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Pereira FES, Jagatheesaperumal SK, Benjamin SR, Filho PCDN, Duarte FT, de Albuquerque VHC. Advancements in non-invasive microwave brain stimulation: A comprehensive survey. Phys Life Rev 2024; 48:132-161. [PMID: 38219370 DOI: 10.1016/j.plrev.2024.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 01/16/2024]
Abstract
This survey provides a comprehensive insight into the world of non-invasive brain stimulation and focuses on the evolving landscape of deep brain stimulation through microwave research. Non-invasive brain stimulation techniques provide new prospects for comprehending and treating neurological disorders. We investigate the methods shaping the future of deep brain stimulation, emphasizing the role of microwave technology in this transformative journey. Specifically, we explore antenna structures and optimization strategies to enhance the efficiency of high-frequency microwave stimulation. These advancements can potentially revolutionize the field by providing a safer and more precise means of modulating neural activity. Furthermore, we address the challenges that researchers currently face in the realm of microwave brain stimulation. From safety concerns to methodological intricacies, this survey outlines the barriers that must be overcome to fully unlock the potential of this technology. This survey serves as a roadmap for advancing research in microwave brain stimulation, pointing out potential directions and innovations that promise to reshape the field.
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Affiliation(s)
| | - Senthil Kumar Jagatheesaperumal
- Department of Teleinformatics Engineering, Federal University of Ceará, Fortaleza, 60455-970, Ceará, Brazil; Department of Electronics and Communication Engineering, Mepco Schlenk Engineering College, Sivakasi, 626005, Tamilnadu, India
| | - Stephen Rathinaraj Benjamin
- Department of Pharmacology and Pharmacy, Laboratory of Behavioral Neuroscience, Faculty of Medicine, Federal University of Ceará, Fortaleza, 60430-160, Ceará, Brazil
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2
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Lauzier DC, Srienc AI, Vellimana AK, Dacey Jr RG, Zipfel GJ. Peripheral macrophages in the development and progression of structural cerebrovascular pathologies. J Cereb Blood Flow Metab 2024; 44:169-191. [PMID: 38000039 PMCID: PMC10993883 DOI: 10.1177/0271678x231217001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/10/2023] [Accepted: 09/15/2023] [Indexed: 11/26/2023]
Abstract
The human cerebrovascular system is responsible for maintaining neural function through oxygenation, nutrient supply, filtration of toxins, and additional specialized tasks. While the cerebrovascular system has resilience imparted by elaborate redundant collateral circulation from supportive tertiary structures, it is not infallible, and is susceptible to developing structural vascular abnormalities. The causes of this class of structural cerebrovascular diseases can be broadly categorized as 1) intrinsic developmental diseases resulting from genetic or other underlying aberrations (arteriovenous malformations and cavernous malformations) or 2) extrinsic acquired diseases that cause compensatory mechanisms to drive vascular remodeling (aneurysms and arteriovenous fistulae). Cerebrovascular diseases of both types pose significant risks to patients, in some cases leading to death or disability. The drivers of such diseases are extensive, yet inflammation is intimately tied to all of their progressions. Central to this inflammatory hypothesis is the role of peripheral macrophages; targeting this critical cell type may lead to diagnostic and therapeutic advancement in this area. Here, we comprehensively review the role that peripheral macrophages play in cerebrovascular pathogenesis, provide a schema through which macrophage behavior can be understood in cerebrovascular pathologies, and describe emerging diagnostic and therapeutic avenues in this area.
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Affiliation(s)
- David C Lauzier
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Anja I Srienc
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ananth K Vellimana
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ralph G Dacey Jr
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Gregory J Zipfel
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
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3
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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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4
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Guillaumet G, Shotar E, Clarençon F, Sourour NA, Premat K, Lenck S, Dupont S, Jacquens A, Degos V, Boeken T, Nouet A, Carpentier A, Mathon B. Incidence and risk factors of epilepsy following brain arteriovenous malformation rupture in adult patients. J Neurol 2022; 269:6342-6353. [PMID: 35867151 DOI: 10.1007/s00415-022-11286-6] [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: 04/28/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Little is known about incidence, time of onset, clinical presentation, and risk factors of epileptic seizure following brain arteriovenous malformation (bAVM) rupture. METHODS We performed a monocentric retrospective cohort study from January 2003 to March 2021. The main objective of this study was to determine the incidence of seizures after spontaneous bAVM rupture in nonepileptic adult patients and describe the corresponding clinical features. The secondary objective was to identify clinical, radiological, or biological predictors for the occurrence of de novo seizures after bAVM rupture. RESULTS Of the 296 cases of bAVM rupture registered during the study period, 247 nonepileptic patients (male 53%, median age 40) were included in the study. Fifty-nine patients (23.9%) had at least one seizure after bAVM rupture. The use of preventive antiepileptic drugs (10.3 [1.5-74.1]; P = 0.02) and decompressive craniectomy (15.4 [2.0-125]; P < 0.009) were independently associated with the occurrence of epilepsy after the bAVM rupture. The factors independently associated with the absence of any seizure after the rupture were isolated intraventricular hemorrhage (0.3 [0.1-0.99]; P = 0.04) and infratentorial location of the bAVM (0.2 [0.1-0.5]; P = 0.09). The first seizure occurred within the first year or within 5 years in, respectively, 83.1% and 98.3% of the patients. CONCLUSIONS Epilepsy affects nearly a quarter of patients after bAVM rupture. Decompressive craniectomy represents an independent risk factor significantly associated with the occurrence of epilepsy after bAVM rupture. The introduction of preventive AEDs after rupture could be considered in these most severe patients who have a decompressive craniectomy.
