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State of the Art in the Role of Endovascular Embolization in the Management of Brain Arteriovenous Malformations-A Systematic Review. J Clin Med 2022; 11:jcm11237208. [PMID: 36498782 PMCID: PMC9739246 DOI: 10.3390/jcm11237208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
As a significant cause of intracerebral hemorrhages, seizures, and neurological decline, brain arteriovenous malformations (bAVMs) are a rare group of complex vascular lesions with devastating implications for patients' quality of life. Although the concerted effort of the scientific community has improved our understanding of bAVM biology, the exact mechanism continues to be elucidated. Furthermore, to this day, due to the high heterogeneity of bAVMs as well as the lack of objective data brought by the lack of evaluative and comparative studies, there is no clear consensus on the treatment of this life-threatening and dynamic disease. As a consequence, patients often fall short of obtaining the optimal treatment. Endovascular embolization is an inherent part of multidisciplinary bAVM management that can be used in various clinical scenarios, each with different objectives. Well-trained neuro-interventional centers are proficient at curing bAVMs that are smaller than 3 cm; are located superficially in noneloquent areas; and have fewer, larger, and less tortuous feeding arteries. The transvenous approach is an emerging effective and safe technique that potentially offers a chance to cure previously untreatable bAVMs. This review provides the state of the art in all aspects of endovascular embolization in the management of bAVMs.
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Tong X, Li X, Ye M, Hu P, Li G, Zhang P, Zhang H, Zhuang P. Pharmacologic Provocative Testing in Combination With Intraoperative Neurophysiologic Monitoring During Arteriovenous Malformation Embolization. World Neurosurg 2021; 154:e72-e81. [PMID: 34216836 DOI: 10.1016/j.wneu.2021.06.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review our use of pharmacologic provocative testing (PT) and intraoperative neurophysiologic monitoring (IONM) during endovascular embolization for eloquent arteriovenous malformations (AVMs), and better define their clinical utility. METHODS This is a prospective study between 1 June 2018 and 1 June 2020. Prior to endovascular embolization, superselective PTs with propofol injection were performed. The PT results were assessed by IONM. The impact of different doses of propofol on PT results was compared. RESULTS Under general anesthesia, 111 PTs and 48 endovascular embolizations were performed in 22 patients. For the initial 48 PTs before planned embolization, 38 PTs with 5 mg propofol were negative and repeat PTs with 7 mg propofol were also negative. For the remaining 10 positive PTs, the microcatheter tip was adjusted to an alternative site until repeat PTs were negative to ensure a subsequent safe embolization. In comparison, 5-mg-propofol PT results were consistent with 7-mg-propofol PTs in larger-sized feeders, whereas for smaller-sized vessels, 3-mg-propofol PT results were consistent with 5-mg-propofol PTs. The negative predictive value of PTs was 97.9% (47 of 48), as only 1 of the 48 embolizations with negative PTs resulted in postoperative hemorrhage and none of the other 47 embolizations led to a postoperative neurologic deficit. CONCLUSIONS PTs and IONM are valuable techniques to predict neurologic deficits and improve procedure decision-making during AVM embolization under general anesthesia. A 5-mg dose of propofol may be sufficient for PTs in larger-sized feeders and a 3-mg dose may be sufficient in smaller-sized feeding branches.
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Affiliation(s)
- Xianzeng Tong
- Department of Neurosurgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xiaoyu Li
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute (China-INI), Capital Medical University, Beijing, China
| | - Ming Ye
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute (China-INI), Capital Medical University, Beijing, China
| | - Peng Hu
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute (China-INI), Capital Medical University, Beijing, China
| | - Guilin Li
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute (China-INI), Capital Medical University, Beijing, China
| | - Peng Zhang
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute (China-INI), Capital Medical University, Beijing, China
| | - Hongqi Zhang
- Department of Neurosurgery, Xuanwu Hospital, China International Neuroscience Institute (China-INI), Capital Medical University, Beijing, China.
