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Harikrishna A, Chatzidakis S, Ishak A, Faropoulos K, Fotakopoulos G, Georgakopoulou VE, Sklapani P, Trakas N, Yiallouris A, Iosif C, Agouridis AP, Hadjigeorgiou G. Awake craniotomy in patients with arteriovenous malformation: A systematic review and meta‑analysis. MEDICINE INTERNATIONAL 2024; 4:42. [PMID: 38912418 PMCID: PMC11190880 DOI: 10.3892/mi.2024.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024]
Abstract
The present systematic review aimed to identify all the available literature on awake craniotomy (AC) in patients with arteriovenous malformation (AVM) in order to evaluate its safety, risks, benefits and effectiveness. All available literature on AC in patients with AVM was collected and evaluated in an aim to provide a better understanding of its safety, associated risks and benefits. A systematic search for studies employing AC in patients with AVM was conducted using the PubMed, Scopus and ScienceDirect databases without restrictions on the year of publication, language, or study design, from inception up to May 30, 2021. A total of 11 studies published between 2004 and 2021 with 106 patients who underwent ACs were considered eligible. The rate of complete resection was 93% [95% confidence interval (CI), 82 to 100%; I2 0%]. The intraoperative complication rate was 21% (95% CI, 1 to 41%; I2 55%) and the post-operative complication rate was 33% (95% CI, 19 to 48%; I2 40%). During follow-up, the complication rate was 6% (95% CI, 1 to 10%; I2 30%). The post-operative complication rate was higher in the Spetzler-Martin grade (SMG) III-V group (31%; 95% CI, 21 to 42%; I2 46%) than in the SMG I-II group (12%; 95% CI, 2 to 22%; I2 0%). Similarly, the follow-up complication rate was higher in the SMG III-V group (9%; 95% CI, 2 to 16%; I2 34%) than in the SMG I-II group (0%; 95% CI, 0 to 4%; I2 0%). On the whole, the present study provides preliminary evidence to indicate that AC is a possible and useful option for the resection of AVM in selected patients. Well-designed future studies with long-term follow-up are required however, to investigate various aspects of safety and provide solid data for AC in patients with AVM.
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Affiliation(s)
- Arya Harikrishna
- School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus
| | | | - Angela Ishak
- School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus
| | | | - George Fotakopoulos
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece
| | | | - Pagona Sklapani
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | - Nikolaos Trakas
- Department of Biochemistry, Sismanogleio Hospital, 15126 Athens, Greece
| | | | - Christina Iosif
- School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus
| | - Aris P. Agouridis
- School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus
| | - George Hadjigeorgiou
- School of Medicine, European University Cyprus, 2404 Nicosia, Cyprus
- Department of Minimally Invasive Neurosurgery, Athens Medical Center, 14562 Athens, Greece
- Department of Neurosurgery, Apollonion Private Hospital, 2054 Nicosia, Cyprus
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Qiu O, Zhao J, Shi Z, Li H, Wang S, Liao K, Tang M, Xie J, Huang X, Zhang W, Zhou L, Yang X, Zhou Z, Xu L, Huang R, Miao Y, Qiu Y, Lin Y. Asparagine endopeptidase deficiency mitigates radiation-induced brain injury by suppressing microglia-mediated neuronal senescence. iScience 2024; 27:109698. [PMID: 38655198 PMCID: PMC11035374 DOI: 10.1016/j.isci.2024.109698] [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: 10/31/2023] [Revised: 04/05/2024] [Accepted: 04/05/2024] [Indexed: 04/26/2024] Open
Abstract
Mounting evidence supports the role of neuroinflammation in radiation-induced brain injury (RIBI), a chronic disease characterized by delayed and progressive neurological impairment. Asparagine endopeptidase (AEP), also known as legumain (LGMN), participates in multiple malignancies and neurodegenerative diseases and may potentially be involved in RIBI. Here, we found AEP expression was substantially elevated in the cortex and hippocampus of wild-type (Lgmn+/+) mice following whole-brain irradiation. Lgmn knockout (Lgmn-/-) alleviated neurological impairment caused by whole-brain irradiation by suppressing neuronal senescence. Bulk RNA and metabolomic sequencing revealed AEP's involvement in the antigen processing and presentation pathway and neuroinflammation. This was further confirmed by co-culturing Lgmn+/+ primary neurons with the conditioned media derived from irradiated Lgmn+/+ or Lgmn-/- primary microglia. Furthermore, esomeprazole inhibited the enzymatic activity of AEP and RIBI. These findings identified AEP as a critical factor of neuroinflammation in RIBI, highlighting the prospect of targeting AEP as a therapeutic approach.
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Affiliation(s)
- Ouwen Qiu
- Brain Injury Center, Shanghai Institute of Head Trauma, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Jianyi Zhao
- Brain Injury Center, Shanghai Institute of Head Trauma, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Zhonggang Shi
- Brain Injury Center, Shanghai Institute of Head Trauma, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Huan Li
- Department of Radiation Oncology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, P.R. China
| | - Siyuan Wang
- Brain Injury Center, Shanghai Institute of Head Trauma, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Keman Liao
- Brain Injury Center, Shanghai Institute of Head Trauma, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Minchao Tang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Guangxi 530021, P.R. China
| | - Jieqiong Xie
- Department of Neurology, The Second Affiliated Hospital of Guangxi Medical University, Guangxi 530007, P.R. China
| | - Xi Huang
- Department of Digestive Oncology, Guangxi Medical University Cancer Hospital, Guangxi 530021, P.R. China
| | - Wenrui Zhang
- Brain Injury Center, Shanghai Institute of Head Trauma, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Li Zhou
- Brain Injury Center, Shanghai Institute of Head Trauma, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Xi Yang
- Brain Injury Center, Shanghai Institute of Head Trauma, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Zhiyi Zhou
- Brain Injury Center, Shanghai Institute of Head Trauma, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Lei Xu
- Department of Radiation, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Renhua Huang
- Department of Radiation, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Yifeng Miao
- Department of Neurosurgery, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Yongming Qiu
- Brain Injury Center, Shanghai Institute of Head Trauma, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
| | - Yingying Lin
- Brain Injury Center, Shanghai Institute of Head Trauma, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, P.R. China
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Silva AHD, James G. Natural history and clinical manifestation of Pediatric Brain Arteriovenous Malformations. J Korean Neurosurg Soc 2024; 67:280-288. [PMID: 38720544 PMCID: PMC11079564 DOI: 10.3340/jkns.2024.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/04/2024] [Accepted: 04/16/2024] [Indexed: 05/12/2024] Open
Abstract
Brain arteriovenous malformations (bAVMs) are aberrant arteriovenous shunts through a vascular nidus with no intervening capillary beds. They are one of the commonest causes of spontaneous intracranial haemorrhage in children and may be associated with significant morbidity and mortality in cases of rupture. Treatment strategies include microsurgical resection, endovascular embolisation, stereotactic radiosurgery, multimodality treatment with a combination thereof, and particularly in high-grade bAVMs, conservative management. Clinicians involved in treating bAVMs need to have familiarity with the natural history pertaining to bAVMs in terms of risk of rupture, risk factors elevating rupture risk as well as understanding the clinical manifestations of bAVMs. This invited review serves to provide a synthesis on natural history and clinical presentation of bAVMs with particular focus in children to inform decision-making pertaining to management.
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Affiliation(s)
- Adikarige Haritha Dulanka Silva
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Greg James
- Department of Neurosurgery, Great Ormond Street Hospital for Children, London, UK
- Great Ormond Street Institute of Child Health, University College London, London, UK
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Zhang Y, Zhu H, Cao T, Zhang L, Chang Y, Liang S, Ma C, Liang F, Song Y, Zhang J, Li C, Jiang C. Rupture-Related Features of Cerebral Arteriovenous Malformations and Their Utility in Predicting Hemorrhage. Stroke 2024; 55:1339-1348. [PMID: 38511314 DOI: 10.1161/strokeaha.123.045456] [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: 10/07/2023] [Accepted: 02/23/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Evaluating rupture risk in cerebral arteriovenous malformations currently lacks quantitative hemodynamic and angioarchitectural features necessary for predicting subsequent hemorrhage. We aimed to derive rupture-related hemodynamic and angioarchitectural features of arteriovenous malformations and construct an ensemble model for predicting subsequent hemorrhage. METHODS This retrospective study included 3 data sets, as follows: training and test data sets comprising consecutive patients with untreated cerebral arteriovenous malformations who were admitted from January 2015 to June 2022 and a validation data set comprising patients with unruptured arteriovenous malformations who received conservative treatment between January 2009 and December 2014. We extracted rupture-related features and developed logistic regression (clinical features), decision tree (hemodynamic features), and support vector machine (angioarchitectural features) models. These 3 models were combined into an ensemble model using a weighted soft-voting strategy. The performance of the models in discriminating ruptured arteriovenous malformations and predicting subsequent hemorrhage was evaluated with confusion matrix-related metrics in the test and validation data sets. RESULTS A total of 896 patients (mean±SD age, 28±14 years; 404 women) were evaluated, with 632, 158, and 106 patients in the training, test, and validation data sets, respectively. From the training set, 9 clinical, 10 hemodynamic, and 2912 pixel-based angioarchitectural features were extracted. A logistic regression model was built using 4 selected clinical features (age, nidus size, location, and venous aneurysm), whereas a decision-tree model was constructed from 4 hemodynamic features (outflow time, stasis index, cerebral blood flow, and outflow volume ratio). A support vector machine model was designed using 5 pixel-based angioarchitectural features. In the validation data set, the accuracy, sensitivity, specificity, and area under the curve of the ensemble model for predicting subsequent hemorrhages were 0.840, 0.889, 0.823, and 0.911, respectively. CONCLUSIONS The ensemble model incorporating clinical, hemodynamic, and angioarchitectural features showed favorable performance in predicting subsequent hemorrhage of cerebral arteriovenous malformations.
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Affiliation(s)
- Yupeng Zhang
- Department of Neurosurgery, Beijing Neurosurgical Institute (Y.Z., H.Z., Y.C., Y.S., J.Z., C.J.), Capital Medical University, China
- Department of Neurosurgery, Beijing Tiantan Hospital (Y.Z., H.Z., Y.C., Y.S., J.Z., C.J.), Capital Medical University, China
| | - Haoyu Zhu
- Department of Neurosurgery, Beijing Neurosurgical Institute (Y.Z., H.Z., Y.C., Y.S., J.Z., C.J.), Capital Medical University, China
- Department of Neurosurgery, Beijing Tiantan Hospital (Y.Z., H.Z., Y.C., Y.S., J.Z., C.J.), Capital Medical University, China
| | - Tingliang Cao
- Department of Neurosurgery, Kaifeng Central Hospital, Henan, China (T.C.)
| | - Longhui Zhang
- Department of Neurology, Beijing Tiantan Hospital (L.Z.), Capital Medical University, China
| | - Yuzhou Chang
- Department of Neurosurgery, Beijing Neurosurgical Institute (Y.Z., H.Z., Y.C., Y.S., J.Z., C.J.), Capital Medical University, China
- Department of Neurosurgery, Beijing Tiantan Hospital (Y.Z., H.Z., Y.C., Y.S., J.Z., C.J.), Capital Medical University, China
| | - Shikai Liang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, China (S.L., C.M.)
| | - Chao Ma
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, China (S.L., C.M.)
| | - Fei Liang
- Department of Interventional Radiology and Vascular Surgery, Peking University Third Hospital, Beijing, China (F.L.)
| | - Yuqi Song
- Department of Neurosurgery, Beijing Neurosurgical Institute (Y.Z., H.Z., Y.C., Y.S., J.Z., C.J.), Capital Medical University, China
- Department of Neurosurgery, Beijing Tiantan Hospital (Y.Z., H.Z., Y.C., Y.S., J.Z., C.J.), Capital Medical University, China
| | - Jiarui Zhang
- Department of Neurosurgery, Beijing Neurosurgical Institute (Y.Z., H.Z., Y.C., Y.S., J.Z., C.J.), Capital Medical University, China
- Department of Neurosurgery, Beijing Tiantan Hospital (Y.Z., H.Z., Y.C., Y.S., J.Z., C.J.), Capital Medical University, China
| | - Changxuan Li
- Department of Neurosurgery, The First Affiliated Hospital of Hainan Medical University, Hainan, China (C.L.)
| | - Chuhan Jiang
- Department of Neurosurgery, Beijing Neurosurgical Institute (Y.Z., H.Z., Y.C., Y.S., J.Z., C.J.), Capital Medical University, China
- Department of Neurosurgery, Beijing Tiantan Hospital (Y.Z., H.Z., Y.C., Y.S., J.Z., C.J.), Capital Medical University, China
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Anthes VB, Schwartz M, Cusimano M, Radovanovic I, Kulkarni AV, Laperriere N, Payne D, Heaton R, van Prooijen M, Das S, Tsang DS. Effect of Cobalt-60 Treatment Dose Rate on Arteriovenous Malformation Obliteration After Stereotactic Radiosurgery With Gamma Knife. Neurosurgery 2024; 94:575-583. [PMID: 37796152 DOI: 10.1227/neu.0000000000002701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/02/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Stereotactic radiosurgery (SRS) marginal dose is associated with successful obliteration of cerebral arteriovenous malformations (AVM). SRS dose rate-how old the cobalt-60 sources are-is known to influence outcomes for some neurological conditions and benign tumors. The objective of this study was to determine the association between cobalt-60 treatment dose rate and cerebral AVM obliteration in patients treated with SRS. METHODS We performed a retrospective cohort study of 361 patients undergoing 411 AVM-directed SRS treatments between 2005 and 2019 at a single institution. Lesion characteristics, SRS details, obliteration dates, and post-treatment toxicities were recorded. Univariate and multivariate regression analyses of AVM outcomes regarding SRS dose rate (range 1.3-3.7 Gy, mean = 2.4 Gy, median = 2.5 Gy) were performed. RESULTS At 10 years post-SRS, 68% of AVMs were obliterated on follow-up imaging. Dose rates >2.9 Gy/min were found to be significantly associated with AVM obliteration compared with those <2.1 Gy/min ( P = .034). AVM size, biologically effective dose, and SRS marginal dose were also associated with obliteration, with obliteration more likely for smaller lesions, higher biologically effective dose, and higher marginal dose. Higher dose rates were not associated with the development of post-SRS radiological or symptomatic edema, although larger AVM volume was associated with both types of edema. CONCLUSION Patients with cerebral AVMs treated with higher SRS dose rates (from newer cobalt-60 sources) experience higher incidences of obliteration without a significant change in the risk of post-treatment edema.
