Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.621
Filtrar
1.
No Shinkei Geka ; 48(1): 39-45, 2020 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-31983687

RESUMO

We herein report a case of ruptured arterio-venous malformation(AVM)detected using three-dimensional digital subtraction angiography(3DDSA)fusion images and successfully treated with target embolization for pseudoaneurysm. A 50-year-old man with a history of AVM was admitted to our department for the treatment of ruptured high-grade AVM in the right parietal lobe. Although a bleeding point was not evident on DSA, the patient had re-rupture in the right ventricle, one month after admission. Chronological 3DDSA fusion images generated from 3DDSA images taken on admission and after re-rupture revealed a newly visualized intranidal pseudoaneurysm near a hematoma. Contrast-enhanced magnetic resonance imaging showed vessel wall enhancement along the posterior horn of the right ventricle;this enhancement corresponded to the location of the pseudoaneurysm. We planned target embolization for the intranidal pseudoaneurysm to prevent re-bleeding. The origin of the feeder was so steep that a microcatheter could not be advanced deeply, and embolization with 20% n-butyl-2-cyanoacrylate resulted in proximal occlusion. Follow-up angiography 1 week after embolization showed complete disappearance of the pseudoaneurysm, and the patient had no recurrence of aneurysm until one year.


Assuntos
Falso Aneurisma , Aneurisma Roto , Embolização Terapêutica , Malformações Arteriovenosas Intracranianas , Falso Aneurisma/diagnóstico , Falso Aneurisma/terapia , Aneurisma Roto/diagnóstico , Aneurisma Roto/terapia , Angiografia Digital , Humanos , Imagem Tridimensional , Malformações Arteriovenosas Intracranianas/diagnóstico , Malformações Arteriovenosas Intracranianas/terapia , Masculino , Pessoa de Meia-Idade
2.
Medicine (Baltimore) ; 98(52): e18418, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876715

RESUMO

RATIONALE: Brain arteriovenous malformation (BAVM)-associated varix is always asymptomatic, and no special treatment is needed. However, there is no consensus regarding how to address a varix that has led to clinical manifestation. PATIENT CONCERNS: An 11-year-old girl was admitted complaining of left hemiparesis for 4 days. She was previously healthy and denied any history of similar ictus. She was alert, and a physical examination performed upon admission was unremarkable except for the left hemiparesis. DIAGNOSES: Head magnetic resonance imaging (MRI) showed a linear and round flow void and perilesional edema in the region of the right basal ganglia, indicating a BAVM. Gadolinium-enhanced MRI showed peripheral enhancement of the round lesion. Computed tomography angiography (CTA) showed that the BAVM was fed by the ipsilateral posterior cerebral artery and anterior choroidal artery and drained into the vein of Galen. A large varix was also noted at the top of the BAVM and was consistent with the round flow void observed at the right basal ganglia on MRI. The Spetzler-Martin grading scale was grade IV INTERVENTIONS:: The patient experienced a TAE of the BAVM nidus with liquid embolic agent. OUTCOMES: A follow-up investigation showed regression of the varix, although there was still some residual BAVM. The patient experienced a favorable recovery. LESSONS: In the case of a BAVM-associated symptomatic varix, if surgical resection cannot readily be performed, initial TAE of the BAVM nidus can be attempted.


Assuntos
Malformações Arteriovenosas Intracranianas/terapia , Varizes/terapia , Criança , Angiografia por Tomografia Computadorizada , Embolização Terapêutica/métodos , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética , Neuroimagem
3.
No Shinkei Geka ; 47(9): 961-968, 2019 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-31564657

RESUMO

Chronic encapsulated intracerebral hematoma(CEIH)with arteriovenous malformation(AVM)is rare. We report a case of CEIH shrinking after feeder embolization for AVM. A 60-year-old man experiencing headaches for 2 weeks was admitted to our hospital due to intracerebral hematoma detected by MRI. The hematoma was shown as a low-density mass lesion on CT scans. Angiography and enhanced MRI showed an AVM in the right temporal lobe associated with the CEIH. Mild disturbance of consciousness and headaches gradually worsened, as the CEIH grew. Before AVM resection, feeder embolization was performed. On the day after the embolization, symptoms improved and the CEIH shrunk in size. A week following the embolization, the AVM including the partial hematoma capsule was resected without neurological deficit. Previous literature showed similarities between CEIH and chronic subdural hematoma(CSDH)in clinical features and pathological findings of the capsule. This case indicated that feeder embolization might be a treatment option for CEIH with AVM, such as embolization of middle meningeal artery for intractable CSDH.


