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1.
World Neurosurg ; 133: e197-e204, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31491572

RESUMO

OBJECTIVE: To evaluate the functional connectivity (FC) and resting-state networks (RSNs) in patients under anesthesia operated for resection of intracerebral lesions. METHODS: We performed intraoperative resting-state functional magnetic resonance imaging (irs-fMRI) in 24 patients under anesthesia before and after lesion resection. Correlation matrices were established for each session (a total 48 of sessions). We analyzed the changes in overall FC and in FC of the healthy and operated hemispheres between the first and second sessions. We tested the correlation between changes in FC and clinical outcomes and the duration, rate, and total dosage of anesthesia. We also performed a group analysis to detect topographic changes in RSNs in patients under anesthesia. A single-subject analysis was performed to detect clinically relevant RSNs in each patient. RESULTS: FC decreased significantly in the second session, as did interhemispheric connectivity. The decrease in the pathological hemisphere was significant and significantly greater than the decrease in the intrahemispheric connectivity of the healthy hemisphere. The change in FC was not correlated with clinical outcome or with the duration, rate, or dosage of anesthesia. Group analysis showed topographic changes in RSNs, especially in high-level networks such as default mode and salience networks. Identification of clinically relevant networks was also possible. CONCLUSIONS: FC and RSNs could be identified under anesthesia and used for extended brain mapping. Further studies are needed to optimize the depth of hypnosis to stabilize FC between sessions.


Assuntos
Neoplasias Encefálicas/diagnóstico por imagem , Conectoma/métodos , Glioma/diagnóstico por imagem , Hemangioma Cavernoso/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Neuronavegação/métodos , Radiografia Intervencionista/métodos , Cirurgia Assistida por Computador , Adolescente , Adulto , Idoso , Neoplasias Encefálicas/cirurgia , Pré-Escolar , Feminino , Glioma/cirurgia , Hemangioma Cavernoso/cirurgia , Humanos , Malformações Arteriovenosas Intracranianas/cirurgia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
2.
No Shinkei Geka ; 47(12): 1281-1287, 2019 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-31874950

RESUMO

BACKGROUND: Patients with hereditary hemorrhagic telangiectasia(HHT)are known to have high rates of cerebral arteriovenous malformations(AVMs). Compared to patients with sporadic AVMs, patients with HHT are less likely to present with ruptured AVMs. CASE REPORT: A 14-year-old male patient presented with headache that had lasted for 2 days. CT revealed an intracerebral hemorrhage in the right parietal lobe, and enhanced CT revealed an AVM in the upper part of the hematoma. The size of the nidus was 20 mm, and its feeders were the right superior internal parietal artery and a branch of the anterior cerebral artery. In addition, the AVM had no deep drainer. We also found another AVM in the right temporal lobe and identified telangiectasia of the nose using digital subtraction angiography. We suspected HHT and performed whole body CT, which revealed an arteriovenous fistula in the right lung and a hematoma-like lesion in the spleen. Thus, we diagnosed the patient with HHT. His ruptured AVM was removed electively. CONCLUSION: We report a case of HHT that presented as an intracerebral hemorrhage in a patient. Based on our case study findings, it is necessary to perform long-term follow-up not only for brain AVMs but also for visceral vascular malformations in such patients, as well as perform HHT screening for families. Although such cases are rare, some features of HHT must be considered to accurately diagnose suspected HHT.


Assuntos
Fístula Arteriovenosa , Hemorragia Cerebral/cirurgia , Malformações Arteriovenosas Intracranianas , Telangiectasia Hemorrágica Hereditária , Adolescente , Angiografia Digital , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/cirurgia , Hemorragia Cerebral/etiologia , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/cirurgia , Masculino , Telangiectasia Hemorrágica Hereditária/etiologia , Telangiectasia Hemorrágica Hereditária/cirurgia
4.
World Neurosurg ; 132: e66-e75, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31518746