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Affiliation(s)
- Victoria B Anthes
- Radiation Medicine Program, Princess Margaret Cancer Centre and Toronto Western Hospital, University Health Network, Toronto , Ontario , Canada
| | - Michael Schwartz
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto , Ontario , Canada
| | - Michael Cusimano
- Division of Neurosurgery, St. Michael's Hospital, Unity Health Toronto, Toronto , Ontario , Canada
| | - Ivan Radovanovic
- Division of Neurosurgery, University Health Network, Toronto , Ontario , Canada
| | - Abhaya V Kulkarni
- Division of Neurosurgery, The Hospital for Sick Children, Toronto , Ontario , Canada
| | - Normand Laperriere
- Radiation Medicine Program, Princess Margaret Cancer Centre and Toronto Western Hospital, University Health Network, Toronto , Ontario , Canada
| | - David Payne
- Radiation Medicine Program, Princess Margaret Cancer Centre and Toronto Western Hospital, University Health Network, Toronto , Ontario , Canada
| | - Robert Heaton
- Radiation Medicine Program, Princess Margaret Cancer Centre and Toronto Western Hospital, University Health Network, Toronto , Ontario , Canada
| | - Monique van Prooijen
- Radiation Medicine Program, Princess Margaret Cancer Centre and Toronto Western Hospital, University Health Network, Toronto , Ontario , Canada
| | - Sunit Das
- Division of Neurosurgery, St. Michael's Hospital, Unity Health Toronto, Toronto , Ontario , Canada
| | - Derek S Tsang
- Radiation Medicine Program, Princess Margaret Cancer Centre and Toronto Western Hospital, University Health Network, Toronto , Ontario , Canada
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Teng B, Li F, Wang X, Tian H, Zhao Y, Zeng Q. Central Venous Catheter as a Novel Approach to Postoperative Thrombolysis in Patients with Acute Iliofemoral Deep Venous Thrombosis. Clin Exp Hypertens 2023; 45:2224940. [PMID: 37326510 DOI: 10.1080/10641963.2023.2224940] [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: 02/21/2023] [Revised: 05/19/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND AND AIMS Percutaneous mechanical thrombectomy (PMT) along with postoperative thrombolysis (POT) has been the standard treatment for acute iliofemoral deep venous thrombosis (IFDVT). However, commonly used catheter directed thrombolysis (CDT) approaches for POT carry certain disadvantages, including the need for a sheath, inferior comfortability, and catheter-related complications. Therefore, we propose a new simplified method of POT using a central venous catheter (CVC). METHODS The retrospective study analyzed patients with IFDVT who underwent POT using CVC from January 2020 to August 2021. The treatment modalities included filter placement, thrombus removal, iliac vein obstruction release, postoperative CVC thrombolysis, filter retrieval, and adequate full course anticoagulation. RESULTS A total of 39 patients were included in this retrospective study. All patients underwent PMT surgery with a procedure success rate of 100%. In the post-PMT CVC thrombolysis, the puncture sites were located in the below-knee vein, including 58.97% in the peroneal vein. The mean duration of CVC-directed thrombolysis was 3.69 ± 1.08 days, and the total urokinase dose was 2.27 ± 0.71 MIU. A total of 37 patients (94.87%) had successful thrombolysis with a length of hospital stay of 5.82 ± 2.21 days. During CVC-directed thrombolysis, only four minor bleeding complications occurred, two of which were indwelling catheter-related. During the 12-month follow-up period, the patency rate and post-thrombotic syndrome incidences were 97.44% and 2.56%, respectively. CONCLUSION Thrombolysis through a CVC is a feasible, safe, and effective POT method, and could be an alternative to the conventional CDT approach for patients with IFDVT.
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Affiliation(s)
- Biyun Teng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fenghe Li
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuehu Wang
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Tian
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhao
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiu Zeng
- Department of Vascular Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Rodríguez Mallma MJ, Vilca-Aguilar M, Zuloaga-Rotta L, Borja-Rosales R, Salas-Ojeda M, Mauricio D. Machine Learning Approach for Analyzing 3-Year Outcomes of Patients with Brain Arteriovenous Malformation (AVM) after Stereotactic Radiosurgery (SRS). Diagnostics (Basel) 2023; 14:22. [PMID: 38201331 PMCID: PMC10871108 DOI: 10.3390/diagnostics14010022] [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: 11/29/2023] [Revised: 12/14/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
A cerebral arteriovenous malformation (AVM) is a tangle of abnormal blood vessels that irregularly connects arteries and veins. Stereotactic radiosurgery (SRS) has been shown to be an effective treatment for AVM patients, but the factors associated with AVM obliteration remains a matter of debate. In this study, we aimed to develop a model that can predict whether patients with AVM will be cured 36 months after intervention by means of SRS and identify the most important predictors that explain the probability of being cured. A machine learning (ML) approach was applied using decision tree (DT) and logistic regression (LR) techniques on historical data (sociodemographic, clinical, treatment, angioarchitecture, and radiosurgery procedure) of 202 patients with AVM who underwent SRS at the Instituto de Radiocirugía del Perú (IRP) between 2005 and 2018. The LR model obtained the best results for predicting AVM cure with an accuracy of 0.92, sensitivity of 0.93, specificity of 0.89, and an area under the curve (AUC) of 0.98, which shows that ML models are suitable for predicting the prognosis of medical conditions such as AVM and can be a support tool for medical decision-making. In addition, several factors were identified that could explain whether patients with AVM would be cured at 36 months with the highest likelihood: the location of the AVM, the occupation of the patient, and the presence of hemorrhage.
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Affiliation(s)
| | - Marcos Vilca-Aguilar
- Instituto de Radiocirugía del Perú, Clínica San Pablo, Lima 15023, Peru
- Servicio de Neurocirugía, Hospital María Auxiliadora, Lima 15828, Peru
| | - Luis Zuloaga-Rotta
- Facultad de Ingeniería Industrial y de Sistemas, Universidad Nacional de Ingeniería, Lima 15333, Peru
| | - Rubén Borja-Rosales
- Facultad de Ingeniería Industrial y de Sistemas, Universidad Nacional de Ingeniería, Lima 15333, Peru
| | | | - David Mauricio
- Universidad Nacional Mayor de San Marcos, Lima 15081, Peru
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8
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Han H, Gao D, Ma L, Li R, Li Z, Zhang H, Yuan K, Wang K, Zhang Y, Zhao Y, Jin W, Jin H, Meng X, Yan D, Li R, Lin F, Hao Q, Wang H, Ye X, Kang S, Pu J, Shi Z, Chao X, Lin Z, Lu J, Li Y, Zhao Y, Sun S, Chen Y, Chen X, Wang S. Long-term outcomes of microsurgery and stereotactic radiosurgery as the first-line treatment for arteriovenous malformations: a propensity score-matched analysis using nationwide multicenter prospective registry data. Int J Surg 2023; 109:3983-3992. [PMID: 37720924 PMCID: PMC10720861 DOI: 10.1097/js9.0000000000000751] [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: 06/29/2023] [Accepted: 08/25/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND This study aimed to compare the risk and benefit profile of microsurgery (MS) and stereotactic radiosurgery (SRS) as the first-line treatment for unruptured and ruptured arteriovenous malformations (AVMs). MATERIALS AND METHODS The authors included AVMs underwent MS or SRS as the first-line treatment from a nationwide prospective multicenter registry in mainland China. The authors used propensity score-matched methods to balance baseline characteristics between the MS and SRS groups. The primary outcomes were long-term hemorrhagic stroke or death, and the secondary outcomes were long-term obliteration and neurological outcomes. Subgroup analyses and sensitivity analyses with different study designs were performed to confirm the stability of our findings. RESULTS Of the 4286 consecutive AVMs in the registry from August 2011 to December 2021; 1604 patients were eligible. After matching, 244 unruptured and 442 ruptured AVMs remained for the final analysis. The mean follow-up duration was 7.0 years in the unruptured group and 6.1 years in the ruptured group. In the comparison of primary outcomes, SRS was associated with a higher risk of hemorrhagic stroke or death both in the unruptured and ruptured AVMs (unruptured: hazard ratio 4.06, 95% CI: 1.15-14.41; ruptured: hazard ratio 4.19, 95% CI: 1.58-11.15). In terms of the secondary outcomes, SRS was also observed to have a significant disadvantage in long-term obliteration [unruptured: odds ratio (OR) 0.01, 95% CI: 0.00-0.04; ruptured: OR 0.09, 95% CI: 0.05-0.15]. However, it should be noted that SRS may have advantages in preventing neurofunctional decline (unruptured: OR 0.56, 95% CI: 0.27-1.14; ruptured: OR 0.41, 95% CI: 0.23-0.76). The results of subgroup analyses and sensitivity analyses were consistent in trend but with slightly varied powers. CONCLUSIONS This clinical practice-based real-world study comprehensively compared MS and SRS for AVMs with long-term outcomes. MS is more effective in preventing future hemorrhage or death and achieving obliteration, while the risk of neurofunctional decline should not be ignored.
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Affiliation(s)
- Heze Han
- Department of Neurosurgery
- China National Clinical Research Center for Neurological Diseases, Beijing
| | | | - Li Ma
- Department of Neurosurgery
- China National Clinical Research Center for Neurological Diseases, Beijing
| | - Ruinan Li
- Department of Neurosurgery
- China National Clinical Research Center for Neurological Diseases, Beijing
| | - Zhipeng Li
- Department of Neurosurgery
- China National Clinical Research Center for Neurological Diseases, Beijing
| | - Haibin Zhang
- Department of Neurosurgery
- China National Clinical Research Center for Neurological Diseases, Beijing
| | - Kexin Yuan
- Department of Neurosurgery
- China National Clinical Research Center for Neurological Diseases, Beijing
| | - Ke Wang
- Department of Neurosurgery
- China National Clinical Research Center for Neurological Diseases, Beijing
| | - Yukun Zhang
- Department of Neurosurgery, Peking University International Hospital, Peking University
| | - Yang Zhao
- Department of Neurosurgery, Peking University International Hospital, Peking University
| | - Weitao Jin
- Department of Neurosurgery, Peking University International Hospital, Peking University
| | - Hengwei Jin
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University
| | - Xiangyu Meng
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang
| | - Debin Yan
- Department of Neurosurgery, Shanxi Provincial People’s Hospital, Shanxi
| | - Runting Li
- Department of Neurosurgery
- China National Clinical Research Center for Neurological Diseases, Beijing
| | - Fa Lin
- Department of Neurosurgery
- China National Clinical Research Center for Neurological Diseases, Beijing
| | - Qiang Hao
- Department of Neurosurgery
- China National Clinical Research Center for Neurological Diseases, Beijing
| | - Hao Wang
- Department of Neurosurgery
- China National Clinical Research Center for Neurological Diseases, Beijing
| | - Xun Ye
- Department of Neurosurgery
- China National Clinical Research Center for Neurological Diseases, Beijing
| | - Shuai Kang
- Department of Neurosurgery
- China National Clinical Research Center for Neurological Diseases, Beijing
| | - Jun Pu
- First Department of Neurosurgery, The Second Affiliated Hospital of Kunming Medical University, Kunming
| | - Zhiyong Shi
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated to Nanjing University, Nanjing, Jiangsu
| | - Xiaofeng Chao
- Department of Neurosurgery, The Second Affiliated Hospital of Xuzhou Medical University, Jiangsu
| | - Zhengfeng Lin
- Department of Neurosurgery, The First People’s Hospital of Qinzhou, Guangxi
| | - Junlin Lu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University
| | - Yuanli Zhao
- Department of Neurosurgery
- China National Clinical Research Center for Neurological Diseases, Beijing
| | | | - Yu Chen
- Department of Neurosurgery
- China National Clinical Research Center for Neurological Diseases, Beijing
| | - Xiaolin Chen
- Department of Neurosurgery
- China National Clinical Research Center for Neurological Diseases, Beijing
| | - Shuo Wang
- Department of Neurosurgery
- China National Clinical Research Center for Neurological Diseases, Beijing
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9
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Clarençon F, Papagiannaki C, Saleme S, Rouchaud A, Shotar E, Rius E, Burel J, Boch AL, Sourour NA, Mounayer C. Balloon Pressure Technique with the Scepter Mini Balloon as Part of the Endovascular Strategy for Brain Arteriovenous Malformations Embolization : Preliminary Multicenter Experience. Clin Neuroradiol 2023; 33:1055-1065. [PMID: 37401950 DOI: 10.1007/s00062-023-01309-8] [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: 08/24/2022] [Accepted: 05/16/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND The balloon pressure technique (BPT) is an alternative to the pressure cooker technique. A dual lumen balloon (DLB) is used to inject the liquid embolic agent through the working lumen while the balloon is inflated. The purpose of our study was to report our early experience using the Scepter Mini dual lumen balloons for BPT in brain arteriovenous malformation (bAVM) embolization. MATERIAL AND METHODS Consecutive patients treated from July 2020 to July 2021 in 3 tertiary centers using the BPT with low-profile dual lumen balloons (Scepter Mini, Microvention, Tustin, CA, USA) by endovascular means for bAVMs were retrospectively reviewed. Patient demographics and bAVM angio-architectural features were collected. The feasibility of Scepter Mini balloon navigation close to the nidus was evaluated. Technical as well as clinical (ischemic and/or hemorrhagic) complications were also systematically assessed. The occlusion rate was evaluated on follow-up DSA. RESULTS A total of 19 patients (10 females; mean age = 38.2 years) consecutively treated for a bAVM (8 ruptured/11 unruptured) using the BPT with a Scepter Mini through 23 embolization sessions were included in our series. Navigation of the Scepter Mini was feasible in all cases. Of the patients 3 (16%) had procedure-related ischemic stroke and 2 patients (10.5%) had late hemorrhages. None of these complications led to severe permanent sequela. Complete occlusion of bAVM embolized with intention to cure was recorded in 11/13 cases (84.6%). CONCLUSION The BPT using low-profile dual lumen balloons is feasible and seems safe for embolization of bAVMs. It may help to reach high occlusion rates, especially when performed in the intent to cure by embolization only.