Assuntos
Hemorragia Cerebral , Embolização Terapêutica , Hematoma , Malformações Arteriovenosas Intracranianas , Hemorragia Cerebral/complicações , Hemorragia Cerebral/terapia , Hematoma/complicações , Hematoma/terapia , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/terapia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade
4.
Cochrane Database Syst Rev ; 9: CD003436, 2019 09 10.
Artigo em Inglês | MEDLINE | ID: mdl-31503327

RESUMO

BACKGROUND: Brain arteriovenous malformations (AVMs) are the single most common cause of intracerebral haemorrhage in young adults. Brain AVMs also cause seizure(s) and focal neurological deficits (in the absence of haemorrhage, migraine or an epileptic seizure); approximately one-fifth are incidental discoveries. Various interventions are used in an attempt to eradicate brain AVMs: neurosurgical excision, stereotactic radiosurgery, endovascular embolization, and staged combinations of these interventions. This is an update of a Cochrane Review first published in 2006, and last updated in 2009. OBJECTIVES: To determine the effectiveness and safety of the different interventions, alone or in combination, for treating brain AVMs in adults compared against either each other, or conservative management, in randomized controlled trials (RCTs). SEARCH METHODS: The Cochrane Stroke Group Information Specialist searched the Cochrane Stroke Group Trials Register (last searched 7 January 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1) in the Cochrane Library, MEDLINE Ovid (1980 to 14 January 2019), and Embase OVID (1980 to 14 January 2019). We searched international registers of clinical trials, the contents pages of relevant journals, and bibliographies of relevant articles (November 2009). We also contacted manufacturers of interventional treatments for brain AVMs (March 2005). SELECTION CRITERIA: We sought RCTs of any intervention for brain AVMs (used alone or in combination), compared against each other or against conservative management, with relevant clinical outcome measures. DATA COLLECTION AND ANALYSIS: One author screened the results of the updated searches for potentially eligible RCTs for this updated review. Both authors independently read the potentially eligible RCTs in full and confirmed their inclusion according to the inclusion criteria. We resolved disagreement by discussion. We assessed the risk of bias in included studies and applied GRADE. MAIN RESULTS: We included one trial with 226 participants: A Randomized trial of Unruptured Brain Arteriovenous Malformations (ARUBA), comparing intervention versus conservative management for unruptured brain AVMs (that had never bled). The quality of evidence was moderate because we found just one trial that was at low risk of bias other than a high risk of performance bias due to participants and treating physicians not being blinded to allocated treatment. Data on functional outcome and death at a follow-up of 12 months were provided for 218 (96%) of the participants in ARUBA. In this randomized controlled trial (RCT), intervention compared to conservative management increased death or dependency (modified Rankin Scale score ≥ 2, risk ratio (RR) 2.53, 95% confidence interval (CI) 1.28 to 4.98; 1 trial, 226 participants; moderate-quality evidence) and the proportion of participants with symptomatic intracranial haemorrhage (RR 6.75, 95% CI 2.07 to 21.96; 1 trial, 226 participants; moderate-quality evidence), but there was no difference in the frequency of epileptic seizures (RR 1.14, 95% CI 0.63 to 2.06; 1 trial, 226 participants; moderate-quality evidence). Three RCTs are ongoing. AUTHORS' CONCLUSIONS: We found moderate-quality evidence from one RCT including adults with unruptured brain AVMs that conservative management was superior to intervention with respect to functional outcome and symptomatic intracranial haemorrhage over one year after randomization. More RCTs will help to confirm or refute these findings.


Assuntos
Malformações Arteriovenosas Intracranianas/terapia , Adulto , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/prevenção & controle , Tratamento Conservador , Embolização Terapêutica , Epilepsia/etiologia , Epilepsia/prevenção & controle , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto
5.
World Neurosurg ; 131: 82-86, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31369878

RESUMO

BACKGROUND: An unruptured brain arteriovenous malformation (bAVM) is a complex pathological entity with the potential to lead to disabling or fatal intracranial hemorrhage. The treatment approaches for these lesions have included microsurgical resection, endovascular embolization, stereotactic radiosurgery (SRS), and medical management or any combination of these modalities. However, the optimal treatment approach for unruptured bAVMs has not yet been determined. In the present case, we used SRS strategically to downgrade an AVM to allow for improved resectability. CASE DESCRIPTION: A 28-year-old woman had presented with 10 years of headaches and was found to have a Spetzler-Martin grade IV AVM not amenable to resection. She underwent targeted SRS only of the deep portions of the AVM, resulting in a decrease of the AVM to grade III. Subsequent microsurgical resection was successful in complete removal of the AVM. At the 1-year follow-up examination she had no deficits. CONCLUSIONS: We have proposed a protocol of using focused SRS to eliminate the portions of the AVM that confer an increased surgical risk. SRS, followed by microsurgical resection, could represent an optimal treatment strategy for high-grade AVMs with difficult surgical anatomy.


