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Stanishevskiy A, Babichev K, Svistov D, Savello A, Abramyan A, Zelenskiy B. Coexistence of moyamoya syndrome with arteriovenous malformation. Systematic review and illustrative case report. J Clin Neurosci 2024; 121:34-41. [PMID: 38354649 DOI: 10.1016/j.jocn.2024.02.004] [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: 10/30/2023] [Revised: 01/19/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
The coexistence of Moyamoya Syndrome with Arteriovenous Malformation is exceedingly rare. Here, we present the case of a 37-year-old female patient diagnosed with AVM in the right parietal lobe, accompanied by severe stenosis of the right middle cerebral artery and right anterior cerebral artery, along with moyamoya collateral induction. Our objective was to investigate the frequency and mutual influence of these conditions, and to determine a preferable treatment strategy by conducting a comprehensive review of previous case reports. We conducted a thorough search of PubMed, Scopus, and Web of Science databases, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our review encompassed 36 publications, reporting a total of 64 cases of AVM coexisting with Moyamoya Syndrome. Notably, bilateral stenosis was observed in half of the cases. Among patients with unilateral stenosis, AVM was localized in the opposite hemisphere only in 2 cases. Treatment approaches varied, with 18 cases undergoing active treatment for both stenosis and AVM, 11 cases treating stenosis prior to AVM, 5 cases addressing AVM first, and 3 cases treating both AVM and stenosis simultaneously. Embolization, either standalone or supplemented by stereotactic radiosurgery, was employed in six cases. Stereotactic radiosurgery alone was utilized in 12 cases, while 15 patients underwent surgical removal of the AVM. Our findings provide valuable insights for neurosurgeons managing patients with concurrent AVM and Moyamoya Syndrome. The variety of treatment approaches observed in the literature underscores the complexity of these cases, emphasizing the need for individualized strategies. This information may guide future systematic reviews and meta-analyses, contributing to a better understanding of the optimal management of these rare coexisting vascular pathologies.
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Affiliation(s)
- Artem Stanishevskiy
- Department of Neurosurgery, Military Medical Academy named after S.M. Kirov, Saint-Petersburg, Russia.
| | - Konstantin Babichev
- Department of Neurosurgery, Military Medical Academy named after S.M. Kirov, Saint-Petersburg, Russia.
| | - Dmitriy Svistov
- Department of Neurosurgery, Military Medical Academy named after S.M. Kirov, Saint-Petersburg, Russia.
| | - Alexander Savello
- Department of Neurosurgery, Military Medical Academy named after S.M. Kirov, Saint-Petersburg, Russia
| | | | - Bogdan Zelenskiy
- Department of Neurosurgery, Military Medical Academy named after S.M. Kirov, Saint-Petersburg, Russia.
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Yada M, Matsuda K, Kitano M, Iwai Y, Tominaga S. Cerebral Arteriovenous Malformation With Ipsilateral Middle Cerebral Artery Occlusion: A Case Report. Cureus 2023; 15:e51193. [PMID: 38283460 PMCID: PMC10817826 DOI: 10.7759/cureus.51193] [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] [Accepted: 12/22/2023] [Indexed: 01/30/2024] Open
Abstract
We report the case of a 29-year-old man who presented with a sudden headache. Computed tomography showed a small intraventricular hemorrhage in the left lateral ventricle. Cerebral angiograms suggested rupture of a coexisting feeder aneurysm in the left temporal cerebral arteriovenous malformation (AVM). The left proximal middle cerebral artery, a major feeding artery, was occluded near the AVM, with development of abnormal blood supply, such as in moyamoya-like vessels to the nidus. After endovascular embolization of the coexisting feeder aneurysm and feeding arteries, the patient underwent volume-staged Gamma Knife radiosurgery (GKS). Follow-up angiograms performed 4.5 years after the last GKS confirmed complete disappearance of the AVM. Around 4.8 years after GKS, the patient required surgical intervention to develop delayed cyst formation; however, the postoperative course was uneventful.