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Affiliation(s)
- Frédéric Clarençon
- Sorbonne University, Paris, France.
- GRC BioFast, Sorbonne University, Paris, France.
| | | | - Suzanna Saleme
- Department of Neuroradiology, Limoges University Hospital, Limoges, France
| | - Aymeric Rouchaud
- Department of Neuroradiology, Limoges University Hospital, Limoges, France
- University of Limoges, Limoges, France
| | - Eimad Shotar
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Bd de l'Hôpital, 75013, Paris, France
| | - Emily Rius
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Bd de l'Hôpital, 75013, Paris, France
| | - Julien Burel
- Department of Radiology, Rouen University Hospital, Rouen, France
| | - Anne-Laure Boch
- Department of Neurosurgery, APHP-Sorbonne University, Paris, France
| | - Nader-Antoine Sourour
- Department of Neuroradiology, Pitié-Salpêtrière Hospital, 47 Bd de l'Hôpital, 75013, Paris, France
| | - Charbel Mounayer
- Department of Neuroradiology, Limoges University Hospital, Limoges, France
- University of Limoges, Limoges, France
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10
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Sioutas GS, Palepu C, Salem MM, Nia AM, Vivanco-Suarez J, Burkhardt JK, Jankowitz BT, Srinivasan VM. Postoperative de novo epilepsy after resection of brain arteriovenous malformations: A national database study of 536 patients. Epilepsia 2023; 64:2914-2921. [PMID: 37638560 DOI: 10.1111/epi.17765] [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: 05/25/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE We aimed to assess the incidence and risk factors for de novo epilepsy after arteriovenous malformation (AVM) resection and compare them with a nonresection cohort after propensity score matching, utilizing a national database. METHODS Utilizing the TriNetX Research Network, we queried cases from January 1, 2004 to March 1, 2022. We included patients of all ages who underwent supratentorial AVM resection, presenting without seizures on or before surgery and without being on antiseizure medications at least 1 day before surgery. The primary outcome was seizures manifesting at least 6 weeks after surgery. Patient characteristics and outcomes were compared between the cohorts with and without postoperative epilepsy. Further cohorts were created to compare cohorts with and without embolization or rupture. After propensity score matching, we compared an additional cohort of patients with an AVM diagnosis who did not undergo resection. RESULTS Of the 536 patients (mean age = 38.9 ± 19.6, 52% females) presenting without seizure who underwent AVM resection, 99 (18.5%) developed de novo epilepsy, with a 1-year cumulative incidence of 13.8%. Patients with epilepsy had higher rates of intracerebral hemorrhage, and intracerebral hemorrhage was less common in the embolization cohort. Patients in the ruptured cohort were older and more often males. After propensity score matching with 18 588 patients with AVM diagnosis but no resection, each group consisted of 529 patients, and de novo epilepsy at 1 year was significantly higher in the AVM resection cohort compared to the nonresection cohort (11.5% vs. 3.4%, p < .001). SIGNIFICANCE This analysis of 536 patients provides evidence that de novo epilepsy after brain AVM resection occurs at a 1-year cumulative incidence of 13.8%, with a total of 19.4% developing de novo epilepsy. Intracerebral hemorrhage was inconsistently associated with postoperative de novo epilepsy. De novo epilepsy was significantly less frequent after AVM diagnosis without resection.
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Affiliation(s)
- Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Chandrasekhar Palepu
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Anna M Nia
- Department of Neurological Surgery, Montefiore/Albert Einstein College of Medicine, Bronx, New York, USA
| | - Juan Vivanco-Suarez
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
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11
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Lee J, Kim WC, Kim HJ, Park H. CyberKnife based fractionated stereotactic radiotherapy as an upfront treatment for cerebral arteriovenous malformation. J Clin Neurosci 2023; 117:40-45. [PMID: 37757652 DOI: 10.1016/j.jocn.2023.09.011] [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: 06/28/2023] [Revised: 09/10/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND To explore the therapeutic outcomes of CyberKnife based fractionated stereotactic radiotherapy (CKFRT) for patients with cerebral arteriovenous malformations (AVM). METHODS Between January 2008 and October 2020, 45 patients underwent CKFRT for cerebral AVMs as a first treatment. The delineation of AVM targets included AVM nidus. The mean target volume was 4.07 cm3, and 9 lesions (20%) were larger than 10.0 cm3. The mean marginal dose was 24 Gy (range, 20-35 Gy). CKFRT was delivered in median 3 fractions (range, 2 ∼ 5 fractions). AVM obliteration following CKFRT was confirmed by magnetic resonance imaging or angiography. RESULTS During a median follow-up of 47 (5-148) months, complete obliteration and partial obliteration of AVM after CKFRT were obtained in 23 (51%) and 13 (29%) patients, respectively. Median time to complete obliteration was 39 (15-63) months. The cumulative probability of complete obliteration rate at 3 years was 47%. Complete obliteration rate of AVM was associated with Radiosurgery-based AVM score, which was consisted of AVM volume, patients age, and AVM location. One (2%) patient had hemorrhage during the follow-up period. CONCLUSIONS CKFRT is an effective primary treatment for patients with cerebral AVMs with a low hemorrhage risk.
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Affiliation(s)
- Jeongshim Lee
- Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea.
| | - Woo Chul Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Hun Jung Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea
| | - Hyeonseon Park
- Department of Neurosurgery, Inha University Hospital, Inha University School of Medicine, Incheon, South Korea.
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12
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Abdalkader M, Hui F, Amans MR, Raz E, Hanning U, Ma A, Brinjikji W, Malek AM, Oxley TJ, Nguyen TN. Cerebral venous disorders: Diagnosis and endovascular management. J Neuroradiol 2023; 50:581-592. [PMID: 37331820 DOI: 10.1016/j.neurad.2023.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023]
Abstract
The role of the venous circulation in neurological diseases has been underestimated. In this review, we present an overview of the intracranial venous anatomy, venous disorders of the central nervous system, and options for endovascular management. We discuss the role the venous circulation plays in various neurological diseases including cerebrospinal fluid (CSF) disorders (intracranial hypertension and intracranial hypotension), arteriovenous diseases, and pulsatile tinnitus. We also shed light on emergent cerebral venous interventions including transvenous brain-computer interface implantation, transvenous treatment of communicating hydrocephalus, and the endovascular treatment of CSF-venous disorders.
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Affiliation(s)
- Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Ferdinand Hui
- Neuroscience Institute, Division of Neurointerventional Surgery, Queen's Medical Center, Honolulu, Hawaii, USA
| | - Matthew R Amans
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Eytan Raz
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Uta Hanning
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alice Ma
- Department of Neurosurgery, Royal North Shore Hospital, St Leonards, NSW 2065 Australia
| | | | - Adel M Malek
- Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA
| | - Thomas J Oxley
- Department of Neurosurgery, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Thanh N Nguyen
- Department of Neurology, Neurosurgery and Radiology, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
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13
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Zhang B, Qi J, Chen P, Sun B, Ling Y, Wu Q, Xu S, Wu P, Shi H. Deliberately Staged Combined Endovascular Embolization and Subsequent Microsurgery Resection for the Treatment of Cerebral Arteriovenous Malformations. World Neurosurg 2023; 178:e254-e264. [PMID: 37467953 DOI: 10.1016/j.wneu.2023.07.040] [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: 06/15/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
OBJECTIVE Complex cerebral arteriovenous malformations (AVMs) require a combined therapy of endovascular embolization and microsurgical resection to eliminate the lesion and maximize neurological protection, while a deliberate time interval might contribute to optimal clinical outcomes. The present study aimed to explore the feasibility of this paradigm. METHODS All patients who underwent deliberately planned presurgery embolization and microsurgery resection between 2015 and 2023 were reviewed, with baseline data, postoperative complications, and follow-up outcomes recorded. The modified Rankin scale (mRS) was used to evaluate clinical outcomes, with mRS 0-2 defined as good. RESULTS A total of 30 patients were included in the study (15 were ruptured AVMs). The median Spetzler-Martin grade of baseline AVMs was 3 (interquartile range: 2-3). The median interval between the last embolization and microsurgery was 5 days (interquartile range: 2.25-7). The complete removal rate was 100%, and the overall permanent complication rate was 16.67%. At the last follow-up, 26 patients achieved mRS 0-2, while 28 had improved or unaltered mRS. The last follow-up mRS significantly improved from baseline and discharge (P = 0.0006 and P = 0.006). The last follow-up mRS decreased by 0.65 for each additional day of time interval before the 4.4-day inflection point (β = -0.65, P = 0.02) in the AVM ruptured cohort. CONCLUSIONS The deliberately staged combined procedure of embolization and microsurgery might be a safe and efficacious strategy for Spetzler-Martin grade 2-5 AVMs, 4-5 days might be an appropriate staged time interval for ruptured AVMs, although further studies are needed to substantiate these findings.
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Affiliation(s)
- Bohan Zhang
- Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jingtao Qi
- Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Pingbo Chen
- Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bowen Sun
- Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yeping Ling
- Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qiaowei Wu
- Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shancai Xu
- Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Pei Wu
- Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huaizhang Shi
- Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, China.
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14
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Lu C, Han H, Ma L, Li R, Li Z, Zhang H, Yuan K, Zhang Y, Li A, Wang K, Zhao Y, Jin W, Gao D, Jin H, Meng X, Yan D, Li R, Lin F, Hao Q, Wang H, Ye X, Kang S, Pu J, Shi Z, Chao X, Lin Z, Lu J, Li Y, Zhao Y, Sun S, Chen X, Chen W, Chen Y, Wang S. Comparison of Long-Term Outcomes in Ruptured Diffuse Brain Arteriovenous Malformations Between Interventional Therapy and Conservative Management. Transl Stroke Res 2023:10.1007/s12975-023-01197-7. [PMID: 37776489 DOI: 10.1007/s12975-023-01197-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Abstract
Brain arteriovenous malformations (AVMs) with a diffuse nidus structure present a therapeutic challenge due to their complexity and elevated risk of hemorrhagic events. This study examines the long-term effectiveness of interventional therapy versus conservative management in reducing hemorrhagic stroke or death in patients with ruptured diffuse AVMs. The analysis was conducted based on a multi-institutional database in China. Patients were divided into two groups: conservative management and interventional therapy. Using propensity score matching, patients were compared for the primary outcome of hemorrhagic stroke or death and the secondary outcomes of disability and neurofunctional decline. Out of 4286 consecutive AVMs in the registry, 901 patients were eligible. After matching, 70 pairs of patients remained with a median follow-up of 4.0 years. The conservative management group showed a trend toward higher rates of the primary outcome compared to the interventional group (4.15 vs. 1.87 per 100 patient-years, P = 0.090). While not statistically significant, intervention reduced the risk of hemorrhagic stroke or death by 55% (HR, 0.45 [95% CI 0.18-1.14], P = 0.094). No significant differences were observed in secondary outcomes of disability (OR, 0.89 [95% CI 0.35-2.26], P = 0.813) and neurofunctional decline (OR, 0.65 [95% CI 0.26 -1.63], P = 0.355). Subgroup analysis revealed particular benefits in interventional therapy for AVMs with a supplemented S-M grade of II-VI (HR, 0.10 [95% CI 0.01-0.79], P = 0.029). This study suggests a trend toward lower long-term hemorrhagic risks with intervention when compared to conservative management in ruptured diffuse AVMs, especially within supplemented S-M grade II-VI subgroups. No evidence indicated that interventional approaches worsen neurofunctional outcomes.