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Affiliation(s)
- Gonzague Guillaumet
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, 75013, France
| | - Eimad Shotar
- Department of Neuroradiology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Frédéric Clarençon
- Department of Neuroradiology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Nader-Antoine Sourour
- Department of Neuroradiology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Kevin Premat
- Department of Neuroradiology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Stéphanie Lenck
- Department of Neuroradiology, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Sophie Dupont
- Epileptology Unit, Department of Rehabilitation, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Alice Jacquens
- Department of Neurosurgical Anesthesiology and Critical Care, AP-HP, La Pitié Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Vincent Degos
- Department of Neurosurgical Anesthesiology and Critical Care, AP-HP, La Pitié Salpêtrière Hospital, Sorbonne University, Paris, France
| | - Tom Boeken
- Department of Vascular and Oncological Interventional Radiology, AP-HP, Centre, Hôpital Européen Georges-Pompidou, 75015, Paris, France.,Université de Paris, 75006, Paris, France
| | - Aurélien Nouet
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, 75013, France
| | - Alexandre Carpentier
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, 75013, France
| | - Bertrand Mathon
- Department of Neurosurgery, AP-HP, La Pitié-Salpêtrière Hospital, Sorbonne University, Paris, 75013, France. .,ICM, INSERM U 1127, CNRS UMR 7225, UMRS 1127, Paris Brain Institute, Sorbonne University, 75013, Paris, France.
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5
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Garcia JH, Winkler EA, Morshed RA, Lu A, Ammanuel SG, Saggi S, Wang EJ, Braunstein S, Fox CK, Fullerton HJ, Kim H, Cooke DL, Hetts SW, Lawton MT, Abla AA, Gupta N. Factors associated with seizures at initial presentation in pediatric patients with cerebral arteriovenous malformations. J Neurosurg Pediatr 2021; 28:663-668. [PMID: 34560640 DOI: 10.3171/2021.6.peds21126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/07/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Children with cerebral arteriovenous malformations (AVMs) can present with seizures, potentially increasing morbidity and impacting clinical management. However, the factors that lead to seizures as a presenting sign are not well defined. While AVM-related seizures have been described in case series, most studies have focused on adults and have included patients who developed seizures after an AVM rupture. To address this, the authors sought to analyze demographic and morphological characteristics of AVMs in a large cohort of children. METHODS The demographic, clinical, and AVM morphological characteristics of 189 pediatric patients from a single-center database were studied. Univariate and multivariate logistic regression models were used to test the effect of these characteristics on seizures as an initial presenting symptom in patients with unruptured brain AVMs. RESULTS Overall, 28 of 189 patients initially presented with seizures (14.8%). By univariate comparison, frontal lobe location (p = 0.02), larger AVM size (p = 0.003), older patient age (p = 0.04), and the Supplemented Spetzler-Martin (Supp-SM) grade (0.0006) were associated with seizure presentation. Multivariate analysis confirmed an independent effect of frontal lobe AVM location and higher Supp-SM grade. All patients presenting with seizures had AVMs in the cortex or subcortical white matter. CONCLUSIONS While children and adults share some risk factors for seizure presentation, their risk factor profiles do not entirely overlap. Pediatric patients with cortical AVMs in the frontal lobe were more likely to present with seizures. Additionally, the Supp-SM grade was highly associated with seizure presentation. Future clinical research should focus on the effect of therapeutic interventions targeting AVMs on seizure control in these patients.