Assuntos
Embolização Terapêutica/métodos , Malformações Arteriovenosas Intracranianas/terapia , Microcirurgia/métodos , Procedimentos Neurocirúrgicos/métodos , Radiocirurgia/métodos , Adulto , Angiografia Digital , Terapia Combinada , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética , Índice de Gravidade de Doença
6.
World Neurosurg ; 132: 29-32, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31450002

RESUMO

BACKGROUND: The use of nonadhesive liquid embolic agents (NALEAs) has gained great popularity in the treatment of brain vascular malformations, with a lower rate of local complications than surgery. However, we describe the formation of brain abscesses after endovascular treatment of a brain arteriovenous malformation (bAVM) and how important removal of the NALEAs was in the treatment of these abscesses. CASE DESCRIPTION: A 68-year-old man presented with seizures after being treated for an unruptured bAVM using Squid (Emboflu), an NALEA. Radiologic imaging revealed brain lesions suspicious of abscesses around the previously treated bAVM. A surgical excision of the bAVM and the embolized material was performed as was drainage of the brain abscesses. Bacterial cultures were positive for Enterococcus faecalis, and the patient left the hospital with an appropriate antibiotic regimen without new deficits. CONCLUSIONS: This is the first reported case of a bAVM treated with Squid complicated with brain abscesses, a rare but very serious complication. This complication should be treated not only using antibiotherapy but with complete safe removal of the embolic material.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Embolização Terapêutica , Infecções por Bactérias Gram-Positivas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/terapia , Polivinil/uso terapêutico , Idoso , Abscesso Encefálico/cirurgia , Enterococcus faecalis , Infecções por Bactérias Gram-Positivas/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Microcirurgia
7.
BMJ Case Rep ; 12(7)2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31340940

RESUMO

A 30-year-old nulliparous woman at 38 5/7 weeks of gestation developed a sudden, severe headache at work and subsequent loss of consciousness. She underwent evaluation in the emergency department. CT and CT angiogram head revealed a large intraparenchymal haematoma with intraventricular extension secondary to ruptured cerebral arteriovenous malformation (cAVM). She was intubated and transferred to a tertiary care centre. The patient underwent caesarean section followed by partial embolisation of the cAVM with planned second embolisation and resection 1 week later. Due to drowsiness and headache, the planned repeat embolisation and cAVM resection were performed 3 days earlier. The patient had a full recovery. Emergency medicine physicians and obstetrician-gynaecologists should be familiar with differential diagnosis of sudden headache in pregnancy and signs of a ruptured cAVM to facilitate early diagnosis, multidisciplinary team approach and timely treatment. Early diagnosis and management of ruptured cAVM are important due to associated morbidity and mortality.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Embolização Terapêutica/métodos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/terapia , Ruptura Espontânea/terapia , Adulto , Cesárea , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Idade Gestacional , Cefaleia/diagnóstico , Cefaleia/etiologia , Humanos , Malformações Arteriovenosas Intracranianas/fisiopatologia , Gravidez , Resultado da Gravidez , Medição de Risco , Ruptura Espontânea/diagnóstico por imagem , Síncope/diagnóstico , Síncope/etiologia
8.
World Neurosurg ; 130: e715-e721, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31279921

RESUMO

BACKGROUND: Brain arteriovenous malformations (AVMs) are complex vascular lesions composed of abnormal arteries directly connected to veins without the typical intervening angioarchitecture. Rupture rates range from 2% to 4%, with that risk increasing to 4.5% per year for those presenting with hemorrhage. Mortality ranges from 12% to 66.7% after rupture, and up to 40% of survivors suffer from permanent neurologic sequelae. Treatment commonly includes a multimodality approach consisting of a combination of microsurgery, embolization, and radiosurgery. Typically, preoperative embolization is undertaken in a staged manner several days to weeks prior to microsurgical resection. METHODS: We describe a series of 5 pediatric patients harboring intracranial AVMs who underwent embolization and resection in the same anesthetic event, an approach that has not yet been described in the literature. RESULTS: Three patients presented symptomatically, whereas 2 AVMs were discovered incidentally, and average Spetzler-Martin grade was 1.6. Average anesthesia length was 580.8 minutes, and intraoperative angiography revealed complete resection in all cases. All patients were extubated at the end of the case and were discharged and followed up with a modified Rankin Scale score of 0. CONCLUSIONS: We describe a novel approach to treatment of pediatric intracranial AVMs that is shown to be safe and feasible. A single anesthesia event allows for aggressive preoperative embolization without increasing the risk of hemorrhage in the waiting period until resection. A single anesthesia event also prevents the patients from undergoing another intubation and anesthesia and decreases the risk associated with another anesthesia in a relatively short time frame.