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Affiliation(s)
- Changyu Lu
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Heze Han
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Li Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ruinan Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Zhipeng Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Haibin Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Kexin Yuan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yukun Zhang
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Anqi Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ke Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yang Zhao
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Weitao Jin
- Department of Neurosurgery, Peking University International Hospital, Beijing, China
| | - Dezhi Gao
- Department of Gamma-Knife Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hengwei Jin
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiangyu Meng
- Department of Neurosurgery, The First Hospital of Hebei Medical University, Hebei Medical University, Shijiazhuang, China
| | - Debin Yan
- Department of Neurosurgery, Shanxi Provincial People's Hospital, Taiyuan, Shanxi, China
| | - Runting Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Fa Lin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Qiang Hao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xun Ye
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shuai Kang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jun Pu
- First Department of Neurosurgery, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhiyong Shi
- Department of Neurosurgery, Nanjing Drum Tower Hospital, Affiliated to Nanjing University, Nanjing, Jiangsu, China
| | - Xiaofeng Chao
- Department of Neurosurgery, The Second Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Zhengfeng Lin
- Department of Neurosurgery, The First People's Hospital of Qinzhou, Guangxi, China
| | - Junlin Lu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuanli Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shibin Sun
- Department of Gamma-Knife Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiaolin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Weiwei Chen
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Yu Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
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15
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Sattari SA, Shahbandi A, Kim JE, Lee RP, Feghali J, Hung A, Yang W, Rincon-Torroella J, Xu R, Caplan JM, Gonzalez LF, Tamargo RJ, Huang J. Microsurgery Versus Stereotactic Radiosurgery for Treatment of Patients With Brain Arteriovenous Malformation: A Systematic Review and Meta-Analysis. Neurosurgery 2023; 93:510-523. [PMID: 36999929 DOI: 10.1227/neu.0000000000002460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/23/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Treatment decision-making for brain arteriovenous malformations (bAVMs) with microsurgery or stereotactic radiosurgery (SRS) is controversial. OBJECTIVE To conduct a systematic review and meta-analysis to compare microsurgery vs SRS for bAVMs. METHOD Medline and PubMed were searched from inception to June 21, 2022. The primary outcomes were obliteration and follow-up hemorrhage, and secondary outcomes were permanent neurological deficit, worsened modified Rankin scale (mRS), follow-up mRS > 2, and mortality. The GRADE approach was used for grading the level of evidence. RESULTS Eight studies were included, which yielded 817 patients, of which 432 (52.8%) and 385 (47.1%) patients underwent microsurgery and SRS, respectively. Two cohorts were comparable in age, sex, Spetzler-Martin grade, nidus size, location, deep venous drainage, eloquence, and follow-up. In the microsurgery group, the odds ratio (OR) of obliteration was higher (OR = 18.51 [11.05, 31.01], P < .000001, evidence: high) and the hazard ratio of follow-up hemorrhage was lower (hazard ratio = 0.47 [0.23, 0.97], P = .04, evidence: moderate). The OR of permanent neurological deficit was higher with microsurgery (OR = 2.85 [1.63, 4.97], P = .0002, evidence: low), whereas the OR of worsened mRS (OR = 1.24 [0.65, 2.38], P = .52, evidence: moderate), follow-up mRS > 2 (OR = 0.78 [0.36, 1.7], P = .53, evidence: moderate), and mortality (OR = 1.17 [0.41, 3.3], P = .77, evidence: moderate) were comparable between the groups. CONCLUSION Microsurgery was superior at obliterating bAVMs and preventing further hemorrhage. Despite a higher rate of postoperative neurological deficit with microsurgery, functional status and mortality were comparable with patients who underwent SRS. Microsurgery should remain a first-line consideration for bAVMs, with SRS reserved for inaccessible locations, highly eloquent areas, and medically high-risk or unwilling patients.
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Affiliation(s)
- Shahab Aldin Sattari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Ataollah Shahbandi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
- Tehran School of Medicine, Tehran University of Medical Science, Tehran , Iran
| | - Jennifer E Kim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Ryan P Lee
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - James Feghali
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Alice Hung
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Wuyang Yang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Jordina Rincon-Torroella
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Justin M Caplan
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - L Fernando Gonzalez
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Rafael J Tamargo
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore , Maryland , USA
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16
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Zhang L, Zhang W, Shi J, Zhang S, Xu X, Yu H, Zhang Y. Application of 3D Slicer Combined With Simple Coordinate Method in Operation of Cerebral Arteriovenous Malformations in Functional Areas. J Craniofac Surg 2023; 34:1851-1854. [PMID: 37463297 PMCID: PMC10445628 DOI: 10.1097/scs.0000000000009545] [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: 04/10/2023] [Accepted: 05/21/2023] [Indexed: 07/20/2023] Open
Abstract
The authors report a case of intracranial arteriovenous malformation in functional areas, initially presenting with symptomatic epilepsy was surgically excised by the Neurosurgery Department of our hospital. The patient's head computed tomography, magnetic resonance imaging, and digital subtraction angiography examination suggested intracranial arteriovenous malformations in the left frontal functional area. A preoperative 3D-reconstruction technique was used to reconstruct the malformed vascular mass, supplying arteries, draining veins, and precise surgical resection was performed. Postoperative pathology indicated vascular malformation. No seizures occurred after surgery. There was no further neurological impairment. Preoperative use of image postprocessing techniques can facilitate precise surgical resection of brain arteriovenous malformations. Three-dimensional Slicer in cerebral arteriovenous malformations in functional areas not only shortened the preoperative planning time but also improved the efficiency of the surgery. Reduce the incidence of postoperative complications. It is helpful for further popularization and application.
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17
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Nakisli S, Lagares A, Nielsen CM, Cuervo H. Pericytes and vascular smooth muscle cells in central nervous system arteriovenous malformations. Front Physiol 2023; 14:1210563. [PMID: 37601628 PMCID: PMC10437819 DOI: 10.3389/fphys.2023.1210563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 06/29/2023] [Indexed: 08/22/2023] Open
Abstract
Previously considered passive support cells, mural cells-pericytes and vascular smooth muscle cells-have started to garner more attention in disease research, as more subclassifications, based on morphology, gene expression, and function, have been discovered. Central nervous system (CNS) arteriovenous malformations (AVMs) represent a neurovascular disorder in which mural cells have been shown to be affected, both in animal models and in human patients. To study consequences to mural cells in the context of AVMs, various animal models have been developed to mimic and predict human AVM pathologies. A key takeaway from recently published work is that AVMs and mural cells are heterogeneous in their molecular, cellular, and functional characteristics. In this review, we summarize the observed perturbations to mural cells in human CNS AVM samples and CNS AVM animal models, and we discuss various potential mechanisms relating mural cell pathologies to AVMs.
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Affiliation(s)
- Sera Nakisli
- Department of Biological Sciences, Ohio University, Athens, OH, United States
- Neuroscience Program, Ohio University, Athens, OH, United States
| | - Alfonso Lagares
- Department of Neurosurgery, University Hospital 12 de Octubre, Madrid, Spain
- Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigación Imas12, Madrid, Spain
| | - Corinne M. Nielsen
- Department of Biological Sciences, Ohio University, Athens, OH, United States
- Neuroscience Program, Ohio University, Athens, OH, United States
- Molecular and Cellular Biology Program, Ohio University, Athens, OH, United States
| | - Henar Cuervo
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (F.S.P), Madrid, Spain
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18
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Rivera R, Cespedes A, Cruz JP, Rivera GC, Valencia A, Rouchaud A, Mounayer C. Endovascular treatment simulations using a novel in vitro brain arteriovenous malformation model based on three-dimensional printing millifluidic technology. Interv Neuroradiol 2023:15910199231184605. [PMID: 37350047 DOI: 10.1177/15910199231184605] [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: 06/24/2023] Open
Abstract
BACKGROUND Brain arteriovenous malformations (bAVM) are complex vascular diseases. Several models have been used to simulate endovascular treatments; thus in vitro models have not been widely employed because it has been difficult to recreate realistic phantoms of this disease. OBJECTIVE To describe the development and evaluate the preliminary experience of a novel bAVM in vitro model for endovascular embolization using millifluidic three-dimensional (3D) printing technology. METHODS We designed a bAVM phantom starting from simple to more complex designs, composed of a nidus, feeding arteries and draining vein. We recreate the design by using millifluidic technology with stereolithography 3D printing. Structural and functional tests were performed using angiographic images and computer flow dynamics. Treatment simulations with ethylene vinyl alcohol were tested using two different microcatheter position techniques. A Likert-scale questionnaire was applied to perform a qualitative evaluation of the model. RESULTS We developed a realistic model of a bAVM with hollow channels. The structural evaluation showed a high precision of the 3D printing process. Embolization tests with the liquid agent gave similar sensations and material behaviour as in vivo cases. There were no significant differences between microcatheter position techniques, thus we observed a trend for better nidus filling with a deeper in-nidus position technique. CONCLUSIONS We were able to create and test a novel bAVM in vitro model with stereolithography 3D printing in resin. It showed a high capacity for simulating endovascular embolization characteristics, with an excellent user experience. It could be potentially used for training and testing of bAVM embolizations.
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Affiliation(s)
- Rodrigo Rivera
- Neuroradiology Department, Instituto de Neurocirugia Dr Asenjo, Santiago, Chile
- CNRS XLIM UMLR 7252, Université de Limoges, Limoges, France
| | - Alvaro Cespedes
- Department of Design and Manufacturing, Universidad Santa Maria, Viña del Mar, Chile
| | - Juan Pablo Cruz
- Neuroradiology Department, Instituto de Neurocirugia Dr Asenjo, Santiago, Chile
| | | | - Alvaro Valencia
- Department of Mechanical Engineering, Universidad de Chile, Santiago, Chile
| | - Aymeric Rouchaud
- CNRS XLIM UMLR 7252, Université de Limoges, Limoges, France
- Neuroradiology Department, CHU, Limoges, France
| | - Charbel Mounayer
- CNRS XLIM UMLR 7252, Université de Limoges, Limoges, France
- Neuroradiology Department, CHU, Limoges, France
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19
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Mehta TI, Arun A, Heiberger C, Cognetti D, Ray TR, Amans MR, Fargen K, Huisman TAGM, Hui F. Venous Pathologies and Interventions of the Head. Semin Neurol 2023; 43:439-453. [PMID: 37562454 DOI: 10.1055/s-0043-1771512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Intracranial venous pathologies are a historically underrecognized group of disorders that can have a devastating impact on patients. Despite advancements in peripheral venous disorders and arterial neurointerventions, intracranial venous pathologies have received comparatively little attention. Understanding the anatomy, physiology, clinical relevance, and treatment options of intracranial venous pathologies is fundamental to evolving therapies and research priorities. This article provides an overview of major intracranial venous pathologies, the respective pathophysiologies, and treatment options.
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Affiliation(s)
- Tej Ishaan Mehta
- The United States Air Force Medical Corps, Falls Church, Virginia
- Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Anirudh Arun
- Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Caleb Heiberger
- Department of Radiology, The Johns Hopkins Hospital, Baltimore, Maryland
| | - David Cognetti
- Department of Otolaryngology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Tyler R Ray
- Department of Mechanical Engineering, University of Hawai'i at Mānoa, Honolulu, Hawaii
- Department of Cellular and Molecular Biology, John A. Burns School of Medicine, University of Hawai'i at Mānoa, Honolulu, Hawaii
| | - Matthew R Amans
- Department of Radiology, University of California San Francisco, San Francisco, California
- Department of Neurosurgery, University of California San Francisco, San Francisco, California
| | - Kyle Fargen
- Department of Neurosurgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Thierry A G M Huisman
- Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Ferdinand Hui
- Department of Radiology, The Queen's Medical Center, Honolulu, Hawaii
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20
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Zong F, You Z, Zhou L, Deng X. Language function of the superior longitudinal fasciculus in patients with arteriovenous malformation as evidenced by automatic fiber quantification. FRONTIERS IN RADIOLOGY 2023; 3:1121879. [PMID: 37492384 PMCID: PMC10365120 DOI: 10.3389/fradi.2023.1121879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/03/2023] [Indexed: 07/27/2023]
Abstract
The superior longitudinal fasciculus (SLF) is a major fiber tract involved in language processing and has been used to investigate language impairments and plasticity in many neurological diseases. The SLF is divided into four main branches that connect with different cortex regions, with two branches (SLF II, SLF III) being directly related to language. However, most white matter analyses consider the SLF as a single bundle, which may underestimate the relationship between these fiber bundles and language function. In this study, we investigated the differences between branches of the SLF in patients with arteriovenous malformation (AVM), which is a unique model to investigate language reorganization. We analyzed diffusion tensor imaging data of AVM patients and healthy controls to generate whole-brain fiber tractography, and then segmented the SLF into SLF II and III based on their distinctive waypoint regions. The SLF, SLF II, and III were further quantified, and four diffusion parameters of three branches were compared between the AVMs and controls. No significant diffusivity differences of the whole SLF were observed between two groups, however, the right SLF II and III in AVMs showed significant reorganization or impairment patterns as compared to the controls. Results demonstrating the need to subtracting SLF branches when studying structure-function relationship in neurological diseases that have SLF damage.
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Affiliation(s)
- Fangrong Zong
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | - Zhaoyi You
- State Key Laboratory of Oncogenes and Related Genes, Institute for Personalized Medicine, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Leqing Zhou
- School of Artificial Intelligence, Beijing University of Posts and Telecommunications, Beijing, China
| | - Xiaofeng Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
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21
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Shahbandi A, Sattari SA, Haghshomar M, Shab-Bidar S, Lawton MT. Application of diffusion tensor-based tractography in treatment of brain arteriovenous malformations: a systematic review. Neurosurg Rev 2023; 46:115. [PMID: 37162690 DOI: 10.1007/s10143-023-02017-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/21/2023] [Accepted: 04/28/2023] [Indexed: 05/11/2023]
Abstract
There is no systematic review investigating the utility of Diffusion tensor-based tractography findings for treating brain arteriovenous malformations (bAVMs). This systematic review aims to investigate the outcomes following bAVM treatment when tractography data is incorporated into treatment planning. PubMed/MEDLINE, Scopus, and Cochrane Library, were searched for published studies. Prospective or retrospective studies involving at least one patient with confirmed bAVM and available data on tractography and clinical outcomes were included. A total of 16 studies were eligible for this review, consisting of 298 patients. 48.2% of patients were female. The mean age of the patients was 27.5 years (range: 5-77). Stereotactic radiosurgery (SRS) and microsurgical resection each were the treatment of choice in eight studies, respectively. Two-hundred forty-eight patients underwent SRS as the primary treatment, while microsurgery was used to resect the bAVMs in 50 patients. The corticospinal tract, optic pathway, and arcuate fasciculus were the most widely investigated white matter tracts. Tractography disruption and failure frequencies were 19.1% and 1.8%, respectively. The pooled proportions (95% CI) of obliteration rates were 88.78% (73.51-95.76) for microsurgery and 51.45% (13-17-88.10) following SRS. Treatment-related non-hemorrhagic complications rates occurred in 24.2% and 9.9% of patients who underwent microsurgical resection and SRS, respectively. Tractography findings can contribute to providing a more accurate dosimetry analysis of functional white matter tracts at risk prior to SRS and minimizing the surgical morbidity following microsurgical resection.
