management of cerebral arteriovenous malformations. Safe and effective embolization may be performed only in the context of a well-designed, rational treatment plan that is fundamentally based on a clear understanding of the natural history of the lesion, as well as the cumulative risks of multimodality treatment. This article outlines the role of neuroendovascular embolization in arteriovenous malformation therapy with a specific emphasis on decision making in the context of formulating a treatment plan. The authors also provide a summary of the available embolic agents and their technical application, potential intraprocedural and periprocedural complications, and postprocedural management.

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Zhao, Jizong, Tao Yu, Shuo Wang, Yuanli Zhao, and Wu Yang Yang. "Surgical Treatment of Giant Intracranial Arteriovenous Malformations." Neurosurgery 67, no. 5 (November 1, 2010): 1359–70. http://dx.doi.org/10.1227/neu.0b013e3181eda216.

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Abstract BACKGROUND: The treatment of giant arteriovenous malformations (AVMs) remains a challenge in the neurosurgical field. Microsurgery is one of the most effective ways for eliminating giant cerebral AVMs. OBJECTIVE: To review surgical outcomes in treating the disease, and form conclusions regarding the indications for and outcomes of surgical treatment in giant intracranial AVMs. METHODS: We studied 40 consecutive cases of giant AVMs treated in Beijing Tiantan Hospital between 2000 and 2008. The radiologic and clinical features were analyzed. The Spetzler-Martin grading system was used to classify the patients. All patients were surgically treated, and the final outcomes of the patients were gathered for analysis. RESULTS: The major presenting symptoms were seizures, headaches, hemorrhage, and neurological deficits. The mean AVM diameter was 6.3 cm. According to the Spetzler-Martin grading system, 5 patients had grade III lesions, 21 had grade IV lesions, and 14 had grade V lesions. Out of the total 40 patients, 31 (77.5%) demonstrated excellent or good outcome. Complications included hemiparalysis, aphasia, hemianopia, cranial nerve dysfunction, and seizures. After follow-up, 27 of 30 (90%) surviving patients presented normal function or minimal symptoms. CONCLUSION: Presurgical evaluation of every candidate and treatment choice is the determining factor in therapy for giant AVMs. For giant cerebral AVMs located superficially or not involving critical components, a good outcome can be expected through surgical resection. The obliteration and recurrence rates were satisfying, and the complication rate was acceptable.

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Zhang, Jia, Gaoyun Pan, Yingying Zou, Xiaoshu Chen, Jingye Pan, Yi Wang, Shichao Quan, and He Zou. "A missed case of hereditary hemorrhagic telangiectasia: A case report." SAGE Open Medical Case Reports 10 (January 2022): 2050313X2211240. http://dx.doi.org/10.1177/2050313x221124060.

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Hereditary hemorrhagic telangiectasia is a rare autosomal dominant disorder characterized by abnormal blood vessel formation. When an abnormal vascular architecture affects the lungs and central nervous system, serious complications can occur. We report a missed case of hereditary hemorrhagic telangiectasia with pulmonary arteriovenous malformations and cerebral arteriovenous malformations. A 22-year-old Chinese female was taken to the emergency room because of unconsciousness. Emergency head contrast-enhanced computed tomography and transthoracic contrast echocardiography showed that she had cerebral arteriovenous malformations and pulmonary arteriovenous malformations. The patient experienced multiple spontaneous epistaxis since childhood, for which she was treated at a local hospital for a brief period. Her mother also had pulmonary arteriovenous malformations. The patient was diagnosed with hereditary hemorrhagic telangiectasia according to the consensus Curaçao diagnostic criteria and eventually died of hereditary hemorrhagic telangiectasia. The case report highlights the importance of early diagnosis and intervention for hereditary hemorrhagic telangiectasia. Given that hereditary hemorrhagic telangiectasia is frequently undiagnosed, increasing the physician’s awareness of hereditary hemorrhagic telangiectasia can play an important role in the timely diagnosis and treatment of these patients.

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