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Schwarz S, Brevis Nuñez F, Dürr NR, Schlunz-Hendann M, Brassel F, Felderhoff-Müser U, Dohna-Schwake C, Bruns N. Aortic Steal Correlates with Acute Organ Dysfunction and Short-Term Outcomes in Neonates with Vein of Galen Malformation. Neonatology 2023; 121:106-115. [PMID: 37906988 PMCID: PMC10836749 DOI: 10.1159/000534132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/08/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION Vein of Galen aneurysmal malformation (VGAM) is a rare, congenital cerebrovascular malformation with high morbidity and mortality. Parameters to foresee clinical progression and allow individualized parent counseling are lacking. The aim of this study was to evaluate aortic steal measured by Doppler ultrasound as a prognostic parameter in these neonates. METHODS A retrospective monocentric analysis of cardiac ultrasound exams before embolization in neonates with VGAM was conducted. Percentage of aortic steal measured by time-averaged maximum velocity above and below the zero flow baseline by pulsed Doppler ultrasound at the preductal aortic isthmus was calculated. Association of aortic steal with parameters of acute organ dysfunction (Bicêtre neonatal evaluation score [BNES], neonatal multiple organ dysfunction score [NeoMODS]) and mortality and determination of correlation between aortic steal and cerebral damage on initial and follow-up cerebral magnetic resonance imaging (cMRI) were evaluated. RESULTS Twelve neonates were included, of which 3 died. Per 10 percentage point increase of aortic steal, BNES decreased by 1.64 (95% confidence interval [CI]: 1.28-2.0) points and the maximum observed NeoMODS increased by 1.25 (CI: 0.94-1.57) points. The odds for mortality increased by 2.3 (CI: 1.14-13.67) per 10 percentage point increase of aortic steal. There was a correlation between aortic steal and cerebral damage at baseline (white matter ρ [rho] = 0.34, gray matter ρ = 0.81) and follow-up (white matter ρ = 0.80, gray matter ρ = 0.72). CONCLUSION The degree of aortic steal in neonates with VGAM was highly associated with the severity of organ dysfunction, disease progression on cMRI, and mortality.
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Affiliation(s)
- Simone Schwarz
- Department of Neonatology and Pediatric Intensive Care Medicine, Sana Clinics Duisburg, Duisburg, Germany
| | - Francisco Brevis Nuñez
- Department of Neonatology and Pediatric Intensive Care Medicine, Sana Clinics Duisburg, Duisburg, Germany
| | - Nikola R Dürr
- Clinic for Radiology and Neuroradiology, Sana Clinics Duisburg, Duisburg, Germany
| | | | - Friedhelm Brassel
- Clinic for Radiology and Neuroradiology, Sana Clinics Duisburg, Duisburg, Germany
- Centre for Pediatric Interventional Radiology/Neuroradiology and Interventional Treatment of Vascular Malformations, Sana Clinics Duisburg, Duisburg, Germany
| | - Ursula Felderhoff-Müser
- Department for Pediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christian Dohna-Schwake
- Department for Pediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Nora Bruns
- Department for Pediatrics I, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- TNBS, Centre for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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García-Pérez D, Panero I, Munarriz PM, Jimenez-Roldán L, Lagares A, Alén JA. Hemodynamic alterations following a cerebellar arteriovenous malformation resection: Case report and densitometric quantitative analysis from CT imaging. NEUROCIRUGIA (ENGLISH EDITION) 2022; 33:141-148. [PMID: 35526945 DOI: 10.1016/j.neucie.2020.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 12/23/2020] [Indexed: 06/14/2023]
Abstract
BACKGROUND Cerebellar arteriovenous malformations (cAVMs) are rare and challenging lesions with an aggressive natural history. The mechanisms whereby a patient can worsen clinically after a supratentorial AVM resection include an acute alteration in cerebral hemodynamics, which is a known cause of postoperative hyperemia, edema and/or hemorrhage. These phenomena has not been described for cAVMS. Moreover, the underlying pathophysiology of edema and hemorrhage after AVM resection still remains controversial. METHODS We report a patient that presented an abrupt neurological deterioration after cAVM surgical resection. Emergent external ventricular drainage to treat incipient hydrocephalus only partially reverted the patient's deterioration. Consecutive post-surgery CT images revealed fourth ventricle compression secondary to cerebellar swelling that concurred with a new neurological deterioration. Densitometric analysis was performed in these CT images to reveal the nature of these changes as well as their evolution over time. RESULTS Importantly, we demonstrated a dynamic increase in the cerebellum mean density at the interval of Hounsfield values which correspond to hyperemia values. These changes were dynamic, and when hyperemia resolved and cerebellar density returned to basal levels, the fourth ventricle re-expanded and the patient neurologically recovered. CONCLUSIONS This study demonstrated the utility of quantitative CT image analysis in the context of hemodynamic alterations following cAVM resection. Densitometric CT analysis demonstrated that hyperemic changes, but not ischemic ones, were time-dependent and were responsible for swelling and hemorrhage that conditioned neurological status and patient's evolution.