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Affiliation(s)
- Ataollah Shahbandi
- School of Medicine, Tehran University of Medical Sciences, Enghelab Street, Tehran, Iran
| | - Shahab Aldin Sattari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Sakineh Shab-Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Michael T Lawton
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, AZ, USA.
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22
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Li CR, Shen CC, Yang MY, Tsuei YS, Lee CH. Intraoperative Augmented Reality in Microsurgery for Intracranial Arteriovenous Malformation: A Case Report and Literature Review. Brain Sci 2023; 13:brainsci13040653. [PMID: 37190618 DOI: 10.3390/brainsci13040653] [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: 03/20/2023] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
BACKGROUND Intracranial arteriovenous malformations (AVMs) are lesions containing complex vessels with a lack of buffering capillary architecture which might result in hemorrhagic cerebrovascular accidents (CVAs). Intraoperative navigation can improve resection rates and functional preservation in patients with lesions in eloquent areas, but current systems have limitations that can distract the operator. Augmented Reality (AR) surgical technology can reduce these distractions and provide real-time information regarding vascular morphology and location. METHODS In this case report, an adult patient was admitted to the emergency department after a fall, and diagnostic imaging revealed a Spetzler-Martin grade I AVM in the right parietal region with evidence of rupture. The patient underwent a stereotactic microsurgical resection with assistance from augmented reality technology, which allowed for a hologram of the angioarchitecture to be projected onto the cortical surface, aiding in the recognition of the angiographic anatomy during surgery. RESULTS The patient's postoperative recovery went smoothly. At 6-month follow-up, the patient had remained in stable condition, experiencing complete relief from his previous symptoms. The follow-up examination also revealed complete obliteration of the AVMs without any remaining pathological vascular structure. CONCLUSIONS AR-assisted microsurgery makes both the dissection and resection steps safer and more delicate. As several innovations are occurring in AR technology today, it is likely that this novel technique will be increasingly adopted in both surgical applications and education. Although certain limitations exist, this technique may still become more efficient and precise as this novel technology its continues to develop further.
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Affiliation(s)
- Chi-Ruei Li
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Chiung-Chyi Shen
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Meng-Yin Yang
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Yuang-Seng Tsuei
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Chung-Hsin Lee
- Department of Neurosurgery, Neurological Institute, Taichung Veterans General Hospital, Taichung 40705, Taiwan
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23
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Genetics of brain arteriovenous malformations and cerebral cavernous malformations. J Hum Genet 2023; 68:157-167. [PMID: 35831630 DOI: 10.1038/s10038-022-01063-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 06/13/2022] [Accepted: 06/26/2022] [Indexed: 11/08/2022]
Abstract
Cerebrovascular malformations comprise abnormal development of cerebral vasculature. They can result in hemorrhagic stroke due to rupture of lesions as well as seizures and neurological defects. The most common forms of cerebrovascular malformations are brain arteriovenous malformations (bAVMs) and cerebral cavernous malformations (CCMs). They occur in both sporadic and inherited forms. Rapidly evolving molecular genetic methodologies have helped to identify causative or associated genes involved in genesis of bAVMs and CCMs. In this review, we highlight the current knowledge regarding the genetic basis of these malformations.
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24
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Ramírez-Ferrer E, Aponte-Caballero R, Aguilera-Pena MP, Mendoza-Ayús SD, Osorio-Bohorquez LA, Riveros-Castillo WM. Sphenoidal meningoencephalocele associated with CSF fistula and arteriovenous malformation Spetzler-Martin V: A case report. NEUROCIRUGIA (ENGLISH EDITION) 2023; 34:93-96. [PMID: 36754759 DOI: 10.1016/j.neucie.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 03/13/2022] [Indexed: 02/09/2023]
Abstract
Cerebral Arteriovenous malformations (AVMs) are presumed congenital anomalies of the blood vessels, which can increase intracranial pressure by uncertain mechanisms. We report the rare case of a 55-year-old male patient who complained about CSF rhinorrhea. Persisting CSF leakage prompted CT, which evidenced a bone defect in the right middle cranial fossa with protruding brain tissue. The diagnosis of a sphenoidal meningoencephalocele was made. Neuroimaging evidenced an AVM Spetzler Martin V. The lesion was targeted via an endonasal approach with resection of the herniated brain tissue and closure of the bony and dural defects. The postoperative course was uneventful without recurrence of the CSF fistula. Documentation of these cases is essential to come up with standardized therapeutical protocols and follow-up. Nevertheless, conservative management of the AVM and surgical repair of the bone defects is an appropriate approach in the first instance, depending on the morphology and characterization of the AVM.
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Affiliation(s)
- Esteban Ramírez-Ferrer
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritan University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - Rafael Aponte-Caballero
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritan University Hospital, Rosario University School of Medicine, Bogotá, Colombia.
| | - Maria Paula Aguilera-Pena
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritan University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - Santiago David Mendoza-Ayús
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritan University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - Luis Alejandro Osorio-Bohorquez
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritan University Hospital, Rosario University School of Medicine, Bogotá, Colombia
| | - William Mauricio Riveros-Castillo
- Department of Neurosurgery, Center for Research and Training in Neurosurgery (CIEN), Samaritan University Hospital, Rosario University School of Medicine, Bogotá, Colombia
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25
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Rossi J, Hermier M, Eker OF, Berthezene Y, Bani-Sadr A. Etiologies of spontaneous acute intracerebral hemorrhage: A pictorial review. Clin Imaging 2023; 95:10-23. [PMID: 36577316 DOI: 10.1016/j.clinimag.2022.12.007] [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: 10/03/2022] [Revised: 11/26/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
Spontaneous acute intracerebral hemorrhage (SAIH) is a common and life-threatening condition that affects more than three million patients each year. Of these, one in three patients die within one month of onset and the remaining two in three patients have varying degrees of disability and neurological impairment. The role of radiology is paramount in optimizing patient outcomes by diagnosing SAIH, its potential complications, and the most likely etiology. While the positive diagnosis of SAIH is straightforward, the etiologic diagnosis is broad, covering primary SAIH (hypertension, cerebral amyloid angiopathy) and secondary SAIH (vascular malformations, nonatheromatous vasculopathies, neoplasia, coagulation disorders, toxicants). This pictorial review illustrates the imaging of spontaneous SAIH with an emphasis on etiologic workup.
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Affiliation(s)
- Julien Rossi
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Omer Faruk Eker
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Yves Berthezene
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 7 avenue Jean Capelle O, 69100 Villeurbanne, France
| | - Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France; CREATIS Laboratory, CNRS UMR 5220, INSERM U 5220, Claude Bernard Lyon I University, 7 avenue Jean Capelle O, 69100 Villeurbanne, France.
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26
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Bustuchina Vlaicu M. New approaches for brain arteriovenous malformations-related epilepsy. Rev Neurol (Paris) 2023; 179:188-200. [PMID: 36180290 DOI: 10.1016/j.neurol.2022.05.011] [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: 09/23/2021] [Revised: 02/21/2022] [Accepted: 05/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of this review is to present the current literature and to highlight the most recent findings in brain arteriovenous malformations (bAVM)-related epilepsy research. METHODS We searched Medline, PubMed, Biblioinserm, Cochrane Central to study the latest research reports about the different factors that could be responsible for the genesis of bAVM-related epilepsy. We analyzed if epileptogenesis has any characteristics traits and its relation with the vascular malformation. The results of different treatments on epilepsy were considered. Typical errors that may lead towards incorrect or worse management of the seizures for these patients were also examined. RESULTS The development of bAVM results from multifactorial etiologies and bAVM-related epileptogenesis is likely specific for this pathology. Different types of evidence demonstrate a bidirectional relationship between bAVM and epilepsy. Currently, there is not enough published data to determine what may be the right management for these patients. CONCLUSIONS A better understanding of epileptogenesis in conjunction with knowledge of the complex alterations of structures and functions following bAVM-related seizures is necessary. Identification of biomarkers that can identify subgroups most likely to benefit from a specific intervention are needed to help guide clinical management. A new concept for the treatment of epilepsy related to an unruptured bAVM that cannot be treated invasively is proposed as well as new therapeutic perspectives. The next necessary step will be to propose additional algorithms to improve the development of future trials.
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Affiliation(s)
- M Bustuchina Vlaicu
- Pitié-Salpêtrière Hospital, Department of Neurosurgery, Paris, France; Inserm U0955, Translational Neuro-Psychiatry team, Créteil, France.
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27
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He Q, Huo R, Wang J, Xu H, Zhao S, Zhang J, Sun Y, Jiao Y, Weng J, Zhao J, Cao Y. Exosomal miR-3131 derived from endothelial cells with KRAS mutation promotes EndMT by targeting PICK1 in brain arteriovenous malformations. CNS Neurosci Ther 2023; 29:1312-1324. [PMID: 36718590 PMCID: PMC10068464 DOI: 10.1111/cns.14103] [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: 08/25/2022] [Revised: 01/04/2023] [Accepted: 01/13/2023] [Indexed: 02/01/2023] Open
Abstract
AIMS To explore the underlying mechanism by which low-frequency KRAS mutations result in extensive EndMT occurrence. METHODS Exosomes derived from primarily cultured brain arteriovenous malformation (bAVMs) and human umbilical vein endothelial cells (HUVECs) transfected with KRASG12D , KRASWT , or KRASNC lentiviruses were isolated, and their effects on HUVECs were identified by western blotting and immunofluorescence staining. The expression levels of exosomal microRNAs (miRNAs) were evaluated by miRNA microarray, followed by functional experiments on miR-3131 and detection of its downstream target, and miR-3131 inhibitor in reversing the EndMT process induced by KRASG12D -transfected HUVECs and bAVM endothelial cells (ECs) were explored. RESULTS Exosomes derived from KRASG12D bAVM ECs and KRASG12D -transfected HUVECs promoted EndMT in HUVECs. MiR-3131 levels were highest in the exosomes of KRASG12D -transfected HUVECs, and HUVECs transfected with the miR-3131 mimic acquired mesenchymal phenotypes. RNA-seq and dual-luciferase reporter assays revealed that PICK1 is the direct downstream target of miR-3131. Exosomal miR-3131 was highly expressed in KRASG12D bAVMexos compared with non-KRAS-mutant bAVMexos or HUVECexos . Finally, a miR-3131 inhibitor reversed EndMT in HUVECs treated with exosomes or the supernatant of KRASG12D -transfected HUVECs and KRASG12D bAVM ECs. CONCLUSION Exosomal miR-3131 promotes EndMT in KRAS-mutant bAVMs, and miR-3131 might be a potential biomarker and therapeutic target in KRASG12D -mutant bAVMs.
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Affiliation(s)
- Qiheng He
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ran Huo
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jie Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Hongyuan Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shaozhi Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Junze Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yingfan Sun
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuming Jiao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jiancong Weng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Beijing Institute of Brain Disorders, Beijing, China
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28
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Jiao Y, Zhang J, Yang X, Zhan T, Wu Z, Li Y, Zhao S, Li H, Weng J, Huo R, Wang J, Xu H, Sun Y, Wang S, Cao Y. Artificial Intelligence-Assisted Evaluation of the Spatial Relationship between Brain Arteriovenous Malformations and the Corticospinal Tract to Predict Postsurgical Motor Defects. AJNR Am J Neuroradiol 2023; 44:17-25. [PMID: 36549849 PMCID: PMC9835926 DOI: 10.3174/ajnr.a7735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Preoperative evaluation of brain AVMs is crucial for the selection of surgical candidates. Our goal was to use artificial intelligence to predict postsurgical motor defects in patients with brain AVMs involving motor-related areas. MATERIALS AND METHODS Eighty-three patients who underwent microsurgical resection of brain AVMs involving motor-related areas were retrospectively reviewed. Four artificial intelligence-based indicators were calculated with artificial intelligence on TOF-MRA and DTI, including FN5mm/50mm (the proportion of fiber numbers within 5-50mm from the lesion border), FN10mm/50mm (the same but within 10-50mm), FP5mm/50mm (the proportion of fiber voxel points within 5-50mm from the lesion border), and FP10mm/50mm (the same but within 10-50mm). The association between the variables and long-term postsurgical motor defects was analyzed using univariate and multivariate analyses. Least absolute shrinkage and selection operator regression with the Pearson correlation coefficient was used to select the optimal features to develop the machine learning model to predict postsurgical motor defects. The area under the curve was calculated to evaluate the predictive performance. RESULTS In patients with and without postsurgical motor defects, the mean FN5mm/50mm, FN10mm/50mm, FP5mm/50mm, and FP10mm/50mm were 0.24 (SD, 0.24) and 0.03 (SD, 0.06), 0.37 (SD, 0.27) and 0.06 (SD, 0.08), 0.06 (SD, 0.10) and 0.01 (SD, 0.02), and 0.10 (SD, 0.12) and 0.02 (SD, 0.05), respectively. Univariate and multivariate logistic analyses identified FN10mm/50mm as an independent risk factor for long-term postsurgical motor defects (P = .002). FN10mm/50mm achieved a mean area under the curve of 0.86 (SD, 0.08). The mean area under the curve of the machine learning model consisting of FN10mm/50mm, diffuseness, and the Spetzler-Martin score was 0.88 (SD, 0.07). CONCLUSIONS The artificial intelligence-based indicator, FN10mm/50mm, can reflect the lesion-fiber spatial relationship and act as a dominant predictor for postsurgical motor defects in patients with brain AVMs involving motor-related areas.