RESUMO

BACKGROUND: The health care expenditure in Vietnam is equivalent to 1% of that in the United States. For most patients with brain arteriovenous malformations (AVM), surgery is the only available treatment modality. This study reports on the outcomes on AVM microsurgery in this resource-restricted environment. METHODS: This is a prospectively collected, retrospectively analyzed case series of consecutive patients who underwent surgical resection of AVM by a single surgeon in Vietnam. All surgeries were performed in a 3-year period in Hanoi. The primary endpoints were obliteration of the AVM and surgical morbidity (modified Rankin Scale [mRS] > 1). RESULTS: There were 86 patients and 62% presented with hemorrhage. Only 2 patients had preoperative embolization, and 47 patients (54%) had preoperative digital subtraction angiography. All patients underwent microsurgical resection of their AVM. Excluding the 4 patients who died, the AVM obliteration rate was 98%. The mean follow-up was 20.1 months. Before surgery, 36% of patients had at least some disability (mRS > 1). Postoperatively, this was reduced to 10% (McNemar P = 0.007). For the overall cohort, neurologic status was improved from initial encounter to final assessment (P = 0.001). Because of resource restrictions, some patients with hemorrhage experienced delays in treatment. There was no difference in outcome between patients who were admitted before or after 24 hours post ictus (P = 0.6). The days spent waiting for surgery did not correlate with final mRS in univariate regression (R2 = 0.01). CONCLUSIONS: Notwithstanding the limitation in health care resources in Vietnam, surgery for AVMs was successful in eliminating the malformation, with obliteration rates and morbidity comparable with international standards.


Assuntos
Revascularização Cerebral/métodos , Malformações Arteriovenosas Intracranianas/cirurgia , Adolescente , Adulto , Idoso , Angiografia Digital , Criança , Embolização Terapêutica , Determinação de Ponto Final , Feminino , Seguimentos , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/diagnóstico por imagem , Hemorragias Intracranianas/etiologia , Hemorragias Intracranianas/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Ruptura , Tempo para o Tratamento , Resultado do Tratamento , Vietnã , Adulto Jovem
6.
World Neurosurg ; 132: 389, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31520761

RESUMO

Thalamic cavernous malformations (CM) are highly challenging surgically. In this illustrative video (Video 1), we present the case of a 36-year-old man with a CM at the left medial thalamus, which was successfully treated by a contralateral anterior interhemispheric transcallosal approach. Informed consent was obtained from the patient. Preoperative imaging demonstrated that the CM appeared to have reached the pial surface superiorly and medially, and diffusion tensor imaging showed the pyramidal tracts to be traveling laterally to the CM. Based on the "Two-point" principle and to avoid pyramidal tract impingement, an anterior interhemispheric transcallosal approach was chosen. Furthermore, to avoid excessive retraction on the ipsilateral hemisphere, we selected the contralateral trajectory over the ipsilateral trajectory. The head was positioned with the right side down; thus, the space between the right hemisphere and the falx could expand because of gravity autoretraction, which could minimize the need of retraction during the interhemispheric dissection. A small incision on the corpus callosum was performed under the guidance of neuronavigation, and the left ventricle was subsequently entered. After a thin layer of hemosiderin-stained pia was opened on the superior surface of the left thalamus, some sandlike old hemorrhagic component was removed for decompression, and the lesion was carefully dissected away from the normal parenchyma within the surrounding gliosis boundary. The CM was removed en bloc, and the deep venous anomaly was well protected. The patient did not experience any intraoperative changes shown by electrophysiologic monitoring, and he recovered well postoperatively.


Assuntos
Corpo Caloso/cirurgia , Descompressão Cirúrgica/métodos , Malformações Arteriovenosas Intracranianas/cirurgia , Procedimentos Neurocirúrgicos/métodos , Tálamo/cirurgia , Adulto , Corpo Caloso/anatomia & histologia , Imagem de Tensor de Difusão , Lateralidade Funcional , Humanos , Masculino , Tálamo/anatomia & histologia , Resultado do Tratamento
7.
J Korean Med Sci ; 34(36): e232, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31538418