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Affiliation(s)
| | - Ko Matsuda
- Neurosurgery, Tominaga Hospital, Osaka, JPN
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Kushi Y, Satow T, Ikedo T, Ohta T, Hara T, Takahashi JC, Iihara K, Kataoka H. Transvenous Coil-plugging Technique for a Symptomatic Giant Varix Associated with Arteriovenous Malformation. NMC Case Rep J 2022; 8:479-483. [PMID: 35079507 PMCID: PMC8769487 DOI: 10.2176/nmccrj.cr.2020-0432] [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: 12/25/2020] [Accepted: 02/22/2021] [Indexed: 11/20/2022] Open
Abstract
In case of symptomatic varix associated with cerebral arteriovenous malformations (AVM), nidus is usually treated with transarterial embolization (TAE). However, TAE is not always possible due to inaccessible nidus. A man in his 40s presented with numbness and clumsiness in the right hand. Magnetic resonance imaging (MRI) and cerebral angiography revealed a giant varix associated with an AVM nidus in the left parietal lobe. The varix severely compressed the postcentral gyrus with edema. The main feeder was occluded, and tiny collateral vessels fed the nidus. After admission, his symptoms deteriorated rapidly due to the enlarging varix. To extirpate the varix, selective transvenous embolization (TVE) of a small compartment, the varix neck, between the varix and the main cortical drainer with coils was performed. After treatment, the thrombosed varix gradually shrank, and his symptoms improved. The transvenous coil-plugging technique is a potential strategy for symptomatic varix with a varix neck.
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Affiliation(s)
- Yuji Kushi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tetsu Satow
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Taichi Ikedo
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tsuyoshi Ohta
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Takeshi Hara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Jun C Takahashi
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Koji Iihara
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Hiroharu Kataoka
- Department of Neurosurgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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Chen X, Lu X, Yan F, Xu W, Gao L, Zheng J, Yu J. Spontaneous thrombosis in main draining veins of unruptured cerebral arteriovenous malformations: A case report. Medicine (Baltimore) 2019; 98:e15588. [PMID: 31145278 PMCID: PMC6709146 DOI: 10.1097/md.0000000000015588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
RATIONALE Spontaneous obliteration of unruptured arteriovenous malformations (AVMs) is rare. It occurs in <1.5% of cerebral AVMs and only 7 cases have been reported so far. This phenomenon, together with the formation and outcome of cerebral AVMs, remains barely understood. In this work, we presented a case that spontaneous venous thrombosis in main draining veins of an unruptured AVM were confirmed, and reviewed the relevant literature in order to discuss the possible mechanisms. PATIENT CONCERNS Clinical data and treatment of a 33-year-old man with a preliminary diagnosis as right parietal mass with secondary epilepsy. DIAGNOSES The diagnosis of the mass was a right parietal arteriovenous malformation (AVM) that was 3.5 cm in size and supplied mainly by multiple feeders of right middle cerebral artery (MCA). INTERVENTIONS An operation was performed with meticulous hemostasis of the extracranial soft tissue and the AVM was resected completely. OUTCOMES The patient's neurological deficits improved postoperatively and he was subsequently discharged 1 week after surgery. LESSONS Thrombosis of the draining veins may be due to venous stagnation. Spontaneous venous thrombosis in an unruptured AVM is rare. Spontaneous obliteration of an AVM can occur by 2 mechanisms: occlusion of the feeding arteries or of the draining veins. Surgical or interventional treatment of an unruptured AVM with thrombosed draining veins is highly controversial now. However, we favor an aggressive treatment strategy.
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Goto H, Suzuki M, Akimura T, Fujisawa H, Yoneda H, Oka F, Nomura S, Kajiwara K, Kato S, Fujii M. Progression of stenosis into occlusion of the distal posterior cerebral artery supplying an occipital arteriovenous malformation manifesting as multiple ischemic attacks: case report. Neurol Med Chir (Tokyo) 2012; 52:899-902. [PMID: 23269045 DOI: 10.2176/nmc.52.899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A 31-year-old healthy male presented with a rare case of cerebral arteriovenous malformation (AVM) manifesting as repeated ischemic attacks and cerebral infarction causing left sensori-motor disturbance. Neuroimaging revealed cerebral infarction in the right thalamus as well as right occipital AVM without bleeding. The AVM was mainly fed by the right angular artery, and the right posterior cerebral artery (PCA) showed mild stenosis and segmental dilation at the P(2)-P(3) portion. After referral to our hospital, transient ischemic attacks causing left homonymous hemianopsia, and left arm and leg numbness were frequently recognized. Additional imaging revealed a new ischemic lesion in the occipital lobe, and repeated cerebral angiography showed right PCA occlusion at the P(2)-P(3) segment. Cerebral AVM presenting with cerebral infarction due to occlusion of feeding arteries is rare. In our case, intimal injury due to increased blood flow or spontaneous dissection of the artery were possible causes. We should monitor any changes in the architecture and rheology of the feeding vessels during the clinical course to prevent ischemic complications.