| | - Ping Zhuang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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Smajda S, Ciccio G, Fahed R, Robert T, Botta D, Redjem H, Desilles JP, Mazighi M, Zuber K, Escalard S, Baharvahdat H, Blanc R, Chauvet D, Philibert M, Chokron S, Piotin M. Visual Field Defect Before and After Endovascular Treatment of Occipital Arteriovenous Malformations. Neurosurgery 2020; 87:E663-E671. [PMID: 32629471 DOI: 10.1093/neuros/nyaa280] [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: 08/08/2019] [Accepted: 04/25/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Occipital arteriovenous malformations (AVMs) carry a high risk of postoperative morbidity because of their anatomic relation to the visual cortex and optic radiations. Data regarding endovascular management of these lesions are scant. OBJECTIVE To report our single-center experience with occipital AVMs, most of which were treated endovascularly, with a special interest for postoperative visual impairment. METHODS From a prospective database, we assessed the clinical and radiological data of all patients with an occipital AVM managed between 1997 and 2018. The extension of the nidus to the primary visual cortex was assessed and correlated to the pre- and postintervention visual symptomatology. Modified Rankin Scale and visual fields (VFs) were assessed pre- and post-treatment and at the last follow-up. RESULTS A total of 83 patients (47 males [56.6%]) with an occipital AVM were included in the study. Mean age at presentation was 33.5 ± 15.0 yr (min-max = 7-76). A total of 34 patients (41%) presented with hemorrhage related to the AVM. A total of 57 patients (68.7%) underwent endovascular treatment (EVT) alone, 20 (24.1%) underwent embolization and surgery, 3 (3.6%) underwent embolization and radiosurgery, and 3 (3.6%) were conservatively managed. A complete obliteration of the AVM was achieved in 53 patients (66.3%). A post-treatment worsening of the VF was found in 24 of the treated patients (30%), 3 patients (9%) for ruptured AVMs, and in 21 patients (46%) for unruptured AVMs. Morbidity rate was 3.7% and mortality rate was 2.5%. CONCLUSION EVT of occipital AVM carries a non-negligible rate of complications, especially regarding visual functions.
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Affiliation(s)
- Stanislas Smajda
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Gabriele Ciccio
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Robert Fahed
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France.,Department of Medicine (Neurology), Ottawa Hospital Research Institute & University of Ottawa, Ottawa, Canada
| | - Thomas Robert
- Department of Neurosurgery, Neurocenter of Southern Switzerland, Ospedale Civico di Lugano, Lugano, Switzerland.,University of Southern Switzerland, USI, Lugano, Switzerland
| | - Daniele Botta
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Hocine Redjem
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | | | - Mikael Mazighi
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Kevin Zuber
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Simon Escalard
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Humain Baharvahdat
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Raphaël Blanc
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
| | - Dorian Chauvet
- Department of Neurosurgery, Fondation Rothschild Hospital, Paris, France
| | - Manon Philibert
- Department of Neuro-Ophtalmology, Fondation Rothschild Hospital, Paris, France
| | - Sylvie Chokron
- Unité Vision et Cognition, Fondation Rothschild Hospital, Paris, France
| | - Michel Piotin
- Interventional Neuroradiology Department, Fondation Rothschild Hospital, Paris, France
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Bican O, Cho C, Suarez-Roman A, Nguyen V, Lee L, Le S, Heit J, Dodd R, López J. Superselective methohexital challenge prior to intracranial endovascular embolization. J Clin Neurosci 2019; 63:68-71. [DOI: 10.1016/j.jocn.2019.01.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
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Endovascular Therapy for Brainstem Arteriovenous Malformations. World Neurosurg 2018; 125:481-488. [PMID: 30149173 DOI: 10.1016/j.wneu.2018.08.099] [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] [Received: 06/24/2018] [Revised: 08/11/2018] [Accepted: 08/13/2018] [Indexed: 11/21/2022]
Abstract
Brainstem arteriovenous malformations (AVMs) represent ∼5% of all intracranial AVMs and carry a higher risk of hemorrhage than their supratentorial counterparts. There is a high and near-uniform mortality with initial and recurrent episodes of hemorrhage. Brainstem AVMs may also present symptomatically with focal neurologic deficits or hydrocephalus. Treatment is indicated for ruptured and symptomatic brainstem AVMs, as well as those possessing high-risk angioarchitectural features. Microsurgical resection and stereotactic radiosurgery are ideal therapeutic options when feasible. Embolization is most commonly used as adjunctive treatment before surgery or stereotactic radiosurgical irradiation. Preoperative embolization facilitates microsurgical resection and reduces intraoperative and postoperative hemorrhage rates. Use of embolization preradiosurgically helps to reduce nidal size, transforming a large lesion to a size amenable to radiosurgical intervention, increasing the probability of obliteration, decreasing procedural hemorrhage risk, stabilizing the lesion until radiotherapeutic effect achieves obliteration, and providing interval symptomatic resolution. Embolization may also be used effectively as stand-alone monotherapy for small lesions with 1 or 2 arterial feeders not supplying eloquent parenchyma. Although an extensive evidence base exists for clinical usefulness of stereotactic radiosurgery as monotherapy or in combination with other therapeutic modalities, only a few studies have reported specifically on obliteration and complication rates with monotherapeutic embolization in the treatment of brainstem AVMs. The potential role of embolization as monotherapy for brainstem AVMs is reviewed and discussed.
