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Cannizzaro D, Scibilia A, Frio F, Zaed I, Safa A, Cirillo L, Sturiale C, Cardia A, Bortolotti C. IV and V grade arteriovenous Malformations: A multicenter surgical experience. Use of multiple grading system to predict surgical risk. J Clin Neurosci 2022; 104:96-102. [PMID: 35994875 DOI: 10.1016/j.jocn.2022.08.011] [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: 07/25/2022] [Accepted: 08/14/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of our study is to report a multicenter experience in the treatment of IV and V grade arteriovenous malformations (AVMs) and to apply commonly used grading scales for surgical risk assessment for these vascular high-grade lesions. METHODS Between January 2015 and December 2019, a retrospective study was conducted to identify patients undergoing microsurgical intervention for cAVMs at two Italian centers specialized in the treatment of vascular pathologies. Data on patients with Spetzler-Martin IV and V and with a score equal or more than 7 according to Lawton-Young classification were collected. Ruptured AVMs at admission were subsequently classified according to the new proposed AVICH classification. RESULTS A total of 20 patients with high grade (IV and V) cAVMs were enrolled in the study and the average follow-up was 36.45 months. The outcome based on mRS was favorable in 65 % of cases. The pre-operative mRS was a factor influencing clinical outcome, as well as the number of bleedings preceding the treatment, age, and nidus characteristics. S-M IV, L-Y 3 and S-M supp 7 scores were associated with good outcome. Based on the AVICH classification, for ruptured cAVMs, having a score of 9 ore less was correlated to a postoperative mRS fewer or equal than 2. CONCLUSIONS Surgical management for high-grade AVMs should be considered in highly selected patients with repeated bleeding or disabling symptoms. Classification systems provide an aid in selecting patients for surgery, also in grade IV and V. It is essential to establish common registers for the management of these complex vascular malformations.
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Affiliation(s)
- Delia Cannizzaro
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy; Department of Neurosurgery IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Antonino Scibilia
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, Bologna, Italy; Neurosurgical Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy Via Altura, 3, 40139 Bologna, BO, Italy
| | - Federico Frio
- Neurosurgical Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy Via Altura, 3, 40139 Bologna, BO, Italy
| | - Ismail Zaed
- Department of Neurosurgery, ASST Ovest Milanese - Legnano Hospital, Milan, Italy.
| | - Adrian Safa
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
| | - Luigi Cirillo
- Neurosurgical Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy Via Altura, 3, 40139 Bologna, BO, Italy; Neuroradiology Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy
| | - Carmelo Sturiale
- Neurosurgical Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy Via Altura, 3, 40139 Bologna, BO, Italy
| | - Andrea Cardia
- Department of Neurosurgery, Neurocenter of South Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Carlo Bortolotti
- Neurosurgical Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna (ISNB), Bologna, Italy Via Altura, 3, 40139 Bologna, BO, Italy
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Dedeciusova M, Tuleasca C, Hajdu SD, Schiappacasse L, Patin D, Levivier M. Stereotactic Gamma Knife Radiosurgery for Extracranial Arteriovenous Malformations. Stereotact Funct Neurosurg 2020; 98:424-431. [PMID: 32906136 DOI: 10.1159/000509753] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 06/11/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Head and neck extracranial arteriovenous malformations (AVMs) are rare pathological conditions which pose diagnostic and reconstruction challenges. Stereotactic radiosurgery (SRS) is nowadays an established treatment method for brain AVMs, with high obliteration and low complication rates. Here we describe the first report of head extracranial AVMs successfully treated by Gamma Knife (GK) as a retrospective historical cohort. METHODS Over a 9-year period, 2 cases of extracranial AVMs were treated by GK Perfexion (Elekta Instruments AB, Stockholm, Sweden) at a single institution. A stereotactic frame and multimodal imaging, including digital subtraction angiography (DSA), were used. The prescribed dose was 24 Gy at the 50% isodose line. RESULTS The first case was of a patient with pulsating tinnitus and left superficial parotido-condylian AVM. Embolization achieved partial obliteration. Tinnitus disappeared during the following 6 months after GK. The second case was a patient with repetitive gingival hemorrhages and right superior maxillary AVM, fed by the right internal maxillary and facial arteries. Embolization achieved partial obliteration with recurrence of symptoms. GK was further performed. DSA confirmed complete obliteration in both patients. CONCLUSIONS Single-fraction GK radiosurgery appears to be safe and effective for extracranial AVMs. We recommend prescribing doses that are comparable to the ones used for brain AVMs (i.e., 24 Gy). A stereotactic frame is an important tool to ensure higher accuracy in the context of these particular locations. However, in selected cases, a mask could be applied either for single fraction purposes (if in a non-mobile location) or for hypofractionation, in case of larger volumes. These findings should be validated in larger cohorts, inclusively in terms of dose prescription.
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Affiliation(s)
- Michaela Dedeciusova
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,First Faculty of Medicine, Charles University in Prague, Prague, Czechia.,Department of Neurosurgery and Neurooncology, Military University Hospital Prague, Prague, Czechia
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland, .,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland, .,Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland, .,Faculté de Médecine, Sorbonne Université, Paris, France, .,Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Centre Hospitalier Universitaire Bicêtre, Service de Neurochirurgie, Paris, France,
| | - Steven David Hajdu
- Radiology Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Luis Schiappacasse
- Radiation Therapy Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - David Patin
- Institute of Radiation Physics, Lausanne, Switzerland
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,First Faculty of Medicine, Charles University in Prague, Prague, Czechia
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Wang MZ, Qiu HC, Wang S, Cao Y, Zhao M, Zhao JZ. A New Technique for Transvenous Embolization of Brain Arteriovenous Malformations in Hybrid Operation. Chin Med J (Engl) 2019; 131:2993-2996. [PMID: 30539915 PMCID: PMC6302652 DOI: 10.4103/0366-6999.247199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Ming-Ze Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing 100070, China
| | - Han-Cheng Qiu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing 100070, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing 100070, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing 100070, China
| | - Meng Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing 100070, China
| | - Ji-Zong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases; Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing 100070, China
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