Assuntos
Anestesia Geral/métodos , Fístula Arteriovenosa/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Malformações Arteriovenosas Intracranianas/terapia , Adolescente , Fístula Arteriovenosa/diagnóstico por imagem , Criança , Terapia Combinada/métodos , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Masculino , Estudos Retrospectivos , Resultado do Tratamento
9.
Georgian Med News ; (290): 38-44, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31322512

RESUMO

The association of cerebral arteriovenous malformations (bAVM) and associated paranidal aneurysms, that is closely related to the AVM nidus, carry a high risk of rapture and re-rapture after initial hemorrhage. This association is consider as therapeutic challenge and supportive data about their natural history and best treatment modalities are still lacking. In this article we report our experience of their treatment. We reviewed 443 cases of patients with AVMs between 2004 and 2018, who were treated at our institution and found 73 (16,5%) cases of AVM association with paranidal aneurysms (22 (30,2%) arterial - prenidal, 20 (27,4%) intranidal, and 19 (26,0%) venous - postnidal). Twelve (16,4 %) patients had multiple aneurysm. All patients received endovascular treatment with n-butyl cyanoacrylate (NBCA), ONYX or Embolin embolization. We evaluated clinical and radiological data, treatment and outcomes at discharge. Among 73 patients (32 (43,8 %) women and 41 (56,2 %) men, mean age - 34 years, 8 - 65 years) with AVM and paranidal aneurysms who were enrolled in our study, hemorrhage was the most frequent presenting symptom (47 patients (64.4%). The timing of procedure varied between 3 - 23 days. Total occlusion of AVM was achieved in 23 (31,5%) cases, in all other cases partial or target occlusion with obligatory aneurysm embolization was done. Seven (9,6%) patients had complication (5 ischemic and 2 hemorrhagic) after procedure. Clinical improvement was seen in all groups at discharge. Mean change of mRS score between admission and discharge was 0,2-0,5 point. Excellent or good outcome (mRS - 0,1,2) was observed in 58 (79,5%) patients at discharge. Unfavorable outcome (mRS - 3-5) had 13 (17,8%) patients, mRS - 6 - 2 (2,7%) patients. Patients sustaining AVM and multiple paranidal aneurysms had higher risk of hemorrhage comparing with single one (OR-17,5 (95% CI -1,0-309,8 (p=0,010). Relationship between AVM with paranidal aneurysms and hemorrhagic presentation is obvious, however definite source of hemorrhage is difficult to evaluate. To our belief arterial prenidal and intranidal aneurysms especially multiple are the most dangerous and should be in therapeutic focus after it's finding. Endovascular embolization has the potential to be effective and safe in treatment of AVM with paranidal aneurysms.


Assuntos
Artérias/diagnóstico por imagem , Hemorragia Cerebral/etiologia , Embolização Terapêutica , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/terapia , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/terapia , Adolescente , Adulto , Idoso , Angiografia Cerebral , Circulação Cerebrovascular/fisiologia , Criança , Feminino , Humanos , Aneurisma Intracraniano/patologia , Malformações Arteriovenosas Intracranianas/patologia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
10.
World Neurosurg ; 131: 1-5, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31356978