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Yang W, Porras JL, Philadelphia E, Law J, Garzon-Muvdi T, Caplan JM, Colby GP, Coon AL, Tamargo RJ, Huang J. Treatment decision for occipital arteriovenous malformations (AVMs) to achieve hemorrhagic control while maximizing visual preservation: Our experience and review of literature. J Clin Neurosci 2017; 48:50-57. [PMID: 29113859 DOI: 10.1016/j.jocn.2017.10.058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
Despite concern of hemorrhagic risk, patients with occipital AVMs are at significant risk for visual disturbances after treatment. We aim to characterize the hemorrhage risk and visual disturbance in occipital AVMs patients from our experience and literature review. We performed retrospective review of occipital AVM patients seen at our institution from 1990 to 2015. Patient characteristics were compared using multivariable logistic regression with follow-up visual disturbance as the outcome. We also systematically reviewed the PubMed database for English literature describing occipital AVMs (with exclusion of case reports). Ninety-seven patients satisfied inclusion criteria for our study. Mean age was 34.9 ± 16.4 years, with 50.5% male. Thirty-one (32.0%) presented with hemorrhage, and 32 (33.0%) presented with visual disturbance. Average AVM size was 4.0 ± 2.5 cm. Twenty-five (25.8%) were conservatively managed, 13 (13.4%) underwent surgery, and the rest were managed by radiosurgery (52.6%) or embolization (8.2%), with an obliteration rate of 38.9% in treated patients. During average follow-up of 5.4 years, 6 patients (6.7%) hemorrhaged yielding an annual hemorrhage rate of 1.2% for all patients, and 0.0% for surgically-treated patients. Thirty-seven (38.3%) patients experienced visual disturbance in some capacity, nineteen (21.1%) had de novo visual disturbance, fourteen of which were surgically treated patients (19.4%). Multivariable analysis reveals visual disturbance at presentation (p = .012) and microsurgery (p = .047) are significantly predictors of follow-up visual disturbance. While hemorrhage control remains the primary goal of AVM treatment, visual preservation in occipital AVMs is also a major concern. Recommending patients for microsurgery should be weighed carefully and individualized as it bears the highest risk of visual field disturbance despite most optimal hemorrhage control.
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Affiliation(s)
- Wuyang Yang
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jose L Porras
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Eunice Philadelphia
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jody Law
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Tomas Garzon-Muvdi
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Justin M Caplan
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Geoffrey P Colby
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alexander L Coon
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Rafael J Tamargo
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Judy Huang
- Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, United States.
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Fusco MR, Stapleton CJ, Griessenauer CJ, Thomas AJ, Ogilvy CS. Endovascular treatment of intracranial infectious aneurysms in eloquent cortex with super-selective provocative testing: Case series and literature review. Interv Neuroradiol 2015; 22:148-52. [PMID: 26672110 DOI: 10.1177/1591019915617326] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 11/02/2015] [Indexed: 11/15/2022] Open
Abstract
Intracranial infectious aneurysms (IIAs) are a rare subgroup of intracranial aneurysms. Often erroneously termed mycotic aneurysms, these lesions most often result from infectious endocarditis and involve the distal anterior cortical circulation. Diagnosis typically follows headaches or septic infarcts, although increasing numbers of lesions are found incidentally, during screening protocols for infectious endocarditis. Open surgical treatment was previously the mainstay of treatment; however, these IIAs are often fusiform and quite fragile, making open surgical obliteration difficult and typically requiring lesion trapping. Current treatment techniques more commonly involve endovascular coil embolization or parent vessel occlusion. Many of these lesions occur distally, in or around the eloquent cortex, making embolization potentially dangerous. We present cases that highlight the use of super-selective provocative testing with sodium amobarbital and lidocaine, to help clarify and predict the risk of parent vessel occlusion in IIAs located in the eloquent cortex.