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Affiliation(s)
- Joseph H Garcia
- 1Department of Neurological Surgery, University of California San Francisco, San Francisco
| | - Ethan A Winkler
- 1Department of Neurological Surgery, University of California San Francisco, San Francisco
| | - Ramin A Morshed
- 1Department of Neurological Surgery, University of California San Francisco, San Francisco
| | - Alex Lu
- 1Department of Neurological Surgery, University of California San Francisco, San Francisco
| | - Simon G Ammanuel
- 1Department of Neurological Surgery, University of California San Francisco, San Francisco
| | - Satvir Saggi
- 1Department of Neurological Surgery, University of California San Francisco, San Francisco
| | - Elaina J Wang
- 1Department of Neurological Surgery, University of California San Francisco, San Francisco
| | - Steve Braunstein
- 2Department of Radiation Oncology, University of California San Francisco, San Francisco
| | - Christine K Fox
- 3Pediatric Stroke and Cerebrovascular Disease Center, Department of Neurology, University of California San Francisco, San Francisco
| | - Heather J Fullerton
- 3Pediatric Stroke and Cerebrovascular Disease Center, Department of Neurology, University of California San Francisco, San Francisco
| | - Helen Kim
- 4Center for Cerebrovascular Research, Department of Anesthesia and Perioperative Care, University of California San Francisco, San Francisco
| | - Daniel L Cooke
- 5Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco
| | - Steven W Hetts
- 5Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco
| | - Michael T Lawton
- 1Department of Neurological Surgery, University of California San Francisco, San Francisco
- 6Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Adib A Abla
- 1Department of Neurological Surgery, University of California San Francisco, San Francisco
| | - Nalin Gupta
- 1Department of Neurological Surgery, University of California San Francisco, San Francisco
- 7Department of Pediatrics, University of California San Francisco, San Francisco, California; and
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6
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Capocci R, Bustuchina Vlaicu M, Shotar E, Mathon B, Delaitre M, Premat K, Talaat M, Talbi A, Boch AL, Lenck S, Carpentier A, Degos V, Sourour NA, Clarençon F. Benefits from Exclusion Treatment of Unruptured Brain Arteriovenous Malformations on Epilepsy in Adults. Clin Neuroradiol 2021; 32:749-760. [PMID: 34807285 DOI: 10.1007/s00062-021-01119-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE In approximately 30% of the patients, brain arteriovenous malformations (bAVMs) are revealed by seizures, which may alter the patients' quality of life. Our objective was to evaluate the benefits of exclusion treatment (radiosurgery, embolization and/or surgery) on posttherapeutic epilepsy in bAVM patients without intracranial hemorrhage prior to treatment. METHODS Our retrospective observational single-center study included all consecutive adult patients with an unruptured bAVM and epilepsy, treated at our institution from 1995 to 2019 and who were followed for at least 1 year. Data on angioarchitectural characteristics of bAVMs, on epilepsy and posttreatment modified Rankin Scale (mRS) were collected. The primary endpoint was a seizure-free status (defined as Engel class IA) after exclusion treatment versus conservative management. RESULTS In this study one hundred and one consecutive adult patients with bAVMs, epilepsy and without bAVM rupture before any treatment were included; 21 (21%) in the conservative management group vs. 80 (79%) in the exclusion treatment group. After exclusion treatment, 55% of the patients from the group were Engel IA after treatment vs. 10% of the conservative management group (odds ratio [OR] 11.37, 95% confidence interval [CI] 2.48-107.24, p < 0.001). CONCLUSION Our results suggest that exclusion treatment in unruptured bAVMs with epilepsy is associated with a higher seizure-free rate in comparison with conservative management. Data from randomized controlled studies are necessary to confirm these findings.
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Affiliation(s)
- Romain Capocci
- Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | | | - Eimad Shotar
- Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Bertrand Mathon
- Department of Neurosurgery, Pitie-Salpêtrière Hospital, Paris, France.,Sorbonne University Medical School, Paris, France
| | | | - Kévin Premat
- Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.,Sorbonne University Medical School, Paris, France
| | - Maichael Talaat
- Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.,Department of Radiology, Zagazig University Hospital, Zagazig, Egypt
| | - Atika Talbi
- Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Anne-Laure Boch
- Department of Neurosurgery, Pitie-Salpêtrière Hospital, Paris, France
| | - Stéphanie Lenck
- Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Alexandre Carpentier
- Department of Neurosurgery, Pitie-Salpêtrière Hospital, Paris, France.,Sorbonne University Medical School, Paris, France
| | - Vincent Degos
- Sorbonne University Medical School, Paris, France.,Department of Neuro-Intensive Care, Pitie-Salpêtrière Hospital, Paris, France.,GRC BioFast. Paris VI University, Paris, France
| | - Nader Antoine Sourour
- Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France
| | - Frédéric Clarençon
- Department of Neuroradiology, Pitie-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. .,Sorbonne University Medical School, Paris, France. .,GRC BioFast. Paris VI University, Paris, France.
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7
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Current concepts and perspectives on brain arteriovenous malformations: A review of pathogenesis and multidisciplinary treatment. World Neurosurg 2021; 159:314-326. [PMID: 34339893 DOI: 10.1016/j.wneu.2021.07.106] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/22/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022]
Abstract
Brain arteriovenous malformations (bAVMs) are unusual vascular pathologies characterized by the abnormal aggregation of dilated arteries and veins in the brain parenchyma and for which the absence of a normal vascular structure and capillary bed leads to direct connections between arteries and veins. Although bAVMs have long been believed to be congenital anomalies that develop during the prenatal period, current studies show that inflammation is associated with AVM genesis, growth, and rupture. Interventional treatment options include microsurgery, stereotactic radiosurgery, and endovascular embolization, and management often comprises a multidisciplinary combination of these modalities. The appropriate selection of patients with brain arteriovenous malformations for interventional treatment requires balancing the risk of treatment complications against the risk of hemorrhaging during the natural course of the pathology; however, no definitive guidelines have been established for the management of brain arteriovenous malformations. In this paper, we comprehensively review the current basic and clinical studies on bAVMs and discuss the contemporary status of multidisciplinary management of bAVMs.