RESUMO

BACKGROUND: A randomized trial of unruptured brain arteriovenous malformations (ARUBA) reported superior outcomes in conservative management compared to interventional treatment. There were numerous limitations to the study. This study aimed to investigate the efficacy of gamma knife radiosurgery (GKS) for patients with brain arteriovenous malformations (AVMs) by comparing its outcomes to those of the ARUBA study. METHODS: We retrospectively reviewed ARUBA-eligible patients treated with GKS from June 2002 to September 2017 and compared against those in the ARUBA study. AVM obliteration and hemorrhage rates, and clinical outcomes following GKS were also evaluated. RESULTS: The ARUBA-eligible cohort comprised 264 patients. The Spetzler-Martin grade was Grade I to II in 52.7% and III to IV in 47.3% of the patients. The mean AVM nidus volume, marginal dose, and follow-up period were 4.8 cm³, 20.8 Gy, and 55.5 months, respectively. AVM obliteration was achieved in 62.1%. The annual hemorrhage rate after GKS was 3.4%. A stroke or death occurred in 14.0%. The overall stroke or death rate of the ARUBA-eligible cohort was significantly lower than that of the interventional arm of the ARUBA study (P < 0.001) and did not significantly differ from that of the medical arm in the ARUBA study (P = 0.601). CONCLUSION: GKS was shown to achieve a favorable outcome with low procedure-related morbidity in majority of the ARUBA-eligible patients. The outcome after GKS in our patients was not inferior to that of medical care alone in the ARUBA study. It is suggested that GKS is rather superior to medical care considering the short follow-up duration of the ARUBA study.


Assuntos
Hemorragia/etiologia , Malformações Arteriovenosas Intracranianas/cirurgia , Radiocirurgia/efeitos adversos , Acidente Vascular Cerebral/etiologia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Malformações Arteriovenosas Intracranianas/mortalidade , Malformações Arteriovenosas Intracranianas/patologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco , Índice de Gravidade de Doença , Adulto Jovem
10.
J Clin Neurosci ; 70: 108-112, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31492483

RESUMO

PURPOSE: To describe 30-day outcomes following craniotomy for arteriovenous malformation in children and identify risk factors for readmission, reoperation, and perioperative complication using the National Surgical Quality Improvement Program (NSQIP) Pediatric database. METHODS: Patients aged 0-18 years who underwent surgery for arteriovenous malformations (years 2015-2016) were identified from the NSQIP Pediatric database. Descriptive statistics, uni-variate, and multi-variate regression analysis were performed using preoperative and perioperative data. The outcome of interest was postoperative adverse event including reoperation within 30 days, readmission within 30 days, discharge to rehab, and the complications wound infection/dehiscence, pneumonia, unplanned reintubation, pulmonary embolism (PE), renal insufficiency, urinary tract infection (UTI), stroke, venous thromboembolism (VT), and sepsis. RESULTS: 167 patients were identified who met study criteria. 58% were male, and the majority had an ASA classification of 3 or greater (68%). 96 (57%) patients were found to have a preoperative comorbidity, with the most common comorbidity being seizure disorder (54 patients, 32%). 76 patients (46%) had documented perioperative events or complications. The incidence of wound infection/dehiscence was 4%; and of pneumonia, PE, unplanned reintubation, renal insufficiency, UTI, stroke, VT, sepsis were <1%. There were no deaths. The incidence of unplanned reoperation was 10% and unplanned readmission was 12%. Most (90%) were discharged to home. Operative time (p = .0001, OR = 9.53), emergent surgery status (p = .0001, OR = 8.19) and preoperative comorbidities (p = .007) were found to be significant predictors of poor outcome. CONCLUSION: In the NSQIP-P dataset, the incidence of perioperative complications and suboptimal outcomes among patients undergoing AVM resection were low.


Assuntos
Fístula Arteriovenosa/cirurgia , Craniotomia/efeitos adversos , Malformações Arteriovenosas Intracranianas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Fatores de Risco
11.
World Neurosurg ; 132: 399-402, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31505294

RESUMO

BACKGROUND: Infundibular dilations (IDs) are funnel-shaped enlargements located at the origin of cerebral arteries. Neuroradiologists and neurosurgeons are familiar with IDs of the posterior communicating artery, which are relatively common. Other locations, being unexpected sites of IDs, can pose diagnostic and therapeutic challenges. CASE DESCRIPTION: In this paper, we describe a case of infundibulum of the accessory anterior cerebral artery, diagnosed with 3-dimensional reconstructions of computed tomography angiography, which is to our knowledge the first report of an ID of this anatomic variant. CONCLUSIONS: Anterior communicating artery represents a rare location for infundibular dilations. Differential diagnosis between them and true aneurysms can be sometimes challenging, especially when associated with anatomic variants; thus neurosurgeons and radiologists must be aware of these pathologic entities.