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Affiliation(s)
- Matthew R Fusco
- Department of Neurosurgery, Vanderbilt University, Nashville, USA Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Christopher J Stapleton
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Christoph J Griessenauer
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Ajith J Thomas
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
| | - Christopher S Ogilvy
- Division of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
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Common procedures and strategies for anaesthesia in interventional radiology. Curr Opin Anaesthesiol 2015; 28:458-63. [DOI: 10.1097/aco.0000000000000208] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Stapleton CJ, Walcott BP, Fusco MR, Thomas AJ, Ogilvy CS. Brain Mapping for Safe Microsurgical Resection of Arteriovenous Malformations in Eloquent Cortex. World Neurosurg 2015; 83:1148-56. [DOI: 10.1016/j.wneu.2015.01.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 12/21/2014] [Accepted: 01/19/2015] [Indexed: 10/24/2022]
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Dumont TM, Kan P, Snyder KV, Hopkins LN, Siddiqui AH, Levy EI. A proposed grading system for endovascular treatment of cerebral arteriovenous malformations: Buffalo score. Surg Neurol Int 2015; 6:3. [PMID: 25657856 PMCID: PMC4310056 DOI: 10.4103/2152-7806.148847] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 09/05/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The Spetzler-Martin arteriovenous malformation (AVM) grading system has proven to be useful in guiding treatment of cerebral AVMs with craniotomy. It is based on anatomical characteristics each of which makes surgical resection of an AVM more difficult, namely, deep venous drainage, eloquence of surrounding tissue, and large nidus size. A higher score correlates with more complications after treatment. Although this grading system has proven reliable over time, it does not reflect the major determinants of risk associated with endovascular treatment. The authors developed a grading system unique to endovascular treatment of cerebral AVMs. METHODS The proposed grading system accounts for the principal AVM anatomical and physiological features that make endovascular embolization more difficult and, thus, the likelihood of complications greater. These include number of arterial pedicles, diameter of arterial pedicles, and eloquent location of AVM nidus. The proposed grading system was retrospectively applied to 50 patients undergoing endovascular AVM embolization, and its ability to predict complications was compared to the Spetzler-Martin grading system. RESULTS Perioperative complications among the 50 patients included 4 major and 9 minor complications. The proposed grading system was predictive of complication risk, with an increasing rate of perioperative complications associated with an increasing AVM grade. An improved correlation of perioperative complication incidence was noted with the proposed system (P = 0.002), when compared with the Spetzler-Martin grading system (P = 0.33). CONCLUSION This grading system for the endovascular treatment of AVMs is simple, easily reproduced, and clinically valuable.
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Affiliation(s)
- Travis M Dumont
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, New York, USA ; Division of Neurosurgery, Department of Surgery, The University of Arizona, Tucson, Arizona, USA
| | - Peter Kan
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, New York, USA ; Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
| | - Kenneth V Snyder
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Neurology, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, New York, USA
| | - L Nelson Hopkins
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, New York, USA ; Jacobs Institute, Buffalo, New York, USA
| | - Adnan H Siddiqui
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Jacobs Institute, Buffalo, New York, USA
| | - Elad I Levy
- Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York, USA ; Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, USA ; Toshiba Stroke and Vascular Research Center, University at Buffalo, State University of New York, USA ; Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, New York, USA
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Crowley RW, Ducruet AF, McDougall CG, Albuquerque FC. Endovascular advances for brain arteriovenous malformations. Neurosurgery 2014; 74 Suppl 1:S74-82. [PMID: 24402496 DOI: 10.1227/neu.0000000000000176] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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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Affiliation(s)
- R Webster Crowley
- Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Abstract
Pediatric patients in the neurointerventional radiology setting pose the dual challenges of caring for relatively sick patients in the outfield environment. For safe and successful practice, the anesthesiologist must not only understand the nuances of pediatric anesthesia and the physiologic demands of the cerebral lesions. They must also help maintain a team-based approach to safe, compassionate care of the child in this challenging setting. In this review article, we summarize key aspects of success for several of these topics.
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Affiliation(s)
- Mary Landrigan-Ossar
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Mokin M, Dumont TM, Levy EI. Novel Multimodality Imaging Techniques for Diagnosis and Evaluation of Arteriovenous Malformations. Neurol Clin 2014; 32:225-36. [DOI: 10.1016/j.ncl.2013.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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14
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Ali M, Kumpe DA. Embolization of Bronchial Artery–supplied Ectopic Parathyroid Adenomas Located in the Aortopulmonary Window. J Vasc Interv Radiol 2014; 25:138-43. [DOI: 10.1016/j.jvir.2013.10.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Revised: 10/02/2013] [Accepted: 10/03/2013] [Indexed: 10/25/2022] Open
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Massoud TF. Transvenous Retrograde Nidus Sclerotherapy Under Controlled Hypotension (TRENSH). Neurosurgery 2013; 73:332-42; discussion 342-3. [DOI: 10.1227/01.neu.0000430765.80102.77] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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