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8
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Prablek M, LoPresti MA, Du R, Lam S. Arteriovenous Malformations-Associated Epilepsy in Pediatrics. Childs Nerv Syst 2021; 37:2261-2268. [PMID: 33895871 DOI: 10.1007/s00381-021-05170-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/14/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Seizures are the second most common presentation of cerebral arteriovenous malformations (AVMs); pediatric patients are more likely to develop AVM-associated epilepsy. We examined the role of multimodality AVM treatment in pediatric AVM-associated epilepsy to characterize long-term epilepsy outcomes. METHODS A retrospective chart review identified pediatric patients with AVM-associated epilepsy seen at our institution from 2005 to 2018. Variables measured included demographic and descriptive data. Primary outcomes included seizure freedom, seizure control, and functional outcomes. RESULTS Of 105 pediatric patients with AVMs, 18 had AVM-related epilepsy. Thirteen underwent surgical resection, of which 6 underwent preoperative embolization. Twelve (92.31%) had complete resection; one (7.69%) with residual underwent redo craniotomy with subsequent complete resection. All had radiographic cure at most recent follow-up, with no recurrence seen during length of follow-up (mean 2.17 years, SD 1.40, range 0.25-4.41). Eight (61.54%) experienced seizure freedom postoperatively; 12 (92.31%) were modified Engel Class I at last follow-up. Five patients underwent treatment without open surgical resection, with conservative management (3, 60%) or endovascular embolization (2, 40%). None in our cohort underwent radiosurgery. Of those embolized, one had complete AVM obliteration and two had partial obliteration. Four of the 5 patients (80%) treated without open surgery achieved seizure freedom. CONCLUSION Long-term outcomes of AVM-related epilepsy are poorly characterized in children. We found that in addition to improved AVM outcomes regarding obliteration, treatment of residual, and recurrence, pediatric patients undergoing surgical AVM treatment had improved AVM-associated epilepsy outcomes, with 61.54% achieving seizure freedom and 92.31% classified as modified Engel Class I seizure control.
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Affiliation(s)
- Marc Prablek
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, 7200 Cambridge Ave, Suite 9A, Houston, TX, 77030, USA.
| | - Melissa A LoPresti
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, 7200 Cambridge Ave, Suite 9A, Houston, TX, 77030, USA
| | - Rebecca Du
- Department of Neurosurgery, Northwestern University School of Medicine, Lurie Children's Hospital, Chicago, IL, USA
| | - Sandi Lam
- Department of Neurosurgery, Northwestern University School of Medicine, Lurie Children's Hospital, Chicago, IL, USA
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9
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Posttraumatic epilepsy may be a state in which underlying epileptogenicity involves focal cortical dysplasia. Epilepsy Behav 2021; 114:107352. [PMID: 32843304 DOI: 10.1016/j.yebeh.2020.107352] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/16/2020] [Accepted: 07/16/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The occurrence rate of posttrauma epilepsy ranges widely from 1% to 30%. Little is known about the underlying epileptogenesis of traumatic brain injury (TBI)-related epilepsy (TRE), because no comparison between TRE and TBI without epilepsy has been performed in terms of neuropathology. Therefore, we postulated that different neuropathological factors may be present between TRE and TBI without epilepsy. The purpose of this study was to clarify differences between TRE and TBI without epilepsy. METHODS We studied patients who experienced severe head trauma and underwent brain surgery. The age range of the patients was 9-71 years old. Patients with medically resistant epilepsy were included in the Epilepsy group, and patients without epilepsy were included in the nonepilepsy group. Pathological findings, age, sex, and cause of head trauma were statistically compared between these two groups. RESULTS This study involved 10 patients, nine of whom met the inclusion criteria. Pathological findings for all patients in the Epilepsy group included focal cortical dysplasia (FCD) (p = 0.012). CONCLUSION The difference between TRE and TBI without epilepsy was underlying FCD in patients with TRE.