Assuntos
Artéria Cerebral Anterior/anormalidades , Artéria Cerebral Anterior/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Artéria Cerebral Anterior/cirurgia , Angiografia por Tomografia Computadorizada , Diagnóstico Diferencial , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Imagem Tridimensional , Malformações Arteriovenosas Intracranianas/cirurgia , Angiografia por Ressonância Magnética , Adulto Jovem
12.
World Neurosurg ; 132: e604-e612, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31442655

RESUMO

OBJECTIVE: Large brain arteriovenous malformations (AVMs) pose a management dilemma because of the limited success of any single treatment modality by itself. Surgery alone is associated with significant morbidity and mortality. Similarly, embolization alone has limited efficacy. Volume-staged Gamma Knife radiosurgery (VSGR) has been developed for the treatment of large AVMs to increase the efficacy and improve safety of treatment of these lesions. The aim of this study was to assess the efficacy and safety of VSGR technique for the treatment of large brain AVMs. METHODS: The study included patients treated by VSGR between May 2009 and July 2015. All patients had large AVMs (>10 mL). There were 29 patients. RESULTS: Twenty-four patients completed radiographic follow-up, with 15 obliteration cases (62.5%). A total of 56 sessions were performed. The mean AVM volume was 16 mL (range, 10.1-29.3 mL). The mean prescription dose was 18 Gy (range, 14-22 Gy). The mean follow-up duration was 43 months (range, 21-73 months). One patient died during follow-up of an unrelated cause. Two patients had hemorrhage during follow-up. Symptomatic edema developed in 5 patients (17%). The factors affecting obliteration were smaller total volume, higher dose/stage, nondeep location, compact AVM, AVM score <3, >18 Gy dose, and <15 mL total volume. The factors affecting symptomatic edema were smaller total volume and shorter time between first and last sessions (P = 0.012). T2 image changes were affected by Spetzler-Martin grade ≥3 (P = 0.013) and AVM score ≥3 (P = 0.014). CONCLUSIONS: VSGR provides an effective and safe treatment option for large brain AVMs. Smaller AVM volume is associated with higher obliteration rate.


Assuntos
Fístula Arteriovenosa/cirurgia , Malformações Arteriovenosas Intracranianas/cirurgia , Radiocirurgia/métodos , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
J Craniofac Surg ; 30(8): 2429-2431, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31403511

RESUMO

Scalp arteriovenous malformations (AVMs) are rare entities that may present as large, tortuous vascular lesions with resultant craniofacial deformity. Radiologic findings include feeding arteries and veins associated with dilated tortuous vessels. Intracranial extension is rare. A 5-year-old African American male presented with an occipital mass presumed to be a dermoid cyst on referral. Further workup revealed the presence of a scalp AVM that demonstrated extension into the left sigmoid sinus. Radiologic and intraoperative images are presented. Literature search revealed only 4 patients with scalp AVM extending intracranially into the sagittal sinus, 2 of which were managed with coagulation and division of the feeding vessels and the other 2 underwent preoperative embolization. Our patient is the 1st to be reported to have sigmoid sinus extension. Scalp AVMs with intracranial extension are rare, and require further preoperative workup. Following ultrasound evaluation, computed tomography angiography, magnetic resonance angiography, magnetic resonance imaging, or cerebral angiography can be considered. Treatment entails resection, but preoperative embolization is increasingly used, mirroring patients without intracranial extension. Further studies are needed to evaluate the efficacy and risk profile of these treatments.


Assuntos
Malformações Arteriovenosas Intracranianas/diagnóstico , Malformações Arteriovenosas Intracranianas/cirurgia , Couro Cabeludo/irrigação sanguínea , Couro Cabeludo/cirurgia , Angiografia Cerebral , Pré-Escolar , Cavidades Cranianas , Embolização Terapêutica/métodos , Humanos , Angiografia por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X
14.
BMC Ophthalmol ; 19(1): 148, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299930

RESUMO

BACKGROUND: To report the first case of a cerebral arteriovenous malformation (AVM) with ocular symptoms and review the characteristics of this case and the main point of confusion for the diagnosis of such a case. CASE PRESENTATION: A 58-year-old woman presented to the ophthalmology clinic with 1 and a half years of right eye redness, ocular hypertension and recurrent headache. One and a half years ago she was diagnosed with right eye dry eye and glaucoma and had received treatment according to this diagnosis. However, none of the treatments led to any improvement in redness and headache. Physical examination revealed dry eye and severe corkscrew hyperaemia with dilated vessels in the right eye. The results of fundoscopic examination of both eyes were normal. After we considered that the symptoms may be related to abnormal intracranial vessels, computed tomography angiography and venography (CTA + CTV) were performed, and the results showed an arteriovenous malformation in the right parietal-occipital area in the brain. The AVM was definitively located by further examination with digital subtraction angiography (DSA). After AVM endovascular embolism treatment, the conjunctival congestion of the right eye was significantly relieved, and the intraocular pressure decreased to normal. CONCLUSION: In clinical practice, when corkscrew hyperaemia accompanied by neurological symptoms is found, cerebral vascular diseases might be considered. In this case, the ophthalmologist's diagnosis should combine disease history and imaging examination.