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Affiliation(s)
- Daniel García-Pérez
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain.
| | - Irene Panero
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
| | - Pablo M Munarriz
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
| | - Luis Jimenez-Roldán
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
| | - José A Alén
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
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Aboukais R, Devalckeneer A, Boussemart P, Bourgeois P, Menovsky T, Leclerc X, Vinchon M, Lejeune JP. Is malignant edema and hemorrhage after occlusion of high-flow arteriovenous malformation related to the size of feeding arteries and draining veins? Neurochirurgie 2022; 68:e1-e7. [DOI: 10.1016/j.neuchi.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/25/2022] [Accepted: 01/25/2022] [Indexed: 11/16/2022]
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García-Pérez D, Panero I, Munarriz PM, Jimenez-Roldán L, Lagares A, Alén JA. Hemodynamic alterations following a cerebellar arteriovenous malformation resection: Case report and densitometric quantitative analysis from CT imaging. Neurocirugia (Astur) 2021; 33:S1130-1473(21)00008-7. [PMID: 33716014 DOI: 10.1016/j.neucir.2020.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cerebellar arteriovenous malformations (cAVMs) are rare and challenging lesions with an aggressive natural history. The mechanisms whereby a patient can worsen clinically after a supratentorial AVM resection include an acute alteration in cerebral hemodynamics, which is a known cause of postoperative hyperemia, edema and/or hemorrhage. These phenomena has not been described for cAVMS. Moreover, the underlying pathophysiology of edema and hemorrhage after AVM resection still remains controversial. METHODS We report a patient that presented an abrupt neurological deterioration after cAVM surgical resection. Emergent external ventricular drainage to treat incipient hydrocephalus only partially reverted the patient's deterioration. Consecutive post-surgery CT images revealed fourth ventricle compression secondary to cerebellar swelling that concurred with a new neurological deterioration. Densitometric analysis was performed in these CT images to reveal the nature of these changes as well as their evolution over time. RESULTS Importantly, we demonstrated a dynamic increase in the cerebellum mean density at the interval of Hounsfield values which correspond to hyperemia values. These changes were dynamic, and when hyperemia resolved and cerebellar density returned to basal levels, the fourth ventricle re-expanded and the patient neurologically recovered. CONCLUSIONS This study demonstrated the utility of quantitative CT image analysis in the context of hemodynamic alterations following cAVM resection. Densitometric CT analysis demonstrated that hyperemic changes, but not ischemic ones, were time-dependent and were responsible for swelling and hemorrhage that conditioned neurological status and patient's evolution.
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Affiliation(s)
- Daniel García-Pérez
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain.
| | - Irene Panero
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
| | - Pablo M Munarriz
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
| | - Luis Jimenez-Roldán
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
| | - Alfonso Lagares
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
| | - José A Alén
- Department of Neurosurgery, University Hospital 12 de Octubre, Avda de Córdoba s/n, Madrid 28041, Spain
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Shen B, Hu C, Jia L, Hu Y. Acute cerebral venous outflow obstruction during convexity meningioma resection. Int J Neurosci 2020; 132:100-106. [PMID: 32729769 DOI: 10.1080/00207454.2020.1802264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cerebral venous outflow obstruction involves idiopathic intracranial hypertension, and the most common related condition is dural venous sinus stenosis or, in other words, an obstruction of the dural venous sinuses. In these cases, the pathological process is often chronic, displays only mild symptoms, and rarely requires urgent surgical intervention. In this study, we present a unique case involving an acute cerebral venous outflow obstruction that occurred during meningioma resection that ultimately had catastrophic consequences. MATERIALS AND METHODS The patient's preoperative imaging only revealed an unremarkable frontal convexity meningioma with an average diameter exceeding 8 cm. She was admitted for a scheduled right frontoparietal craniotomy for lesion resection. RESULTS The patient's unique congenital dural venous sinus structure along with a non-surgical epidural hematoma both contributed to a catastrophic outcome, causing a progressive hemispheric encephalocele, significant blood loss, and wound closure difficulties. CONCLUSION Neurosurgeons should place an additional focus on cerebral venous outflow patency during tumor resection, even if the tumor does not involve the transverse or sigmoid sinuses. It is well known that the tacking sutures play an essential role in preventing an epidural hematoma, but the procedure to mitigate hematomas occurring outside the surgical field of view is not fully recognized by neurosurgeons. If dural tacking sutures are placed after complete tumor resection, the prophylactic effect for preventing EDH in the non-surgical areas may not be guaranteed. Therefore, we strongly advocate for the tacking sutures to be accurately placed before dural incisions are made.