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10
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Florian IA, Popovici L, Timis TL, Florian IS, Berindan-Neagoe I. Intracranial Gorgon: Surgical Case Report of a Large Calcified Brain Arteriovenous Malformation. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e922872. [PMID: 32341328 PMCID: PMC7200094 DOI: 10.12659/ajcr.922872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Patient: Male, 55-year-old Final Diagnosis: Right frontal arteriovenous malformation, partially calcified • multiple generalised epileptic seizures • chronic headache Symptoms: Epilectic seizure • headache Medication: — Clinical Procedure: Neurosurgical resection of the right frontal AVM Specialty: Neurosurgery
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Affiliation(s)
- Ioan Alexandru Florian
- Clinic of Neurosurgery, Cluj County Emergency Clinical Hospital, Cluj-Napoca, Romania.,Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Laura Popovici
- Department of General Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Teodora Larisa Timis
- Department of Physiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Stefan Florian
- Department of Neurosurgery, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioana Berindan-Neagoe
- MEDFUTURE Research Center for Advanced Medicine, Cluj-Napoca, Romania.,Research Center for Functional Genomics, Biomedicine, and Translational Medicine, Institute of Doctoral Studies, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Experimental Pathology, "Prof. Ion Chiricuta", The Oncology Institute, Cluj-Napoca, Romania
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11
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Soldozy S, Norat P, Yağmurlu K, Sokolowski JD, Sharifi KA, Tvrdik P, Park MS, Kalani MYS. Arteriovenous malformation presenting with epilepsy: a multimodal approach to diagnosis and treatment. Neurosurg Focus 2020; 48:E17. [DOI: 10.3171/2020.1.focus19899] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 01/28/2020] [Indexed: 11/06/2022]
Abstract
Arteriovenous malformation (AVM) presenting with epilepsy significantly impacts patient quality of life, and it should be considered very much a seizure disorder. Although hemorrhage prevention is the primary treatment aim of AVM surgery, seizure control should also be at the forefront of therapeutic management. Several hemodynamic and morphological characteristics of AVM have been identified to be associated with seizure presentation. This includes increased AVM flow, presence of long pial draining vein, venous outflow obstruction, and frontotemporal location, among other aspects. With the advent of high-throughput image processing and quantification methods, new radiographic attributes of AVM-related epilepsy have been identified. With respect to therapy, several treatment approaches are available, including conservative management or interventional modalities; this includes microsurgery, radiosurgery, and embolization or a combination thereof. Many studies, especially in the domain of microsurgery and radiosurgery, evaluate both techniques with respect to seizure outcomes. The advantage of microsurgery lies in superior AVM obliteration rates and swift seizure response. In addition, by incorporating electrophysiological monitoring during AVM resection, adjacent or even remote epileptogenic foci can be identified, leading to extended lesionectomy and improved seizure control. Radiosurgery, despite resulting in reduced AVM obliteration and prolonged time to seizure freedom, avoids the risks of surgery altogether and may provide seizure control through various antiepileptic mechanisms. Embolization continues to be used as an adjuvant for both microsurgery and radiosurgery. In this study, the authors review the latest imaging techniques in characterizing AVM-related epilepsy, in addition to reviewing each treatment modality.
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12
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Benson JC, Chiu S, Flemming K, Nasr DM, Lanzino G, Brinjikji W. MR characteristics of unruptured intracranial arteriovenous malformations associated with seizure as initial clinical presentation. J Neurointerv Surg 2019; 12:186-191. [DOI: 10.1136/neurintsurg-2019-015021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 11/04/2022]
Abstract
BackgroundPatients with intracranial arteriovenous malformations (AVMs) are at increased risk of seizures.ObjectiveTo identify MRI characteristics of unruptured intracranial AVMs associated with seizures at presentation.Materials and methodsA retrospective review was completed of patients diagnosed with unruptured intracranial AVMs on MRI between January 1, 2000 and December 31, 2016. Two blinded reviewers assessed demographics, lesion locality, and imaging and architectural characteristics of AVMs and surrounding parenchyma, including, but not limited to, AVM location, venous drainage pattern, venous varix, thrombosed venous varix, long draining vein, AVM-related gliosis, peri-AVM edema, and peri-AVM T2* signal. Findings were statistically analyzed for correlation with seizure using Student’s t-test for continuous variables and Χ2 test for categorical variables.ResultsOf 165 included patients, 57/165 (34.5%) patients were imaged as part of an investigation for seizures. Patients with seizures more commonly had peri-AVM edema (36.8%, compared with 11.1% of non-seizure patients, p<0.0001), peri-AVM T2* blooming (28.1% vs 7.4%; p=0.029), a venous pouch/varix (61.4% vs 31.5%, p=0.0003), long draining vein (91.2% vs 55.6%, p<0.0001), and larger size based on Spetzler-Martin grade categorization (p=0.006). By location, AVMs located in the frontal lobe, primary motor cortex, and primary sensory cortex were associated with seizures (p=0.004, p=0.001, and p=0.006, respectively); temporal lobe location was not associated with seizures (p=0.459).ConclusionsCertain MRI characteristics of unruptured intracranial AVMs are associated with seizures. Such correlations may assist in identifying the pathophysiological mechanisms by which AVMs cause seizures.
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Zhang Y, Yan P, Liang F, Ma C, Liang S, Jiang C. Predictors of Epilepsy Presentation in Unruptured Brain Arteriovenous Malformations: A Quantitative Evaluation of Location and Radiomics Features on T2-Weighted Imaging. World Neurosurg 2019; 125:e1008-e1015. [PMID: 30771548 DOI: 10.1016/j.wneu.2019.01.229] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To explore predictors of epilepsy presentation in unruptured brain arteriovenous malformations (bAVMs) with quantitative evaluation of location and radiomics features on T2-weighted imaging. METHODS This retrospective study identified 117 patients with unruptured bAVMs. Cases were randomly split into training dataset (n = 90) and test dataset (n = 27). On the training dataset, we applied atlas-based analysis to identify epilepsy-susceptible brain regions of bAVMs, and then applied the radiomics technique to explore shape, intensity, and textural features that were correlated with epilepsy presentation. Informative radiomics predictors were selected by least absolute shrinkage and selection operator with 3-fold cross-validation. A linear classification score was then constructed, and we tested if we could precisely identify epilepsy-susceptible bAVMs with the location and radiomics predictors. RESULTS Two brain regions and 4 radiomics features were screened out as predictors for epilepsy. The percent of damage of the right precentral gyrus and the right superior longitudinal fasciculus was associated with epilepsy presentation. The 4 radiomics features were Original_firstorder_Median, Wavelet-LHL_firstorder_InterquartileRange, Wavelet-HHL_firstorder_InterquartileRange, and Wavelet-HHH_glrlm_RunVariance. Epileptogenic bAVMs had larger variance of run lengths, larger median value, and interquartile range of voxel intensities. On the training dataset, these 6 predictors were able to classify epilepsy-susceptible bAVMs with accuracy at 0.822, and the area under the curve was 0.866 (95% confidence interval, 0.791-0.940). On the test dataset, sensitivity, specificity, and accuracy of classification reached 0.786, 0.769, and 0.778, respectively. CONCLUSIONS Epilepsy-susceptible bAVMs had distinct locations and radiomics features on T2-weighted imaging.