Assuntos
Angiografia Cerebral/métodos , Erros de Diagnóstico , Síndromes do Olho Seco/diagnóstico , Glaucoma/diagnóstico , Malformações Arteriovenosas Intracranianas/diagnóstico , Lobo Occipital/irrigação sanguínea , Angiografia Digital , Diagnóstico Diferencial , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/cirurgia , Pressão Intraocular , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos
15.
World Neurosurg ; 131: 321-327, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31284052

RESUMO

Deep-seated cerebral lesions have fascinated and frustrated countless surgical innovators since the dawn of the microneurosurgical era. To determine the optimal approach, the microneurosurgeon must take into account the characteristics and location of the pathological lesion as well as the operator's range of technical expertise. Increasingly, microneurosurgeons must select between multiple operative corridors that can provide access to the surgical target. Innovative trajectories have emerged for many indications that provide more flexible operative angles and superior exposure but result in longer working distances and more technically demanding maneuvers. In this article, we highlight 4 innovative surgical corridors and compare their strengths and weaknesses against those of more conventional approaches. Our goal is to use these examples to illustrate the following principles of microneurosurgical innovation: (1) discover more efficient and flexible exposures with superior working angles; (2) ensure maximal early protection of critical neurovascular structures; and (3) effectively handle target pathology with minimal disruption of normal tissues.


Assuntos
Malformações Arteriovenosas Intracranianas/cirurgia , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Craniotomia/métodos , Humanos , Ilustração Médica , Pinealoma/cirurgia , Neoplasias da Base do Crânio/cirurgia
16.
Neurosurg Rev ; 42(3): 783-790, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31359304

RESUMO

Brain arteriovenous malformations (AVMs) near/within eloquent areas are challenging to treat surgically. The insufficient lesion-to-eloquence distance (LED) is related to poor neurological outcomes. This paper reports the use of in situ embolization combined with surgical resection in a one-staged hybrid operation for eloquent area protection. Nine patients who underwent one-staged in situ embolization combined with surgical resection were selected from the database of a prospective clinical trial (NCT03774017). Nidus got partial in situ embolization in the parts located near/within the eloquence. The rest of nidus was removed via a microsurgical procedure in the same operation. The in situ embolization ensured a sufficient LED to prevent eloquent areas and tracts from being damaged in the subsequent resection. All of the patients achieved complete obliteration with no neurological deficits or complications. One-staged hybrid operation initiates closer cooperation between surgical and endovascular treatments and proposes an integrative therapeutic mode for AVMs. The in situ embolization combined with surgical resection is safe and effective for improving the functional outcome of AVMs with eloquence and tracts involved. The clinical trial is registered at ClinicalTrials.gov (NCT03774017, https://clinicaltrials.gov/ct2/show/NCT03774017 ).


Assuntos
Embolização Terapêutica/métodos , Malformações Arteriovenosas Intracranianas/cirurgia , Microcirurgia/métodos , Adolescente , Adulto , Criança , Terapia Combinada , Bases de Dados Factuais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
17.
World Neurosurg ; 130: e1041-e1050, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31323399