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Affiliation(s)
- Bo Shen
- Department of Neurosurgery, Shanxi Provincial Peoples Hospital, Taiyuan, China.,Academic Department of Neurosurgery, Shanxi Medical University, Taiyuan, China
| | - Changchen Hu
- Department of Neurosurgery, Shanxi Provincial Peoples Hospital, Taiyuan, China
| | - Liming Jia
- Department of Anesthesiology, Shanxi Provincial Peoples Hospital, Taiyuan, China
| | - Yanjun Hu
- Magnetic Resonance Center, Shanxi Provincial Peoples Hospital, Taiyuan, China
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Technique of Fractionated Transcatheter Arterial Embolization for Treating Large Arteriovenous Malformation in Brain Functional Area. J Craniofac Surg 2019; 30:e131-e135. [PMID: 30550449 DOI: 10.1097/scs.0000000000005065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE At present, large cranial function area arteriovenous malformation (fAVM) is mainly treated by craniotomy with a high risk of operation and high disability. In recent years, with the continuous improvement of the neural intervention technology, fractionated transcatheter arterial embolization (fTAE) may be used to treat the fAVM instead of surgical treatment. However, its effectiveness for treating fAVM has never been explored. The authors hypothesized that fTAE can be effective in the treatment of fTAE. METHODS A retrospective study was conducted in 229 cases of large fAVM in multicenter hospitals. Among them, 103 cases were performed fTAE and the other 126 cases were carried on minimally invasive craniotomy (MIC). Clinically relevant symptomatic improvement and complications were compared between 2 groups. RESULTS Complete resection rate of arteriovenous malformation in MIC group (100%) was significantly higher than that of complete embolization rate in fTAE group (77.7%) (P = 0.000). However, the incidence of postoperative complications includes decreased limb muscle strength (P = 0.001), sensory loss of extremities (P = 0.003), visual field defect (P = 0.025) that were lower in fTAE group and remission rate of headache (P = 0.012) but not epilepsy (P = 0.952) was higher in fTAE group compared with that in MIC group. After 1 year follow-up, the rebleeding rate in the fTAE treatment group was 4.85%, higher than that in MIC group (0%) (P = 0.000). CONCLUSIONS Fractionated transcatheter arterial embolization therapy is beneficial for reducing the postoperative complications and preoperative symptoms of fAVM, but not for recurrence rate.
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Orlov K, Panarin V, Krivoshapkin A, Kislitsin D, Berestov V, Shayakhmetov T, Gorbatykh A. Assessment of periprocedural hemodynamic changes in arteriovenous malformation vessels by endovascular dual-sensor guidewire. Interv Neuroradiol 2018; 21:101-7. [PMID: 25934783 DOI: 10.15274/inr-2014-10096] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Endovascular embolization is an important modality in the treatment of brain AVMs. Nowadays staged embolization is the method of choice for the prevention of perioperative hemorrhagic complications. Current theory suggests that simultaneous occlusion of more than 60% of AVM volume induces significant redistribution local blood flow. That, in turn, may lead to hemorrhage due to AVM rupture. Aside from angiographic findings, there is still no method that predicts the degree of safe partial embolization. Intraluminal measurement of flow velocity and pressure in the vicinity of the AVM nidus might allow detecting the changes in local hemodynamics. That can provide a valuable data and shed the light on the origin of vascular catastrophes. Ten patients underwent 12 embolization sessions with intraluminal flow velocity and pressure monitoring. The measurements were performed by dual-sensor guidewire. The "Combomap" (Volcano) system with Combowire microguidewires was chosen for measurements, as there is a documented experience of safe use of said guidewires in the cerebral vasculature. The findings observed during the study matched empirical data as well as the current physiological hypothesis of AVM hemorrhage. In conjunction with DSA runs, intraluminal flow velocity and pressure monitoring has the potential to become a valuable tool in AVM treatment.