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Affiliation(s)
- Hisaharu Goto
- Department of Neurosurgery, Yamaguchi University School of Medicine, Ube, Yamaguchi.
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Stapf C, Mohr J, Hartmann A, Mast H, Khaw A, Choi JH, Pile-Spellman J. Arteriovenous Malformations and Other Vascular Anomalies. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10031-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Ahn SH, Choo IS, Kim JH, Kim HW. Arteriovenous Malformation with an Occlusive Feeding Artery Coexisting with Unilateral Moyamoya Disease. J Clin Neurol 2010; 6:216-20. [PMID: 21264203 PMCID: PMC3024527 DOI: 10.3988/jcn.2010.6.4.216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2008] [Revised: 09/23/2009] [Accepted: 09/23/2009] [Indexed: 11/21/2022] Open
Abstract
Background Arteriovenous malformations (AVMs) with vascular abnormalities, including aneurysms, have been reported frequently. However, the coexistence of AVM and unilateral moyamoya disease is rare. We report herein an AVM patient who presented with acute ischemic stroke with unilateral moyamoya disease and occlusion of the feeding artery. Case Report A-41-year old man was admitted with sudden dysarthria and facial palsy. Brain computed tomography and magnetic resonance imaging revealed an acute infarction adjacent to a large AVM in the right frontal lobe. Cerebral angiography revealed occlusions of the proximal right middle cerebral and proximal anterior cerebral arteries, which were the main feeders of the AVM. Innumerable telangiectatic moyamoya-type vessels between branches of the anterior cerebral artery and dilated lenticulostriate arteries on the occluded middle cerebral artery were detected. However, a nidus of the AVM was still opacified through the distal right callosomarginal artery, which was supplied by the remaining anterior cerebral artery and leptomeningeal collaterals from the posterior cerebral artery. Conclusions While AVM accompanied by unilateral moyamoya disease is rare, our case suggests an association between these two dissimilar vascular diseases.
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Affiliation(s)
- Seong Hwan Ahn
- Department of Neurology, Chosun University School of Medicine, Gwangju, Korea
| | - In Seong Choo
- Department of Neurology, Chosun University School of Medicine, Gwangju, Korea
| | - Jin Ho Kim
- Department of Neurology, Chosun University School of Medicine, Gwangju, Korea
| | - Hoo Won Kim
- Department of Neurology, Chosun University School of Medicine, Gwangju, Korea
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Wu TC, Guo WY, Wu HM, Chang FC, Shiau CY, Chung WY. The rare association of moyamoya disease and cerebral arteriovenous malformations: a case report. Korean J Radiol 2008; 9 Suppl:S65-7. [PMID: 18607130 PMCID: PMC2627196 DOI: 10.3348/kjr.2008.9.s.s65] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
A 36-year-old man was diagnosed with a right temporal lobe grade II cerebral arteriovenous malformation (cAVM) and was treated with radiosurgery. At nine months after the cAVM radiosurgery, the patient began to develop bilateral focal narrowing at the M1 segments of the bilateral middle cerebral arteries. The narrowing progressively deteriorated as was demonstrated on longitudinal serial follow-up MR imaging. X-ray angiography performed at 51 months after radiosurgery confirmed that the cAVM was cured and a diagnosis of moyamoya disease. To the best of our knowledge, this is the first case of cAVM-associated moyamoya disease that developed after radiosurgery. Given the chronological sequence of disease development and radiation dose distribution of radiosurgery, it is proposed that humoral or unknown predisposing factors, rather than direct radiation effects, are the cause of moyamoya disease associated with cAVM.