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Affiliation(s)
- Yupeng Zhang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Peng Yan
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fei Liang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chao Ma
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shikai Liang
- Department of Neurosurgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Chuhan Jiang
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Ironside N, Chen CJ, Ding D, Ilyas A, Kumar JS, Buell TJ, Taylor D, Lee CC, Sheehan JP. Seizure Outcomes After Radiosurgery for Cerebral Arteriovenous Malformations: An Updated Systematic Review and Meta-Analysis. World Neurosurg 2018; 120:550-562.e3. [DOI: 10.1016/j.wneu.2018.08.121] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 11/30/2022]
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15
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Russell D, Peck T, Ding D, Chen CJ, Taylor DG, Starke RM, Lee CC, Sheehan JP. Stereotactic radiosurgery alone or combined with embolization for brain arteriovenous malformations: a systematic review and meta-analysis. J Neurosurg 2018; 128:1338-1348. [DOI: 10.3171/2016.11.jns162382] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEEmbolization of brain arteriovenous malformations (AVMs) prior to stereotactic radiosurgery (SRS) has been reported to negatively affect obliteration rates. The goal of this systematic review and meta-analysis was to compare the outcomes of AVMs treated with embolization plus SRS (E+SRS group) and those of AVMs treated with SRS alone (SRS group).METHODSA literature review was performed using PubMed to identify studies with 10 or more AVM patients and obliteration data for both E+SRS and SRS groups. A meta-analysis was performed to compare obliteration rates between the E+SRS and SRS groups.RESULTSTwelve articles comprising 1716 patients were eligible for analysis. Among the patients with radiological follow-up data, complete obliteration was achieved in 48.4% of patients (330/681) in the E+SRS group compared with 62.7% of patients (613/978) in the SRS group. A meta-analysis of the pooled data revealed that the obliteration rate was significantly lower in the E+SRS group (OR 0.51, 95% CI 0.41–0.64, p < 0.00001). Symptomatic adverse radiation effects were observed in 6.6% (27/412 patients) and 11.1% (48/433 patients) of the E+SRS and SRS groups, respectively. The annual post-SRS hemorrhage rate was 2.0%–6.5% and 0%–2.0% for the E+SRS and SRS groups, respectively. The rates of permanent morbidity were 0%–6.7% and 0%–13.5% for the E+SRS and SRS groups, respectively.CONCLUSIONSArteriovenous malformation treatment with combined embolization and SRS is associated with lower obliteration rates than those with SRS treatment alone. However, this comparison does not fully account for differences in the initial AVM characteristics in the E+SRS group as compared with those in the SRS group. Further studies are warranted to address these limitations.
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Affiliation(s)
| | | | - Dale Ding
- 2Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Ching-Jen Chen
- 2Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Davis G. Taylor
- 2Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Robert M. Starke
- 4Deparment of Neurological Surgery, University of Miami, Florida
| | - Cheng-Chia Lee
- 3Deparment of Neurological Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; and
| | - Jason P. Sheehan
- 2Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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Quan K, Tang X, Song J, Chen X, Tian Y, Liu P, Shi Y, Yang Z, Liu Y, Zhou F, Pan L, Zhu W. Salvage Therapy for Brain Arteriovenous Malformations After Failure of Gamma Knife Stereotactic Radiosurgery. World Neurosurg 2018; 110:e942-e951. [DOI: 10.1016/j.wneu.2017.11.143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 11/22/2017] [Accepted: 11/23/2017] [Indexed: 10/18/2022]
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17
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Ilyas A, Chen CJ, Ding D, Taylor DG, Moosa S, Lee CC, Cohen-Inbar O, Sheehan JP. Volume-staged versus dose-staged stereotactic radiosurgery outcomes for large brain arteriovenous malformations: a systematic review. J Neurosurg 2018; 128:154-164. [PMID: 28128692 DOI: 10.3171/2016.9.jns161571] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Several recent studies have improved our understanding of the outcomes of volume-staged (VS) and dose-staged (DS) stereotactic radiosurgery (SRS) for the treatment of large (volume > 10 cm3) brain arteriovenous malformations (AVMs). In light of these recent additions to the literature, the aim of this systematic review is to provide an updated comparison of VS-SRS and DS-SRS for large AVMs. METHODS A systematic review of the literature was performed using PubMed to identify cohorts of 5 or more patients with large AVMs who had been treated with VS-SRS or DS-SRS. Baseline data and post-SRS outcomes were extracted for analysis. RESULTS A total of 11 VS-SRS and 10 DS-SRS studies comprising 299 and 219 eligible patients, respectively, were included for analysis. The mean obliteration rates for VS-SRS and DS-SRS were 41.2% (95% CI 31.4%-50.9%) and 32.3% (95% CI 15.9%-48.8%), respectively. Based on pooled individual patient data, the outcomes for patients treated with VS-SRS were obliteration in 40.3% (110/273), symptomatic radiation-induced changes (RICs) in 13.7% (44/322), post-SRS hemorrhage in 19.5% (50/256), and death in 7.4% (24/323); whereas the outcomes for patients treated with DS-SRS were obliteration in 32.7% (72/220), symptomatic RICs in 12.2% (31/254), post-SRS hemorrhage in 10.6% (30/282), and death in 4.6% (13/281). CONCLUSIONS Volume-staged SRS appears to afford higher obliteration rates than those achieved with DS-SRS, although with a less favorable complication profile. Therefore, VS-SRS or DS-SRS may be a reasonable treatment approach for large AVMs, either as stand-alone therapy or as a component of a multimodality management strategy.