RESUMO

OBJECTIVE: The effective treatment of giant cerebral arteriovenous malformations (gAVMs) is challenging. The aim of this study was to determine the risk factors for 1-stage resection of gAVM and develop a reliable indicator for patient selection. METHODS: A prospectively maintained database of patients with AVM in our hospital was reviewed. The neuroradiological findings and clinical characteristics of the patients and lesions were analyzed with respect to postoperative functional deficits (FD). A novel blood oxygen level-dependent functional magnetic resonance imaging score and a diffusion tensor imaging (DTI) score were created to predict surgical outcomes. Furthermore, the long-term outcomes of gAVMs treated by other methods in the literature were reviewed. RESULTS: A total of 35 patients with 35 gAVMs were included. The mean diameter of the gAVMs was 64.8 ± 4.9 mm. In the univariate analysis, the functional magnetic resonance imaging score (P = 0.022) and DTI score (P = 0.003) were both significantly associated with long-term FD. The Spetzler-Martin score (P = 0.092) trended toward significance. Multivariate analysis revealed that a high DTI score (odds ratio, 2.19; 95% confidence interval, 1.08-4.46; P = 0.030) was the only independent risk factor that was correlated with long-term FD. The predictive effect of the DTI score (area under the curve = 0.822) is superior to that of the Spetzler-Martin score (area under the curve = 0.640) according to the receiver operating characteristic analysis, and the cutoff point was 2.5 (sensitivity = 0.860 and specificity = 0.867). CONCLUSIONS: One-stage surgical resection of gAVMs in patients with a low DTI score (0-2) seems to be feasible. The DTI score could be a reliable indicator for patient selection.


Assuntos
Imagem de Tensor de Difusão/métodos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/cirurgia , Adulto , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
19.
J Craniofac Surg ; 30(8): 2582-2585, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31205279

RESUMO

A 26-year-old female patient referred to our emergency service with complaint of increase headache and swelling of the left upper eye led. External examination of the head revealed left frontal scalp and left eye led swelling, which was soft and pulsatile. Brain computed tomography (CT) scan and magnetic resonance imaging showed left frontal soft tissue and left periorbital swelling with crowded left intraorbital contents. Brain CT angiography showed vascular mass lesion in the left frontal subcutaneous lesion. Six-vessel cerebral angiography showed left frontal scalp arteriovenous malformation (AVM) supplied from the right and left superficial temporal arteries from the external carotid artery and from the left supraorbital artery arising from the ophthalmic artery of the internal carotid artery. By endovascular technique, bilateral superficial temporal arteries were occluded with Onyx 18 (Micro-Therapeutics, Inc., Irvine, CA). The patient was operated after 2 days. Left eye-brow incision was performed and the supraorbital artery was exposed, ligated, and cut. Left fronto-temporal skin incision was performed and the AVM totally excised. No intraoperative nor postoperative complications seen. Follow-up cerebral angiography showed total resection of the AVM.


Assuntos
Malformações Arteriovenosas Intracranianas/cirurgia , Artérias Temporais/cirurgia , Adulto , Angiografia Cerebral , Edema/etiologia , Procedimentos Endovasculares , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética , Artérias Temporais/diagnóstico por imagem , Tomografia Computadorizada por Raios X
20.
J Clin Neurosci ; 66: 165-177, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31147229

RESUMO

OBJECTIVE: Developmental venous anomalies (DVAs) are typically benign lesions purely venous in nature. However, a subset of DVAs are either 1) associated with brain arteriovenous malformations (AVMs) or 2) demonstrate shunting themselves. The goal of this case series and literature review is to present clinical characteristics, management strategies and outcomes of this patient population. METHODS: Consecutive patients with arteriovenous shunting DVAs or DVAs draining nidal-AVMs were retrospectively reviewed. Lesions were classified as transitional DVAs or AVM-associated DVAs. Variables studied included clinical presentation, location, size, venous drainage, and malformation architecture. Treatment outcomes were evaluated. RESULTS: We identified 8 patients with transitional or AVM-associated DVAs from our institution. Six patients had unruptured lesions and two presented with hemorrhage. We classified 5 malformations as transitional DVAs and 3 as AVMs draining into DVAs. Three patients were conservatively managed, while 5 patients underwent treatment of the shunt by means of surgery (4) or radiosurgery (1). One patient suffered a right frontal venous infarct resulting in left sided weakness post-operatively. In the literature review we found 44 additional cases (Total = 30 transitional DVAs and 22 AVM-associated DVAs). Patients with transitional DVAs were more symptomatic than patients with AVM-associated DVAs (41.4% vs 22.2%). Permanent neurologic deficit following radiosurgical or microneurosurgical treatment of transitional DVAs was 28.6% compared to 16.7% for AVMs draining into DVAs. CONCLUSIONS: Transitional DVAs and AVMs draining into DVAs are rare lesions. Treatment is associated with substantial risk of venous infarct, particularly in situations where the draining vein is occluded.


Assuntos
Drenagem/efeitos adversos , Malformações Arteriovenosas Intracranianas/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Radiocirurgia/efeitos adversos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Radiocirurgia/métodos
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