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Affiliation(s)
- Y Jiao
- From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China
| | - J Zhang
- From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China
| | - X Yang
- China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China
| | - T Zhan
- China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China
| | - Z Wu
- China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China
| | - Y Li
- China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China
| | - S Zhao
- From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China
| | - H Li
- From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China
| | - J Weng
- From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China
| | - R Huo
- From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China
| | - J Wang
- From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China
| | - H Xu
- From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China
| | - Y Sun
- From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China
| | - S Wang
- From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China
| | - Y Cao
- From the Department of Neurosurgery (Y.J., J.Z., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases (Y.J., J.Z., X.Y., T.Z., Z.W., Y.L., S.Z., H.L., J. Weng, R.H., J. Wang, H.X., Y.S., S.W., Y.C.), Beijing, China
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Sattari SA, Shahbandi A, Yang W, Feghali J, Xu R, Huang J. Microsurgery versus Microsurgery With Preoperative Embolization for Brain Arteriovenous Malformation Treatment: A Systematic Review and Meta-analysis. Neurosurgery 2023; 92:27-41. [PMID: 36519858 DOI: 10.1227/neu.0000000000002171] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/29/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Preoperative embolization has traditionally been regarded as a safe and effective adjunct to microsurgical treatment of brain arteriovenous malformations (bAVM). However, there is currently no high-level evidence to ascertain this presumption. OBJECTIVE To compare the outcomes of microsurgery (MS) vs microsurgery with preoperative embolization (E + MS) in patients with bAVM through systematic review. METHODS We searched MEDLINE, PubMed, and Embase. The primary outcome was bAVM obliteration. Secondary outcomes were intraoperative bleeding (mL), complications, worsened modified Rankin Scale (mRS), and mortality. The pooled proportions of outcomes were calculated through the logit transformation method. The odds ratio (OR) of categorical data and mean difference of continuous data were estimated through the Mantel-Haenszel and the inverse variance methods, respectively. RESULTS Thirty-two studies met the eligibility criteria. One thousand eight hundred twenty-eight patients were treated by microsurgery alone, and 1088 were treated by microsurgery with preoperative embolization, respectively. The meta-analysis revealed no significant difference in AVM obliteration (94.1% vs 95.6%, OR = 1.15 [0.63-2.11], P = .65), mortality (1.7% vs 2%, OR = 0.88 [0.30-2.58], P = .82), procedural complications (18.2% vs 27.2%, OR = 0.47 [0.19-1.17], P = .10), worsened mRS (21.2% vs 18.5%, OR = 1.08 [0.33-3.54], P = .9), and intraoperative blood loss (mean difference = 182.89 [-87.76, 453.55], P = .19). CONCLUSION The meta-analysis showed no significant difference in AVM obliteration, mortality, complications, worse mRS, and intraoperative blood loss between MS and E + MS groups. For AVMs where MS alone has acceptable results, it is reasonable to bypass unnecessary preoperative embolization given higher postoperative complication risk.
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Affiliation(s)
- Shahab Aldin Sattari
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ataollah Shahbandi
- Tehran School of Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Wuyang Yang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - James Feghali
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Risheng Xu
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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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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Patel SD, Saber H, Desai N, Otite FO, Kaneko N, Mehta TV, Hinman J, Hassan AE, Jadhav A, Liebeskind DS, Saver JL. Impact of ARUBA trial on trends and outcomes in symptomatic non-ruptured brain AVMs: A national sample analysis. J Stroke Cerebrovasc Dis 2022; 31:106807. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/11/2022] [Accepted: 09/18/2022] [Indexed: 11/21/2022] Open
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Zhang S, Sun S, Zhai Y, Wang X, Zhang Q, Shi Z, Ge P, Zhang D. Development and validation of a model for predicting the risk of brain arteriovenous malformation rupture based on three-dimensional morphological features. Front Neurol 2022; 13:979014. [DOI: 10.3389/fneur.2022.979014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
ObjectiveBrain arteriovenous malformation (bAVM) is an important reason for intracranial hemorrhage. This study aimed at developing and validating a model for predicting bAVMs rupture by using three-dimensional (3D) morphological features extracted from Computed Tomography (CT) angiography.Materials and methodsThe prediction model was developed in a cohort consisting of 412 patients with bAVM between January 2010 and December 2020. All cases were partitioned into training and testing sets in the ratio of 7:3. Features were extracted from the 3D model built on CT angiography. Logistic regression was used to develop the model, with features selected using L1 Regularization, presented with a nomogram, and assessed with calibration curve, receiver operating characteristic (ROC) curve and decision curve analyze (DCA).ResultsSignificant variations in associated aneurysm, deep located, number of draining veins, type of venous drainage, deep drainage, drainage vein entrance diameter (Dv), type of feeding arteries, middle cerebral artery feeding, volume, Feret diameter, surface area, roundness, elongation, mean density (HU), and median density (HU) were found by univariate analysis (p < 0.05). The prediction model consisted of associated aneurysm, deep located, number of draining veins, deep drainage, Dv, volume, Feret diameter, surface area, mean density, and median density. The model showed good discrimination, with a C-index of 0.873 (95% CI, 0.791–0.931) in the training set and 0.754 (95% CI, 0.710–0.795) in the testing set.ConclusionsThis study presented 3D morphological features could be conveniently used to predict hemorrhage from unruptured bAVMs.
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Associations of Reported Genetic Risk Loci with Sporadic Brain Arteriovenous Malformations: Meta-analysis. J Mol Neurosci 2022; 72:2207-2217. [PMID: 36209311 DOI: 10.1007/s12031-022-02073-z] [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: 05/11/2022] [Accepted: 09/22/2022] [Indexed: 12/13/2022]
Abstract
An arteriovenous malformation (AVM) is an abnormal nidus of blood vessels that is characterized by a direct connection between arteries and veins without intervening in the capillary network. The exact underlying cause of sporadic AVMs is unknown, but many studies have reported genetic associations between genes that contribute to angiogenesis, vasculogenesis, and inflammation. Eleven studies retrieved from Medline Complete, PubMed, and Google Scholar up to February 2022 were included. Heterogeneity was assessed using I2 and Q-tests. Publication bias was also assessed for the shortlisted CDKN2B-AS1 rs1333040 (T > C), ACVRL1 rs2071219 (A > G), and rs11169953 (C > T) polymorphisms. The rs1333040 polymorphism showed a lower association with sporadic brain AVM for T versus C in an allelic model (OR = 0.59, 95% confidence interval [CI] = 0.41-0.84). In the recessive model, rs2071219 for AA + AG vs. GG was OR = 0.62, 95% CI = 0.43-0.9. In the recessive model, rs11169953 CC + CT vs. TT was OR = 0.56, 95% CI = 0.33-0.95. In summary, the results of this study support the association between CDKN2B-AS1 and ACVRL1 polymorphisms and sporadic brain arteriovenous malformations. This study summarized the existing information and showed the need for more replication studies on the genetic basis of sporadic AVM. In the future, more genome-wide studies should be conducted to validate and fill existing gaps in knowledge about the mechanisms of sporadic AVM development.
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Tsentsiper LM, Dryagina NV, Terekhov IS, Aybazova MI, Rumyantseva MV, Petrov AE, Petrova AO, Kondratyev AN. Inflammatory Response in Patients with Spontaneous Intracranial Hemorrhages. MESSENGER OF ANESTHESIOLOGY AND RESUSCITATION 2022. [DOI: 10.21292/2078-5658-2022-19-5-71-78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Mortality and disability rates in spontaneous intracranial hemorrhages remain high despite medical advances. In recent decades, much attention has been paid to neuroinflammation as a typical response to brain damage. Inflammation plays an important role in the acute and chronic phases of the disease. The relationship between plasma and cerebrospinal fluid cytokines, as well as the factors affecting their ratios, is currently not completely clear.The objective was to study the inflammatory response to spontaneous intracranial hemorrhage.Subjects and Methods. 59 patients aged 18 to 72 years (48 ± 6) were enrolled in the study. Patients were admitted to the intensive care unit after an episode of spontaneous intracranial hemorrhage. The levels of interleukins in blood plasma were studied: 6, 8, 10, TNF-α, C-reactive protein,blood leukocytes, and procalcitonin (by a semi-quantitative method). In the cerebrospinal fluid, the following parameters were evaluated: cytosis, protein, glucose, lactate, cytokines (6, 8, 10, TNF-α). Blood samples were collected on days 1, 2, 3, 5, 7, 9, 14, 21, 28, 35, and 45.Results. Systemic inflammatory response developed in all patients from the first day of acute brain injury. The most significant response was formed by glial brain cells which was confirmed by high levels of cytokines in the cerebrospinal fluid, hundreds and thousands of times higher than blood levels of cytokines.Conclusion. Levels of pro-inflammatory cytokines are predictors of an unfavorable outcome.
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Affiliation(s)
- L. M. Tsentsiper
- Polenov Neurosurgical Institute, the Branch of Almazov National Medical Research Center
| | - N. V. Dryagina
- Polenov Neurosurgical Institute, the Branch of Almazov National Medical Research Center
| | - I. S. Terekhov
- Polenov Neurosurgical Institute, the Branch of Almazov National Medical Research Center
| | - M. I. Aybazova
- Polenov Neurosurgical Institute, the Branch of Almazov National Medical Research Center
| | - M. V. Rumyantseva
- North-Western District Scientific and Clinical Center Named after L. G. Sokolov
| | - A. E. Petrov
- Polenov Neurosurgical Institute, the Branch of Almazov National Medical Research Center
| | | | - A. N. Kondratyev
- Polenov Neurosurgical Institute, the Branch of Almazov National Medical Research Center
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Treb K, Ji X, Feng M, Zhang R, Periyasamy S, Laeseke PF, Dingle AM, Brace CL, Li K. A C-arm photon counting CT prototype with volumetric coverage using multi-sweep step-and-shoot acquisitions. Phys Med Biol 2022; 67:10.1088/1361-6560/ac950d. [PMID: 36162399 PMCID: PMC9623602 DOI: 10.1088/1361-6560/ac950d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/26/2022] [Indexed: 11/12/2022]
Abstract
Objective.Existing clinical C-arm interventional systems use scintillator-based energy-integrating flat panel detectors (FPDs) to generate cone-beam CT (CBCT) images. Despite its volumetric coverage, FPD-CBCT does not provide sufficient low-contrast detectability desired for certain interventional procedures. The purpose of this work was to develop a C-arm photon counting detector (PCD) CT system with a step-and-shoot data acquisition method to further improve the tomographic imaging performance of interventional systems.Approach.As a proof-of-concept, a cadmium telluride-based 51 cm × 0.6 cm PCD was mounted in front of a FPD in an Artis Zee biplane system. A total of 10 C-arm sweeps (5 forward and 5 backward) were prescribed. A motorized patient table prototype was synchronized with the C-arm system such that it translates the object by a designated distance during the sub-second rest time in between gantry sweeps. To evaluate whether this multi-sweep step-and-shoot acquisition strategy can generate high-quality and volumetric PCD-CT images without geometric distortion artifacts, experiments were performed using physical phantoms, a human cadaver head, and anin vivoswine subject. Comparison with FPD-CT was made under matched narrow beam collimation and radiation dose conditions.Main results.Compared with FPD-CT images, PCD-CT images had lower noise and improved visualization of low-contrast lesion models, as well as improved visibility of small iodinated blood vessels. Fine structures were visualized more clearly by the PCD-CT than the highest-available resolution provided by FPD-CBCT and MDCT. No perceivable geometric distortion artifacts were observed in the multi-planar PCD-CT images.Significance.This work is the first demonstration of the feasibility of high-quality and multi-planar (volumetric) PCD-CT imaging with a rotating C-arm gantry.
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Affiliation(s)
- Kevin Treb
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Xu Ji
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Mang Feng
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Ran Zhang
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
| | - Sarvesh Periyasamy
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Paul F. Laeseke
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Aaron M. Dingle
- Department of Surgery, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
| | - Christopher L. Brace
- Department of Biomedical Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI, 53706, USA
| | - Ke Li
- Department of Medical Physics, School of Medicine and Public Health, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705, USA
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
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Chen Y, Han H, Ma L, Li R, Li Z, Yan D, Zhang H, Yuan K, Wang K, Zhao Y, Zhang Y, Jin W, Li R, Lin F, Meng X, Hao Q, Wang H, Ye X, Kang S, Jin H, Li Y, Gao D, Sun S, Liu A, Wang S, Chen X, Zhao Y. Multimodality treatment for brain arteriovenous malformation in Mainland China: design, rationale, and baseline patient characteristics of a nationwide multicenter prospective registry. Chin Neurosurg J 2022; 8:33. [PMID: 36253875 PMCID: PMC9575306 DOI: 10.1186/s41016-022-00296-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brain arteriovenous malformation (AVM) is an important cause of hemorrhagic stroke in young adults, which can lead to severe neurological impairment. The registry of Multimodality treatment for brain ArTeriovenous malformation in mainland CHina (MATCH) is a national prospective registry to identify the natural history of AVMs in Asian population; to investigate traditional and emerging hemorrhagic predictors; and to explore the superiority of the multidisciplinary assessment in improving the long-term outcomes. METHODS: Consecutive AVM patients will be enrolled from 52 participating hospitals in mainland China. Baseline demographic, clinical and imaging data will be collected prospectively. Conservation, microsurgery, embolization, stereotactic radiosurgery (SRS), and multimodal strategies are all included in this study. Patients will be divided into experimental and control group according to whether the treatment protocols are formulated by multidisciplinary team. Neurofunctional status, subsequent hemorrhage, seizure, and novel neurofunctional deficit will be queried at 3 months, annually (1 and 2 years), 3 years, and 10 years follow-up. RESULTS Between August 2011 and April 2021, 3241 AVMs were enrolled in 11 participating sites. Among them, 59.0% were male with an average age of 28.4 ± 14.6 years, 61.2% had rupture history and 2268 hemorrhagic events occurred before admission. The median Spetzler-Martin grade and Lawton-Young grade was 3 and 5, respectively. Microsurgery is the dominant strategy (35.7%), with a similar proportion of embolization, SRS, and a combination of both (12.7%; 14.8%; 11.8%; respectively). Among them, 15.43% underwent multidisciplinary assessment and received standardized treatment. At the most recent follow-up, 7.8% were lost and the median follow-up duration was 5.6 years. CONCLUSIONS The MATCH study is a large-sample nationwide prospective registry to investigate multimodality management strategy for AVMs. Data from this registry may also provide the opportunity for individualized risk assessment and the development of optimal individual management strategies. TRIAL REGISTRATION ClinicalTrials.gov Registry ( NCT04572568 ).