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Affiliation(s)
- Te-Chang Wu
- Department of Radiology, Chi-Mei Foundation Hospital, Tainan, Taiwan
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Peretta P, Carlino C, Gennari F, Ferrero G, Ragazzi P, Bradac GB, Stura G, Cinalli G. Spontaneous occlusion of brainstem arteriovenous malformation following ligature of a hepatic patent ductus venosus. Case report and review of the literature. J Neurosurg 2007; 106:147-52. [PMID: 17330544 DOI: 10.3171/ped.2007.106.2.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe the clinical and radiological findings in a case of brainstem arteriovenous malformation (AVM) associated with a hepatic patent ductus venosus (PDV) in a 12-year-old child. The AVM was discovered on magnetic resonance (MR) imaging performed because of slight mental retardation and headache. The malformation was otherwise asymptomatic and no treatment was proposed. An abdominal ultrasonography study performed 1 year later because of hyperammonemia revealed a PDV, which was surgically ligated. One year later, MR images and angiograms showed complete resolution of the brainstem AVM. This report is the first documentation of an association between these two entities in the same patient, and the possible pathophysiological interactions between them are discussed.
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Affiliation(s)
- Paola Peretta
- Department of Pediatric Neurosurgery, "Regina Margherita" Children's Hospital, San Giovanni Battista Hospital, Turin, Italy.
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Chen Z, Zhu G, Feng H, Lin J, Wu N. Giant arteriovenous malformation associated with unilateral moyamoya disease in a child: case report. ACTA ACUST UNITED AC 2007; 67:89-92; discussion 93. [PMID: 17210313 DOI: 10.1016/j.surneu.2006.01.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2005] [Accepted: 01/19/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cerebral AVMs associated with definite or probable moyamoya disease is a very rare situation, and the association between them is unclear. CASE DESCRIPTION An 8-year-old boy presented with repeated transient motor weakness in the left arm and leg for 1 year. On his admission, physical examination and neuropsychological testing showed no exact neurological deficits. Magnetic resonance imaging showed a giant AVM in the right basal ganglia and thalamus. Angiography revealed occlusion of left ICA and bilateral PCA with well-developed basal collateral vessels. A giant AVM was also noticed in angiography, which was filled by basal collateral vessels from both left anterior circulation and posterior circulation. The diagnosis of unilateral moyamoya disease combined with a Spetzler-Martin grade V AVM was made. The patient was managed nonoperatively and discharged with close follow-up. CONCLUSION We present a rare case of giant AVM-associated with unilateral moyamoya disease, and giant AVM makes planning any aggressive treatments difficult.
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Affiliation(s)
- Zhi Chen
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Chongqing 400038, The People's Republic of China.
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Pascual B, Lagares A, Miranda P, Pérez-Núñez A, Arrese I, Lobato R, Campollo J. Regresión espontánea de las malformaciones arteriovenosas cerebrales: presentación de un caso y revisión de la literatura. Neurocirugia (Astur) 2007. [DOI: 10.1016/s1130-1473(07)70277-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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DeCesare B, Omojola MF, Fogarty EF, Brown JC, Taylon C. Spontaneous thrombosis of congenital cerebral arteriovenous malformation complicated by subdural collection: in utero detection with disappearance in infancy. Br J Radiol 2006; 79:e140-4. [PMID: 16980671 DOI: 10.1259/bjr/44174031] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report a case of congenital left temporal lobe arteriovenous malformation (AVM) detected by cranial ultrasound in utero and confirmed immediately after birth by cranial Doppler ultrasound and cranial MRI. The AVM disappeared on follow-up cranial MRI 4 months later. A small left frontal subdural collection was present on these follow-up MR images, which subsequently resolved by the 7 month MRI study. The cause of the spontaneous thrombosis of the AVM is uncertain. The frontal subdural collection may be secondary to volume loss. This case documents the perinatal presence of AVM. The baby was neurologically intact before, during and after the thrombosis of the AVM.