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Affiliation(s)
- Adeel Ilyas
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Ching-Jen Chen
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Dale Ding
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Davis G Taylor
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Shayan Moosa
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Cheng-Chia Lee
- 2Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Or Cohen-Inbar
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Jason P Sheehan
- 1Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia; and
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Ambrosi M, Orsini A, Verrotti A, Striano P. Medical management for neurosurgical related seizures. Expert Opin Pharmacother 2017; 18:1491-1498. [DOI: 10.1080/14656566.2017.1373092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Michela Ambrosi
- Department of Pediatrics, University of L’Aquila, L’Aquila, Italy
| | - Alessandro Orsini
- Paediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, “G.Gaslini” Institute, University of Genova, Genova, Italy
| | - Alberto Verrotti
- Department of Pediatrics, University of L’Aquila, L’Aquila, Italy
| | - Pasquale Striano
- Paediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, “G.Gaslini” Institute, University of Genova, Genova, Italy
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O’Donnell JM, Morgan MK, Heller GZ. The Risk of Seizure Following Surgery for Brain Arteriovenous Malformation: A Prospective Cohort Study. Neurosurgery 2017; 81:935-948. [DOI: 10.1093/neuros/nyx101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/15/2017] [Indexed: 11/15/2022] Open
Abstract
Abstract
BACKGROUND
The evidence for the risk of seizures following surgery for brain arteriovenous malformations (bAVM) is limited.
OBJECTIVE
To determine the risk of seizures after discharge from surgery for supratentorial bAVM.
METHODS
A prospectively collected cohort database of 559 supratentorial bAVM patients (excluding patients where surgery was not performed with the primary intention of treating the bAVM) was analyzed. Cox proportional hazards regression models (Cox regression) were generated assessing risk factors, a Receiver Operator Characteristic curve was generated to identify a cut-point for size and Kaplan–Meier life table curves created to identify the cumulative freedom from postoperative seizure.
RESULTS
Preoperative histories of more than 2 seizures and increasing maximum diameter (size, cm) of bAVM were found to be significantly (P < .01) associated with the development of postoperative seizures and remained significant in the Cox regression (size as continuous variable: P = .01; hazard ratio: 1.2; 95% confidence interval: 1.0-1.3; more than 2 seizures: P = .02; hazard ratio: 2.1; 95% confidence interval: 1.1-3.8). The cumulative risk of first seizure after discharge from hospital following resection surgery for all patients with bAVM was 5.8% and 18% at 12 mo and 7 yr, respectively. The 7-yr risk of developing postoperative seizures ranged from 11% for patients with bAVM ≤4 cm and with 0 to 2 preoperative seizures, to 59% for patients with bAVM >4 cm and with >2 preoperative.
CONCLUSION
The risk of seizures after discharge from hospital following surgery for bAVM increases with the maximum diameter of the bAVM and a patient history of more than 2 preoperative seizures.