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Affiliation(s)
- Kirill Orlov
- Department of Neurosurgery, Novosibirsk Research Institution of Circulation Pathology, Novosibirsk, Russia
| | - Vyacheslav Panarin
- Department of Neurosurgery, Novosibirsk Research Institution of Circulation Pathology, Novosibirsk, Russia
| | - Alexey Krivoshapkin
- Department of Neurosurgery, Novosibirsk Research Institution of Circulation Pathology, Novosibirsk, Russia
| | - Dmitry Kislitsin
- Department of Neurosurgery, Novosibirsk Research Institution of Circulation Pathology, Novosibirsk, Russia
| | - Vadim Berestov
- Department of Neurosurgery, Novosibirsk Research Institution of Circulation Pathology, Novosibirsk, Russia
| | - Timur Shayakhmetov
- Department of Neurosurgery, Novosibirsk Research Institution of Circulation Pathology, Novosibirsk, Russia
| | - Anton Gorbatykh
- Department of Neurosurgery, Novosibirsk Research Institution of Circulation Pathology, Novosibirsk, Russia
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8
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Orlov K, Panarin V, Krivoshapkin A, Kislitsin D, Berestov V, Shayakhmetov T, Gorbatykh A. Assessment of periprocedural hemodynamic changes in arteriovenous malformation vessels by endovascular dual-sensor guidewire. Interv Neuroradiol 2015. [DOI: 10.1177/inr-2014-10096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Rangel-Castilla L, Spetzler RF, Nakaji P. Normal perfusion pressure breakthrough theory: a reappraisal after 35 years. Neurosurg Rev 2014; 38:399-404; discussion 404-5. [PMID: 25483235 DOI: 10.1007/s10143-014-0600-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 09/03/2014] [Accepted: 09/28/2014] [Indexed: 11/26/2022]
Abstract
The intrinsic ability of the brain to maintain constant cerebral blood flow (CBF) is known as cerebral pressure autoregulation. This ability protects the brain against cerebral ischemia and hyperemia within a certain range of blood pressures. The normal perfusion pressure breakthrough (NPPB) theory described by Spetzler in 1978 was adopted to explain the edema and hemorrhage that sometimes occur after resection of brain arteriovenous malformations (AVMs). The underlying pathophysiology of edema and hemorrhage after AVM resection still remains controversial. Over the last three decades, advances in neuroimaging, CBF, and cerebral perfusion pressure (CPP) measurement have both favored and contradicted the NBBP theory. At the same time, other theories have been proposed, including the occlusive hyperemia theory. We believe that both theories are related and complementary and that they both explain changes in hemodynamics after AVM resection. The purpose of this work is to review the current status of the NBBP theory 35 years after its original description.
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Affiliation(s)
- Leonardo Rangel-Castilla
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Hwang PYK, Lewis PM, Maller JJ. Use of intracranial and ocular thermography before and after arteriovenous malformation excision. JOURNAL OF BIOMEDICAL OPTICS 2014; 19:110503. [PMID: 25408956 DOI: 10.1117/1.jbo.19.11.110503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/28/2014] [Indexed: 06/04/2023]
Abstract
Excision of arteriovenous malformations (AVMs) is known to carry a risk of postoperative hemorrhage, postulated to be the result of normal perfusion pressure breakthrough. It is also possible that AVMs may cause a steal effect, reducing perfusion in nearby vessels. There is currently no simple method of visualizing the presence or absence of steal effect intraoperatively. We hypothesized that the infrared thermographic (heat sensitive) imaging of perilesional brain may be useful for detecting reduced perfusion due to steal. Moreover, we hypothesized that if steal effect was present, it could impact on ocular perfusion and thereby temperature. Our objective was, therefore, to investigate whether perilesional cortical and ocular temperature (OT) may be a marker of steal effect. We intraoperatively acquired conventional and thermal images of the surgical field and eyes bilaterally, pre- and post-excisions of a large left hemisphere AVM. We found OT asymmetry preoperatively, which was absent after the AVM was excised. Intraoperative thermal images showed an increase of perilesional temperature, although this could be confounded by generalized changes in cortical perfusion due to anesthetics or surgery.