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Affiliation(s)
- B DeCesare
- Creighton University Medical School, Omaha, Nebraska, USA
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Torrico T A, Tevah C J. Oclusión espontánea de malformación arteriovenosa cerebral parcialmente embolizada: reporte de dos casos. ARQUIVOS DE NEURO-PSIQUIATRIA 2006; 64:681-5. [PMID: 17119819 DOI: 10.1590/s0004-282x2006000400032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2005] [Accepted: 04/28/2006] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Mostrar dos casos de oclusión espontánea de remanente malformativo previamente embolizado y analizar sus probables causas. MÉTODO: Revisión retrospectiva de pacientes con malformaciones arteriovenosas cerebrales (MAV) embolizadas entre Enero de 1999 y Agosto de 2005 en nuestra institución y análisis de dos casos de oclusión de MAV remanentes. RESULTADOS: Se presentan dos casos de MAV tratadas por vía endovascular, con remanentes del nido malformativo post-embolización, que posteriormente en controles angiográficos presentan desaparición completa de las lesiones sin mediar otro tratamiento. CONCLUSIÓN: La oclusión espontánea de un remanente arteriovenoso es un hecho infrecuente. Se discuten diversos mecanismos relacionados.
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Affiliation(s)
- Alejandro Torrico T
- Departamento de Radiología, Hospital Clínico, Pontificia Universidad Católica de Chile, Santiago, Chile
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Mohr J, Hartmann A, Mast H, Pile-Spellman J, Schumacher HC, Stapf C. Arteriovenous Malformations and Other Vascular Anomalies. Stroke 2004. [DOI: 10.1016/b0-44-306600-0/50019-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
BACKGROUND This review seeks to provide a structured presentation of existing knowledge of leptomeningeal anastomoses from anatomic and functional points of view and to identify problems and possible research directions to foster a better understanding of the subject and of stroke mechanisms. SUMMARY OF REVIEW Available data show that leptomeningeal anastomoses may be important in understanding stroke mechanisms and that leptomeningeal anastomoses play an important role in penumbra outcome. However, the literature shows no consensus between statements on the existence of leptomeningeal anastomoses and compensatory capacity. CONCLUSIONS By analyzing the available literature and identifying the factors that contribute to this confusion, we found that variability and the functional consequences thereof are important but that quantitative data are lacking. Moreover, vascular remodeling is an issue to consider.
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Affiliation(s)
- Mariana Brozici
- Department of Functional Anatomy, University Medical Center Utrecht, H.P. Str 0.305, PO Box 85060, 3508 AB Utrecht, Netherlands.
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Atkinson RP, Awad IA, Batjer HH, Dowd CF, Furlan A, Giannotta SL, Gomez CR, Gress D, Hademenos G, Halbach V, Hemphill JC, Higashida RT, Hopkins LN, Horowitz MB, Johnston SC, Lawton MW, McDermott MW, Malek AM, Mohr JP, Qureshi AI, Riina H, Smith WS, Pile-Spellman J, Spetzler RF, Tomsick TA, Young WL. Reporting terminology for brain arteriovenous malformation clinical and radiographic features for use in clinical trials. Stroke 2001; 32:1430-42. [PMID: 11387510 DOI: 10.1161/01.str.32.6.1430] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
“If you wish to converse with me,” said Voltaire, “define your terms.” How many a debate would have been deflated into a paragraph if the disputants had dared to define their terms!
Will Durant: The Story of Philosophy
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Numaguchi Y, Wang HZ, Stern A, Alleyne CH, Lunsford LD. The arteriovenous malformation associated with major arterial occlusion and moyamoya vessels: a cerebral blood flow study. Interv Neuroradiol 2000; 6:185-93. [PMID: 20667197 DOI: 10.1177/159101990000600303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2000] [Accepted: 08/31/2000] [Indexed: 11/15/2022] Open
Abstract
SUMMARY We report 2 patients with arteriovenous malformation (AVM) associated with complete occlusion of the unilateral middle cerebral artery and moyamoya vessels. Xenon CT CBF study demonstrated diffusely decreased CMF in unilateral or bilateral hemispheres with multiple areas of decreased vascular reserve. A significant reduction of AVM size was seen in one patient who received radiosurgery with marked CBF improvement.
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Affiliation(s)
- Y Numaguchi
- Department of Radiology; University of Rochester Medical Center; Rochester, NY, USA -
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