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Affiliation(s)
| | | | - Gillian Z Heller
- Department of Statistics, Macquarie University, Sydney NSW, Australia
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20
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Akhigbe T, Zolnourian A, Bulters D. Compliance of systematic reviews articles in brain arteriovenous malformation with PRISMA statement guidelines: Review of literature. J Clin Neurosci 2017; 39:45-48. [PMID: 28246008 DOI: 10.1016/j.jocn.2017.02.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 02/08/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The knowledge of reporting compliance of systematic reviews with PRISMA guidelines may assist in improving the quality of secondary research in brain AVM management and subsequently application to patient population and clinical practice. This may allow researchers and clinicians to be equipped to appraise existing literatures based on known deficit to look for or expect. The objective of this study was to assess the compliance of systematic reviews and meta-analysis in the management of brain AVM. METHODS Systematic reviews and meta-analyses articles published in medical journals between 1st of May 2011 and 30th April 2016 (five-year period) were examined. Exclusion criteria were articles that were not systematic reviews and not meta-analyses, narrative literature reviews, historical literature reviews, animal studies, unpublished articles, commentaries and letter to the editor. Electronic database search performed through Medline PubMed on 20th September 2016. RESULTS This systematic review examined seven systematic review articles on intracranial arteriovenous malformation compliance with PRISMA statement guidelines. The mean percentage of applicable PRISMA items across all studies was 74% (range 67-93%). Protocol registration and declaration, risk of bias and funding sources were the most poorly reported of the PRISMA items (14% each). A significant variance in the total percentages was evident between studies (67-93%). CONCLUSION Systematic review reporting in medical literature is excessively variable and overall poor. As these papers are being published with increasing frequency, need to fully adhere to PRISMA statement guide for systematic review to ensure high-quality publications. Complete reporting of PRISMA items within systematic reviews in cerebral arteriovenous malformation enhance quality assessment, robust critical appraisal, better judgement and ultimately sound application to practice thereby improving research standards and patients care.
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Affiliation(s)
- T Akhigbe
- Clincal Research Fellow, University Hospital Southampton, UK.
| | - A Zolnourian
- Clincal Research Fellow, University Hospital Southampton, UK.
| | - D Bulters
- Consultant Neurosurgeon, University Hospital Southampton, UK.
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Tong X, Wu J, Cao Y, Zhao Y, Wang S, Zhao J. Microsurgical Outcome of Unruptured Brain Arteriovenous Malformations: A Single-Center Experience. World Neurosurg 2016; 99:644-655. [PMID: 28042014 DOI: 10.1016/j.wneu.2016.12.088] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/19/2016] [Accepted: 12/20/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We describe our single-center experience treating unruptured brain arteriovenous malformations (uBAVMs) with microsurgical treatment. METHODS During a 7-year period, 282 patients with uBAVMs were surgically treated at our institution. Patient clinical features, postsurgical complications, arteriovenous malformation obliteration rate, seizure control, and functional outcome were collected and analyzed. Seizure control was evaluated with the Engel classification system. Patient functional outcome was assessed with modified Rankin Scale score. RESULTS Complete obliteration was achieved in 98.2% of cases. Surgical mortality rate was zero, and overall mortality rate was 1.1%. Good functional outcome (modified Rankin Scale score 0-1) was achieved in 86.9% of all patients, including 92.5% of patients with Spetzler-Martin (S-M) grade I and II uBAVMs, 80.6% of patients with S-M grade III uBAVMs, and 62.5% of patients with S-M grade IV and V uBAVMs. Poor outcome was significantly associated with arteriovenous malformation size ≥6 cm, deep venous drainage, eloquent location, and poor seizure control (all P < 0.05). For 177 patients with presurgical seizures, good seizure outcome (Engel class I) was achieved in 124 (70.1%) patients after microsurgical treatment. A short history of seizure occurrence, fewer presurgical seizures, and generalized tonic-clonic seizure type may be predictors of good seizure outcome (all P < 0.05). CONCLUSIONS Good functional outcome can be achieved by microsurgical resection in S-M grade I and II and selected grade III uBAVMs. Surgical resection for high-grade (grade IV and V) uBAVMs is challenging. A high seizure-free rate can be achieved in patients with initial seizure presentation.
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Affiliation(s)
- Xianzeng Tong
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China
| | - Jun Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular 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; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, 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; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular 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; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Diseases, Beijing, China
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Biological relevance of tissue factor and IL-6 in arteriovenous malformations. Neurosurg Rev 2016; 40:359-367. [PMID: 27542852 DOI: 10.1007/s10143-016-0780-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 08/02/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
Abstract
Arteriovenous malformations (AVMs) are congenital abnormal vessels that shunt blood directly from the arterial to the venous system without a capillary bed. The underlying pathology of AVMs is not fully understood. The objective of the study was to determine the association between the expression patterns of tissue factor (TF) and interleukin-6 (IL-6) in AVMs with clinical and pathological findings. Eighteen cases of sporadic AVM with operative specimens were included in this study. The expression of messenger RNA (mRNA) of TF and IL-6 was assayed, and association with clinical factors was investigated. The distribution of TF and IL-6 was examined with immunofluorescence. The mRNA expression of TF was significantly higher in AVM specimens than in control tissues (P = 0.002) and significantly higher in the symptomatic group than in the asymptomatic group (P = 0.037). The mRNA expression of IL-6 was likewise significantly higher in AVM specimens than in control tissues (P = 0.038). Examination of immunostained sections indicated that TF+ cells were also positive for IL-6 and were distributed around normal endothelial cells and pericytes. Moreover, TF+/IL-6+ cells also expressed CD31, vascular endothelial growth factor receptor 2 (VEGFR2), and platelet-derived growth factor receptor beta (PDGFR-beta). These results suggest that TF is elevated in AVMs and that it mediates symptomatic events. IL-6 is associated with the angiogenic activity of TF, and both are present in the same abnormal endothelial cells and pericytes. These factors may have interactive effects and may serve in a prognostic role for AVMs.
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