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Affiliation(s)
- Yu Chen
- grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Heze Han
- grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Li Ma
- grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ruinan Li
- grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhipeng Li
- grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Debin Yan
- grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Haibin Zhang
- grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Kexin Yuan
- grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ke Wang
- grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yang Zhao
- grid.449412.eDepartment of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China
| | - Yukun Zhang
- grid.449412.eDepartment of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China
| | - Weitao Jin
- grid.449412.eDepartment of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China
| | - Runting Li
- grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fa Lin
- grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xiangyu Meng
- grid.411617.40000 0004 0642 1244Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Qiang Hao
- grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Wang
- grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xun Ye
- grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuai Kang
- grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hengwei Jin
- grid.411617.40000 0004 0642 1244Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxiang Li
- grid.411617.40000 0004 0642 1244Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dezhi Gao
- grid.411617.40000 0004 0642 1244Department of Gamma-Knife Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shibin Sun
- grid.411617.40000 0004 0642 1244Department of Gamma-Knife Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ali Liu
- grid.411617.40000 0004 0642 1244Department of Gamma-Knife Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shuo Wang
- grid.411617.40000 0004 0642 1244Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China ,grid.411617.40000 0004 0642 1244China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xiaolin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. .,Stroke Center, Beijing Institute for Brain Disorders, Beijing, China.
| | - Yuanli Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China.
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37
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Thomas JM, Sasankan D, Abraham M, Surendran S, Kartha CC, Rajavelu A. DNA methylation signatures on vascular differentiation genes are aberrant in vessels of human cerebral arteriovenous malformation nidus. Clin Epigenetics 2022; 14:127. [PMID: 36229855 PMCID: PMC9563124 DOI: 10.1186/s13148-022-01346-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 10/02/2022] [Indexed: 12/04/2022] Open
Abstract
Arteriovenous malformation (AVM) is a tangle of arteries and veins, rupture of which can result in catastrophic hemorrhage in vulnerable sites such as the brain. Cerebral AVM is associated with a high mortality rate in humans. The causative factor or the stimulus at the artery-venous junction and the molecular basis of the development and progression of cerebral AVM remain unknown. While it is known that aberrant hemodynamic forces in the artery-vein junction contribute to the development of AVMs, the mechanistic pathways are unclear. Given that various environmental stimuli modulate epigenetic modifications on the chromatin of cells, we speculated that misregulated DNA methylome could lead to cerebral AVM development. To identify the aberrant epigenetic signatures, we used AVM nidus tissues and analyzed the global DNA methylome using the Infinium DNA methylome array. We observed significant alterations of DNA methylation in the genes associated with the vascular developmental pathway. Further, we validated the DNA hypermethylation by DNA bisulfite sequencing analysis of selected genes from human cerebral AVM nidus. Taken together, we provide the first experimental evidence for aberrant epigenetic signatures on the genes of vascular development pathway, in human cerebral AVM nidus.
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Affiliation(s)
- Jaya Mary Thomas
- Cardio Vascular Diseases and Diabetes Biology, Rajiv Gandhi Centre for Biotechnology, Poojappura, Thycaud, Thiruvananthapuram, Kerala, India, 695014
| | - Dhakshmi Sasankan
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology, Madras, Chennai, Tamil Nadu, 600036, India
| | - Mathew Abraham
- Department of Neurosurgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India, 695011
| | - Sumi Surendran
- Cardio Vascular Diseases and Diabetes Biology, Rajiv Gandhi Centre for Biotechnology, Poojappura, Thycaud, Thiruvananthapuram, Kerala, India, 695014
| | - Chandrasekharan C Kartha
- Department of Neurology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, 682041, Kerala, India.
| | - Arumugam Rajavelu
- Department of Biotechnology, Bhupat and Jyoti Mehta School of Biosciences, Indian Institute of Technology, Madras, Chennai, Tamil Nadu, 600036, India.
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A human model of arteriovenous malformation (AVM)-on-a-chip reproduces key disease hallmarks and enables drug testing in perfused human vessel networks. Biomaterials 2022; 288:121729. [PMID: 35999080 PMCID: PMC9972357 DOI: 10.1016/j.biomaterials.2022.121729] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/29/2022] [Accepted: 08/03/2022] [Indexed: 02/09/2023]
Abstract
Brain arteriovenous malformations (AVMs) are a disorder wherein abnormal, enlarged blood vessels connect arteries directly to veins, without an intervening capillary bed. AVMs are one of the leading causes of hemorrhagic stroke in children and young adults. Most human sporadic brain AVMs are associated with genetic activating mutations in the KRAS gene. Our goal was to develop an in vitro model that would allow for simultaneous morphological and functional phenotypic data capture in real time during AVM disease progression. By generating human endothelial cells harboring a clinically relevant mutation found in most human patients (activating mutations within the small GTPase KRAS) and seeding them in a dynamic microfluidic cell culture system that enables vessel formation and perfusion, we demonstrate that vessels formed by KRAS4AG12V mutant endothelial cells (ECs) were significantly wider and more leaky than vascular beds formed by wild-type ECs, recapitulating key structural and functional hallmarks of human AVM pathogenesis. Immunofluorescence staining revealed a breakdown of adherens junctions in mutant KRAS vessels, leading to increased vascular permeability, a hallmark of hemorrhagic stroke. Finally, pharmacological blockade of MEK kinase activity, but not PI3K inhibition, improved endothelial barrier function (decreased permeability) without affecting vessel diameter. Collectively, our studies describe the creation of human KRAS-dependent AVM-like vessels in vitro in a self-assembling microvessel platform that is amenable to phenotypic observation and drug delivery.
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Rodemerk J, Oppong MD, Junker A, Deuschl C, Forsting M, Zhu Y, Dammann P, Uerschels A, Jabbarli R, Sure U, Wrede KH. Ischemia-induced inflammation in arteriovenous malformations. Neurosurg Focus 2022; 53:E3. [DOI: 10.3171/2022.4.focus2210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/14/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE
The pathophysiology of development, growth, and rupture of arteriovenous malformations (AVMs) is only partially understood. However, inflammation is known to play an essential role in many vascular diseases. This feasibility study was conducted to investigate the expression of enzymes (cyclooxygenase 2 [COX-2] and NLRP3 [NOD-, LRR-, and pyrin domain–containing protein 3]) in the AVM nidus that are essential in their inflammatory pathways and to explore how these influence the pathophysiology of AVMs.
METHODS
The study group comprised 21 patients with partially thrombosed AVMs. The cohort included 8 ruptured and 13 unruptured AVMs, which had all been treated microsurgically. The formaldehyde-fixed and paraffin-embedded samples were immunohistochemically stained with a monoclonal antibody against COX-2 and NLRP3 (COX-2 clone: CX-294; NLRP3: ab214185). The authors correlated MRI and clinical data with immunohistochemistry, using the Trainable Weka Segmentation algorithm for analysis.
RESULTS
The median AVM volume was 2240 mm3. The proportion of NLRP3-positive cells was significantly higher (26.23%–83.95%), compared to COX-2 positive cells (0.25%–14.94%, p < 0.0001). Ruptured AVMs had no higher expression of NLRP3 (p = 0.39) or COX-2 (p = 0.44), compared to nonruptured AVMs. Moreover, no patient characteristics could be reported that showed significant correlations to the enzyme expression.
CONCLUSIONS
NLRP3 consistently showed an approximately 10-fold higher expression level than COX-2, making the inflammatory process in AVMs appear to be mainly associated with ischemic (NLRP3)–driven rather than with mechanical (COX-2)–driven inflammatory pathways. No direct associations between NLRP3 and COX-2 expression and radiological, standard histopathological, or patient characteristics were found in this cohort.
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Affiliation(s)
- Jan Rodemerk
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen
| | | | - Andreas Junker
- Institute for Neuropathology, University Hospital Essen, University Duisburg-Essen; and
| | - Cornelius Deuschl
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Yuan Zhu
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen
| | - Philipp Dammann
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen
| | - Anne Uerschels
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen
| | - Karsten H. Wrede
- Department of Neurosurgery, University Hospital Essen, University Duisburg-Essen
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Karanth S, Rao S, Savardekar A, HR A, Pruthi N, Arivazhagan A, Bhat DI, Srinivas D, Devi BI, Somanna S, Mahadevan A. Pathological Spectrum of Vascular Malformations of the Central Nervous System: A Single Institution Experience of a Decade. INDIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1055/s-0042-1749141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Abstract
Background Vascular malformations (VMs) of the central nervous system comprise a variety of lesions that could affect the arteries, veins, or capillaries.
Materials and Methods We analyzed the histopathological features of all the VMs diagnosed at our centre over a decade.
Results Intracranial VM included arteriovenous malformation (AVM) (53%), cerebral cavernous malformations (CCMs) (45%), capillary telangiectasia (2%), venous angioma (0.5%), and arteriovenous fistula (AVF) (0.5%). In spinal VMs, capillary telangiectasia (40%) were the most common, followed by cavernomas (34%), AVF (16%), and AVMs and venous angiomas (5%). Clinical presentation varied from focal deficit to features of raised intracranial tension.
Conclusion Imaging and histopathology plays an important role in the diagnosis and management of VMs. Histopathological examination is essential for characterization of the VMs, which influences the prognosis.
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Affiliation(s)
- Shrithi Karanth
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Shilpa Rao
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Amey Savardekar
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Aravind HR
- Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangaluru, India
| | - Nupur Pruthi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Arimapamagan Arivazhagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Dhananjaya I. Bhat
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Bhagvatula Indira Devi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sampath Somanna
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Behzadi F, Heiferman DM, Wozniak A, Africk B, Ballard M, Chazaro J, Zsigray B, Reynolds M, Anderson DE, Serrone JC. Comparison of transarterial n-BCA and Onyx embolization of brain arteriovenous malformations: A single-center 18-year retrospective analysis. J Cerebrovasc Endovasc Neurosurg 2022; 24:144-153. [PMID: 35526856 PMCID: PMC9260459 DOI: 10.7461/jcen.2022.e2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 03/02/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Brain arteriovenous malformations (AVM) are commonly treated with endovascular embolization. Due to the rapid evolution of endovascular technology and lack of consistent practice guidelines regarding AVM embolization, further study of AVM embolization outcomes is warranted. METHODS We conducted a retrospective review of AVMs embolized at a single center from 2002-2019. Patient demographics, AVM characteristics, intention of embolization, and angiographic and clinical outcome after embolization were recorded. We compared the embolization results of those treated with n-butyl cyanoacrylate (n-BCA) and Onyx. RESULTS Over an 18-year period at our institution, 30 (33%) of 92 AVMs were treated with embolization. n-BCA was used in 12 cases and Onyx in 18 cases. Eighty-seven pedicles were embolized over 47 embolization sessions. Fifty percent of AVMs treated with n-BCA underwent more than one embolization session compared to 22% when Onyx was used. The median total percent volume reduction in the n-BCA AVMs was 52% compared to 51% in Onyx AVMs. There were 2 periprocedural complications in the n-BCA cohort and none in the Onyx cohort. CONCLUSIONS In this small retrospective series, Onyx and n-BCA achieved similar occlusion results, although n-BCA required more sessions and pedicles embolized to do so.
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Affiliation(s)
- Faraz Behzadi
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | | | - Amy Wozniak
- Clinical Research Office, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Benjamin Africk
- Department of Pediatric Neurology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Matthew Ballard
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Joshua Chazaro
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Brandon Zsigray
- Department of Neurological Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Matthew Reynolds
- Department of Neurological Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Douglas E Anderson
- Department of Neurological Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Joseph C Serrone
- Department of Neurological Surgery, Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
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42
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Yan L, Tao W, Zhan Q, Huang Z, Chen F, Li S. Angioarchitectural features of brain arteriovenous malformation presented with seizures. Neurosurg Rev 2022; 45:2909-2918. [PMID: 35589870 DOI: 10.1007/s10143-022-01814-3] [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: 03/07/2022] [Revised: 03/07/2022] [Accepted: 05/13/2022] [Indexed: 12/01/2022]
Abstract
Seizures are the second most common manifestations of brain arteriovenous malformations (bAVMs). This study was conducted to investigate the clinical and angioarchitectural features of bAVMs with seizures and provide guidelines for the clinical management of these patients. We collected clinical and radiological data on patients with bAVMs diagnosed by digital subtraction angiography between January 2013 and December 2020 and dichotomized the patients into the seizures and non-seizures groups. We identified differences in demographic and angiographic features. Logistic regression and random forest (RF) models were developed and compared. The diagnostic capacity was assessed using receiver operating characteristic (ROC) curves. A nomogram was constructed, and the clinical impact was determined by decision curve analysis. A total of 414 patients with bAVMs were included in the analysis, of which 78 (18.8%) had bAVM-related seizures. In the multivariable logistic regression model, the location and side of bAVMs were independently associated with seizures. In RF models, the maximal diameter of veins and the cross-sectional area of feeding arteries and draining veins were the most important features. ROC curves showed that the RF model was not better than MLR in predicting seizures. Decision curve analysis revealed that the use of a constructed nomogram to stratify the seizure patients was beneficial at all threshold probabilities in our study. The side and location of bAVMs are specific angioarchitectural features independently associated with the occurrences of seizures with bAVMs.
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Affiliation(s)
- Langchao Yan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Wengui Tao
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Qian Zhan
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zheng Huang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Fenghua Chen
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Shifu Li
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China.