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Affiliation(s)
- Peter Y K Hwang
- The Alfred Hospital, Department of Neurosurgery, Level 1, Old Baker Building, Prahran VIC 3188, Melbourne 3004, AustraliabMonash University, Central Clinical School, Department of Surgery, Melbourne 3004, Australia
| | - Philip M Lewis
- The Alfred Hospital, Department of Neurosurgery, Level 1, Old Baker Building, Prahran VIC 3188, Melbourne 3004, AustraliabMonash University, Central Clinical School, Department of Surgery, Melbourne 3004, AustraliacMonash University, Monash Institute of M
| | - Jerome J Maller
- The Alfred Hospital, Department of Neurosurgery, Level 1, Old Baker Building, Prahran VIC 3188, Melbourne 3004, AustraliabMonash University, Central Clinical School, Department of Surgery, Melbourne 3004, AustraliacMonash University, Monash Institute of M
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Ding D, Yen CP, Xu Z, Starke RM, Sheehan JP. Radiosurgery for primary motor and sensory cortex arteriovenous malformations: outcomes and the effect of eloquent location. Neurosurgery 2014; 73:816-24; discussio 824. [PMID: 23867301 DOI: 10.1227/neu.0000000000000106] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Eloquent intracranial arteriovenous malformations (AVMs) located in the primary motor or somatosensory cortex (PMSC) carry a high risk of microsurgical morbidity. OBJECTIVE To evaluate the outcomes of radiosurgery on PMSC AVMs and compare them with radiosurgery outcomes in a matched cohort of noneloquent lobar AVMs. METHODS Between 1989 and 2009, 134 patients with PMSC AVMs underwent Gamma Knife radiosurgery with a median radiographic and clinical follow-up of 64 and 80 months, respectively. Seizure (40.3%) and hemorrhage (28.4%) were the most common presenting symptoms. Pre-radiosurgery embolization was performed in 33.6% of AVMs. Median AVM volume was 4.1 mL (range, 0.1-22.6 mL), and prescription dose was 20 Gy (range, 7-30 Gy). Cox regression analysis was performed to identify factors associated with obliteration. RESULTS The overall obliteration rate, including magnetic resonance imaging and angiography, after radiosurgery was 63%. Obliteration was achieved in 80% of AVMs with a volume less than 3 mL compared with 55% for AVMs larger than 3 mL. No previous embolization (P = .002) and a single draining vein (P = .001) were independent predictors of obliteration on multivariate analysis. The annual post-radiosurgery hemorrhage risk was 2.5%. Radiosurgery-related morbidity was temporary and permanent in 14% and 6% of patients, respectively. Comparing PMSC AVMs with matched noneloquent lobar AVMs, the obliteration rates and clinical outcomes after radiosurgery were not statistically different. CONCLUSION For patients harboring PMSC AVMs, radiosurgery offers a reasonable chance of obliteration with a relatively low complication rate. Eloquent location does not appear to confer the same negative prognostic value for radiosurgery that it does for microsurgery.
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Affiliation(s)
- Dale Ding
- Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia
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Importance of the venous outflow pattern in predicting hyperemic complications after treatment of cerebral arteriovenous malformations. World Neurosurg 2013; 82:e59-60. [PMID: 24035991 DOI: 10.1016/j.wneu.2013.07.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 07/27/2013] [Indexed: 11/20/2022]
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Zhao WG, Luo Q, Jia JB, Yu JL. Cerebral hyperperfusion syndrome after revascularization surgery in patients with moyamoya disease. Br J Neurosurg 2013; 27:321-5. [PMID: 23461748 DOI: 10.3109/02688697.2012.757294] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Moyamoya disease (MMD) is a progressive occlusive disease of the distal internal carotid artery that is primarily treated by superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Despite its effectiveness, several postoperative complications have been reported with STA-MCA bypass. Cerebral hyperperfusion syndrome (CHS) after STA-MCA has attracted considerable attention as a hemodynamics-related complication because more cases of CHS after STA-MCA bypass are reported in MMD than in non-MMD patients. The mechanisms underlying CHS after revascularization in MMD patients are poorly understood. This report presents a comprehensive review of the literature on CHS after revascularization in MMD patients, focusing on the pathogenesis, clinical features, imaging techniques, treatment, and prognosis of CHS. Impaired cerebrovascular autoregulation has been implicated in the pathogenesis of CHS, which is characterized by unilateral headache, face and eye pain, seizures, and focal neurological deficits secondary to cerebral edema, and intracranial hemorrhage. Imaging techniques, such as single photon emission computed tomography (SPECT), 3-T magnetic resonance imaging/angiography, and selective arterial spin-labeling magnetic resonance imaging, are valuable for identifying patients at risk for CHS. Treatment strategies include strict blood pressure control, intracranial hemorrhage prevention, and free oxygen radical scavenger administration. Most patients can achieve a satisfying prognosis after effective treatment.
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Affiliation(s)
- W G Zhao
- Department of Neurosurgery, First Hospital of Jilin University, Changchun, P R China
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