RESUMO
Unruptured brain AVMs (bAVMs) remain a controversial subject for practicing neurosurgeons, especially in the light of ARUBA and other observational studies. This retrospective study aims to analyze our experience with unruptured bAVMs to see whether it is beneficial in the long-term and how it corresponds to large literature trials. The study comprised 160 adult patients with unruptured bAVMs surgically treated in Burdenko NMC (Moscow) in 2009-2017. Mean age: 33.4 ± 10леÑ. Clinical presentations were: seizures in 99 (61.9%), chronical headaches-49 (30.6%), ischemic symptoms-4 (2.5%), asymptomatic in 8 (5%) patients. Spetzler-Martin scale: I-18 pt. (11.3%), II-71 pt. (44.4%), III-60 pt. (37.5%), IV-11 pt. (6.8%). Good outcomes (mRS = 0-2) at discharge were achieved in 149 (93.1%), satisfactory (mRS-3)-9 (5.6%). Follow-up was complete for 97 (60.6%) patients, mean-59.3 (13-108 month). Excellent outcomes (mRS = 0-1) reached in 94.8%. For epilepsy patients, Engel I outcome was found in 50 (84.8%); for chronic headaches, 43 (66.1%) patients reported improvement. Postoperative visual field defects were followed in 22 of 55 (40%), complete recovery was reported in 6 (27%) and partial recovery in 8 (36%) patients. Overall, our results support the conclusion that surgery for low-grade bAVMs (S-M I-II) is a beneficial, low-risk option.
Assuntos
Malformações Arteriovenosas Intracranianas , Radiocirurgia , Adulto , Encéfalo , Humanos , Malformações Arteriovenosas Intracranianas/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Developmental venous anomaly (DVA) or venous angioma is a common anomaly of cerebral veins that is found incidentally in the majority of cases. There are few cases of arteriovenous shunting in DVA associated with a more malignant course of the disease. Whether these DVAs with shunts are of congenital pathology or lifetime formations is unclear. CASE DESCRIPTION: We report a case of lifetime arteriovenous shunt formation in DVA that caused intracerebral hemorrhage in a child. The patient underwent 2 sequential direct surgeries: an emergency evacuation of the intracerebral hematoma and a scheduled excision of the DVA with arteriovenous shunting. CONCLUSIONS: Arteriovenous shunting in DVA may develop during a lifetime and cause intracerebral hemorrhages. This case showed that localization of DVA with arteriovenous shunting in a noneloquent area enables its complete microsurgical excision with favorable functional outcomes.
Assuntos
Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/fisiopatologia , Angioma Venoso do Sistema Nervoso Central/complicações , Angioma Venoso do Sistema Nervoso Central/fisiopatologia , Hemorragia Cerebral/etiologia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Angioma Venoso do Sistema Nervoso Central/diagnóstico por imagem , Angioma Venoso do Sistema Nervoso Central/cirurgia , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/fisiopatologia , Hemorragia Cerebral/cirurgia , Criança , Pré-Escolar , Progressão da Doença , Feminino , HumanosRESUMO
BACKGROUND: Angiolipomas are mesenchymal tumors composed of mature adipocytes with abnormal vascular elements. They are most commonly found in subcutaneous tissues of the trunk and are rarely seen at craniospinal axes. CASE DESCRIPTION: We present an untypical case of frontal lobe angiolipoma manifested with seizures and initially described as an arteriovenous malformation. CONCLUSION: MRI with fat-suppression sequence plays key role in angiolipomas diagnostics.