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43
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O'Hare M, Arboleda-Velasquez JF. Notch Signaling in Vascular Endothelial and Mural Cell Communications. Cold Spring Harb Perspect Med 2022; 12:a041159. [PMID: 35534207 PMCID: PMC9435572 DOI: 10.1101/cshperspect.a041159] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Notch signaling pathway is a highly versatile and evolutionarily conserved mechanism with an important role in cell fate determination. Notch signaling plays a vital role in vascular development, regulating several fundamental processes such as angiogenesis, arterial/venous differentiation, and mural cell investment. Aberrant Notch signaling can result in severe vascular phenotypes as observed in cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and Alagille syndrome. It is known that vascular endothelial cells and mural cells interact to regulate vessel formation, cell maturation, and stability of the vascular network. Defective endothelial-mural cell interactions are a common phenotype in diseases characterized by impaired vascular integrity. Further refinement of the role of Notch signaling in the vascular junctions will be critical to attempts to modulate Notch in the context of human vascular disease. In this review, we aim to consolidate and summarize our current understanding of Notch signaling in the vascular endothelial and mural cells during development and in the adult vasculature.
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Affiliation(s)
- Michael O'Hare
- Department of Ophthalmology at Harvard Medical School, Schepens Eye Research Institute of Mass Eye and Ear, Boston, Massachusetts 02114, USA
| | - Joseph F Arboleda-Velasquez
- Department of Ophthalmology at Harvard Medical School, Schepens Eye Research Institute of Mass Eye and Ear, Boston, Massachusetts 02114, USA
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44
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Ramírez-Ferrer E, Aponte-Caballero R, Aguilera-Pena MP, Mendoza-Ayús SD, Osorio-Bohorquez LA, Riveros-Castillo WM. Sphenoidal meningoencephalocele associated with CSF fistula and arteriovenous malformation Spetzler-Martin V: A case report. Neurocirugia (Astur) 2022. [DOI: 10.1016/j.neucir.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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45
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Winkler E, Wu D, Gil E, McCoy D, Narsinh K, Sun Z, Mueller K, Ross J, Kim H, Weinsheimer S, Berger M, Nowakowski T, Lim D, Abla A, Cooke D. Endoluminal Biopsy for Molecular Profiling of Human Brain Vascular Malformations. Neurology 2022; 98:e1637-e1647. [PMID: 35145012 PMCID: PMC9052570 DOI: 10.1212/wnl.0000000000200109] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 01/11/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Ras-mitogen-activated protein kinase (MAPK) signaling abnormalities occur in most brain arteriovenous malformations (bAVMs). No means exist to molecularly profile bAVMs without open surgery, limiting precision medicine approaches to treatment. Here, we report use of endoluminal biopsy of the vessel lumen of bAVMs to characterize gene expression and blood flow-mediated transcriptional changes in living patients. METHODS Endoluminal biopsy and computational fluid dynamic modeling (CFD) were performed in adults with unruptured AVMs with cerebral angiography. Each patient underwent surgical resection and cell sampling from a contiguous arterial segment. Fluorescence-assisted cell sorting enriched endothelial cells, which were sequenced on an Illumina HiSeq 4000 sequencer. Gene expression was quantified with RNA sequencing (RNAseq). Differential gene expression, ontology, and correlative analyses were performed. Results were validated with quantitative reverse transcription PCR (RT-qPCR). RESULTS Endoluminal biopsy was successful in 4 patients without complication. Endoluminal biopsy yielded 269.0 ± 79.9 cells per biopsy (control 309.2 ± 86.6 cells, bAVM 228.8 ± 133.4 cells). RNAseq identified 106 differentially expressed genes (DEGs) in bAVMs (false discovery rate ≤0.05). DEGs were enriched for bAVM pathogenic cascades, including Ras-MAPK signaling (p < 0.05), and confirmed with RT-qPCR and a panel predictive of MAPK/extracellular signal-regulated kinase inhibitor response. Compared to patient-matched surgically excised tissues, endoluminal biopsy detected 83.3% of genes, and genome-wide expression strongly correlated (Pearson r = 0.77). Wall shear stress measured by CFD correlated with inflammatory pathway upregulation. Comparison of pre-embolization and postembolization samples confirmed flow-mediated gene expression changes. DISCUSSION Endoluminal biopsy allows molecular profiling of bAVMs in living patients. Gene expression profiles are similar to those of tissues acquired with open surgery and identify potentially targetable Ras-MAPK signaling abnormalities in bAVMs. Integration with CFD allows determination of flow-mediated transcriptomic alterations. Endoluminal biopsy may help facilitate trials of precision medicine approaches to bAVMs in humans.
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Affiliation(s)
- Ethan Winkler
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - David Wu
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Eugene Gil
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - David McCoy
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Kazim Narsinh
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Zhengda Sun
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Kerstin Mueller
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Jayden Ross
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Helen Kim
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Shantel Weinsheimer
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Mitchel Berger
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Tomasz Nowakowski
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Daniel Lim
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Adib Abla
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
| | - Daniel Cooke
- From the Department of Neurological Surgery (E.W., D.W., E.G., J.R., M.B., D.L., A.A.), Department of Radiology and Biomedical Imaging (D.M., K.N., Z.S., D.C.), Center for Cerebrovascular Research (H.K., S.W.), Department of Psychiatry (T.N.), Department of Behavioral Sciences (T.N.), and Eli and Edythe Broad Center for Regeneration Medicine and Stem Cell Research (T.N., D.L.), University of California San Francisco; Siemens Medical Solutions Inc (K.M.), Malvern, PA; and Department of Anatomy (J.R., T.N.), University of California San Francisco, Chan Zuckerberg Biohub
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Abdelilah-Seyfried S, Iruela-Arispe ML, Penninger JM, Tournier-Lasserve E, Vikkula M, Cleaver O. Recalibrating vascular malformations and mechanotransduction by pharmacological intervention. J Clin Invest 2022; 132:160227. [PMID: 35426368 PMCID: PMC9012280 DOI: 10.1172/jci160227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - M. Luisa Iruela-Arispe
- Department of Cell and Developmental Biology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Josef M. Penninger
- Department of Medical Genetics, Life Sciences Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elisabeth Tournier-Lasserve
- INSERM UMR 1141 Neurodiderot, University of Paris, Paris, France
- AP-HP, Department of Genetics of Neurovascular Diseases, Hôpital Saint-Louis, Paris, France
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, Brussels, Belgium
| | - Ondine Cleaver
- Department of Molecular Biology, UT Southwestern Medical Center, Dallas, Texas, USA
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He Y, Bai W, Xu B, Kang X, Xue J, He Y, Li T. Perioperative Complications of Transvenous Embolization of Ruptured Intracranial Arteriovenous Malformations. Front Neurol 2022; 13:873186. [PMID: 35432177 PMCID: PMC9009503 DOI: 10.3389/fneur.2022.873186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo investigate the perioperative complications of transvenous embolization of ruptured intracranial arteriovenous malformations.Materials and MethodsA total of 27 patients with ruptured intracranial arteriovenous malformations underwent transvenous embolization were enrolled from November 2016 to May 2020 in our prospective database. Perioperative complications and angiographic characteristics were analyzed retrospectively.ResultsComplete disappearance of the nidus occured in 22 (88%) of 25 patients with technically feasible AVMs immediately after embolization. Two cases were partially treated by transarterial embolization due to the failure of microcatheter placement into the draining vein. Seven (25.9%, 7/27) patients had perioperative complications, including three cases of intraoperative hemorrhage, three cases of postoperative hemorrhage and one case of ischemic infarction. No significant differences in complication rates between patients with nidus ≥3 cm and <3 cm (P = 0.659), eloquent area and non-eloquent (P = 0.137), deep location and superficial (P = 0.637), deep venous drainage and cortical vein (P = 1.0), the number of venous drainage (P = 0.49), the angle of draining vein entering venous sinus <90° and ≥90° (P = 1.0), aneurysms (P = 0.058) and the time between hemorrhage and TVE (P = 1.0) were found. Three of these patients received ventriculostomy, two of which received lumbar drainage treatments at the same time, and four patients just received conservative management. Good outcomes (mRS ≤ 2) at the 1-month evaluation were achieved in 5 of the patients who had complications, but poor outcome (mRS = 5) at the 1-month evaluation was in 1 patient, and 1 lethal complication occurred.ConclusionThe most common complication of AVMs with transvenous endovascular embolization is cerebral hemorrhage. The prevention of complications may improve the efficacy of AVM embolization, but the current quality of evidence is low and limited in guiding policy development and improving the TVE for AVMs. It is, therefore, necessary to develop clinical research programs in this field.
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Affiliation(s)
- Yanyan He
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Zhengzhou, China
- Department of Cerebrovascular Disease and Neurosurgery, Henan University People's Hospital, Zhengzhou, China
- Department of Cerebrovascular Disease and Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
| | - Weixing Bai
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Zhengzhou, China
- Department of Cerebrovascular Disease and Neurosurgery, Henan University People's Hospital, Zhengzhou, China
- Department of Cerebrovascular Disease and Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
- Weixing Bai
| | - Bin Xu
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Zhengzhou, China
- Department of Cerebrovascular Disease and Neurosurgery, Henan University People's Hospital, Zhengzhou, China
- Department of Cerebrovascular Disease and Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
| | - Xiaoyu Kang
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Zhengzhou, China
- Department of Cerebrovascular Disease and Neurosurgery, Henan University People's Hospital, Zhengzhou, China
- Department of Cerebrovascular Disease and Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
| | - Jiangyu Xue
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Zhengzhou, China
- Department of Cerebrovascular Disease and Neurosurgery, Henan University People's Hospital, Zhengzhou, China
- Department of Cerebrovascular Disease and Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
| | - Yingkun He
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Zhengzhou, China
- Department of Cerebrovascular Disease and Neurosurgery, Henan University People's Hospital, Zhengzhou, China
- Department of Cerebrovascular Disease and Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
- *Correspondence: Yingkun He
| | - Tianxiao Li
- Department of Cerebrovascular Disease and Neurosurgery, Zhengzhou University People's Hospital, Zhengzhou, China
- Department of Cerebrovascular Disease and Neurosurgery, Henan University People's Hospital, Zhengzhou, China
- Department of Cerebrovascular Disease and Neurosurgery, Henan Provincial People's Hospital, Zhengzhou, China
- Henan Provincial NeuroInterventional Engineering Research Center, Henan International Joint Laboratory of Cerebrovascular Disease, and Henan Engineering Research Center of Cerebrovascular Intervention Innovation, Zhengzhou, China
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Pérez-Alfayate R, Grasso G. State of the Art and Future Direction in Diagnosis, Molecular Biology, Genetics, and Treatment of Brain Arteriovenous Malformations. World Neurosurg 2022; 159:362-372. [PMID: 35255635 DOI: 10.1016/j.wneu.2021.08.111] [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: 07/19/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
Brain arteriovenous malformations (bAVMs) are uncommon and represent a heterogeneous group of lesions. Although these 2 facts have delayed research on this topic, knowledge about the pathophysiology, diagnosis, and treatment of bAVMs has evolved in recent years. We conducted a review of the literature to update the knowledge about diagnosis, molecular biology, genetic, pathology, and treatment by searching for the following terms: "Epidemiology AND Natural History," "risk of hemorrhage," "intracranial hemorrhage," "diagnosis," "angiogenesis," "molecular genetics," "VEGF," "KRAS," "radiosurgery," "endovascular," "microsurgery," or "surgical resection." Our understanding of bAVMs has significantly evolved in recent years. The latest investigations have helped in defining some molecular pathways involved in the pathology of bAVM. Although there is still more to learn and discover, describing these pathways will allow the creation of targeted treatments that could improve the prognosis of patients with bAVMs.
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Affiliation(s)
- Rebeca Pérez-Alfayate
- Department of Neurosurgery, Neuroscience Institute, Hospital Clínico San Carlos, Madrid, Spain.
| | - Giovanni Grasso
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
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Gamma Knife radiosurgery for cerebral arteriovenous malformations: a systematic review and meta-analysis. Neurosurg Rev 2022; 45:1987-2004. [PMID: 35178626 PMCID: PMC9160151 DOI: 10.1007/s10143-022-01751-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/16/2022]
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Soluble Endoglin Stimulates Inflammatory and Angiogenic Responses in Microglia That Are Associated with Endothelial Dysfunction. Int J Mol Sci 2022; 23:ijms23031225. [PMID: 35163148 PMCID: PMC8835690 DOI: 10.3390/ijms23031225] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/16/2022] [Accepted: 01/19/2022] [Indexed: 02/06/2023] Open
Abstract
Increased soluble endoglin (sENG) has been observed in human brain arteriovenous malformations (bAVMs). In addition, the overexpression of sENG in concurrence with vascular endothelial growth factor (VEGF)-A has been shown to induce dysplastic vessel formation in mouse brains. However, the underlying mechanism of sENG-induced vascular malformations is not clear. The evidence suggests the role of sENG as a pro-inflammatory modulator, and increased microglial accumulation and inflammation have been observed in bAVMs. Therefore, we hypothesized that microglia mediate sENG-induced inflammation and endothelial cell (EC) dysfunction in bAVMs. In this study, we confirmed that the presence of sENG along with VEGF-A overexpression induced dysplastic vessel formation. Remarkably, we observed increased microglial activation around dysplastic vessels with the expression of NLRP3, an inflammasome marker. We found that sENG increased the gene expression of VEGF-A, pro-inflammatory cytokines/inflammasome mediators (TNF-α, IL-6, NLRP3, ASC, Caspase-1, and IL-1β), and proteolytic enzyme (MMP-9) in BV2 microglia. The conditioned media from sENG-treated BV2 (BV2-sENG-CM) significantly increased levels of angiogenic factors (Notch-1 and TGFβ) and pERK1/2 in ECs but it decreased the level of IL-17RD, an anti-angiogenic mediator. Finally, the BV2-sENG-CM significantly increased EC migration and tube formation. Together, our study demonstrates that sENG provokes microglia to express angiogenic/inflammatory molecules which may be involved in EC dysfunction. Our study corroborates the contribution of microglia to the pathology of sENG-associated vascular malformations.
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