RESUMO

BACKGROUND: Distal catheterization in the ophthalmic artery beyond the origin of the central retinal artery has been attempted to avoid visual complications in cases of transarterial embolization (TAE). Although avoiding visual complications is important, extraocular complications have been rarely reported and discussed. Here, we report a case of an intraorbital arteriovenous fistula (AVF) presenting with impaired extraocular movement after a provocation test and discuss the potential risks associated with TAE at the third segment of the ophthalmic artery. CASE DESCRIPTION: A 53-year-old man was referred to our hospital for a newly diagnosed vascular lesion on the left optic chiasm. A left internal carotid angiogram revealed an intraorbital AVF fed by distal branches of the left ophthalmic artery taking a recurrent course toward the proximal ophthalmic artery, and the anterior branches of the inferior lateral trunk draining into the tortuous basal vein of Rosenthal with a varix. Neither the cavernous sinus nor the superior ophthalmic vein was opacified as draining routes of this lesion. A provocation test was done for diagnostic and therapeutic purposes at the third segment of the ophthalmic artery. During the test, the patient developed a transient impaired adduction of the left eye without any visual field deficit; therefore, TAE was avoided. The patient made an uneventful recovery and was recommended a transcranial transvenous embolization for a radical treatment. CONCLUSIONS: In intraorbital hypervascular lesions, occlusion of the third segment of the ophthalmic artery is associated with a potential risk of extraocular complications.


Assuntos
Fístula Arteriovenosa/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Músculos Oculomotores/irrigação sanguínea , Artéria Oftálmica/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Embolização Terapêutica/métodos , Humanos , Malformações Arteriovenosas Intracranianas/terapia , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/prevenção & controle , Músculos Oculomotores/fisiopatologia
11.
Eur J Radiol ; 116: 8-13, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31153578

RESUMO

PURPOSE: To evaluate the outcomes of combined preoperative embolization and microsurgical resection in comparison with microsurgical resection alone as the current standard of care for low-grade cerebral arteriovenous malformations (AVM) in the pediatric population. MATERIALS & METHODS: We performed a single-center retrospective study of pediatric patients presenting with Spetzler-Martin (SM) grade I and II cerebral AVMs at a high-volume tertiary pediatric hospital between January 2005 and September 2016. Low grade AVM patients were divided into two groups: pre-operative embolization with subsequent microsurgical resection or microsurgical resection alone. Patient demographics, clinical and imaging presentations, AVM morphological characteristics, post-operative complications, and mid to long-term clinical outcomes were studied. Post-embolization and post-surgical outcomes were assessed prior to and after treatment, at 3 months and at final follow-up using the modified Rankin Scale (mRS) to compare both final independent (mRS 0-2) and favorable (no change or improved mRS) clinical outcomes for comparison between study groups. Statistical associations of patient demographics, AVM characteristics/SM grading, and treatment modality group with post-operative complications were performed using univariate logistic regression analysis. RESULTS: Thirty-four patients with low grade cerebral AVMs met the study inclusion criteria (mean age 10.6 ± 3.4 years; range 3-16 years, 22M:12 F). Twenty patients (59%) presented with ruptured AVMs. Twenty-five patients (73.5%) underwent combined treatment with embolization and microsurgical resection, while 9/34 (26.5%) underwent microsurgical resection alone. A total of 35 embolization procedures performed in 25 patients (Mode, 1; Range, 1-7) were associated with two minor post-embolization and 7 subsequent post-surgical (28%) complications, resulting in clinical deterioration in a single patient. Microsurgical resection alone was associated with 3 post-surgical complications (33%), resulting in permanent neurological disability in a single patient. There was no significance association of post-operative complications with either treatment modality group, combined treatment versus surgical resection alone [OR:1.13; 95% CI:0.23-5.62; p-value 0.88]. SM Grade II and eloquent locations were found to be significantly associated with post-surgical complications of low grade pediatric cerebral AVMs [OR 13.2 and OR 8 respectively, p-value 0.004 and 0.005). On mean follow-up time of 35.7 months, final clinical outcome was favorable in the majority of both treatment arms with no dependent (mRS>2) patients in the combined endovascular and surgical cohort. Two patients in the surgical cohort failed to achieve independent functional status, primarily due to a pre-operative morbid status (p-value 0.015). However, there was no significant difference in favorable outcomes between the treatment groups [p-value 0.14]. CONCLUSION: Our study suggests equivalent safety and favorable clinical outcomes related to combined endovascular embolization and microsurgical resection of low grade pediatric cerebral AVMs in comparison to microsurgical resection alone. On long term clinical follow-up, the vast majority of patients achieved an independent and favorable functional status irrespective of pre-operative embolization.


Assuntos
Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Malformações Arteriovenosas Intracranianas/terapia , Microcirurgia/métodos , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Terapia Combinada/métodos , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/cirurgia , Modelos Logísticos , Masculino , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Resultado do Tratamento
12.
J Neurointerv Surg ; 11(10): 1040-1044, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31147436

RESUMO

BACKGROUND AND PURPOSE: Liquid embolic agents (LEAs) are the determinant tool for successful embolization of cranial arteriovenous shunts. There are few currently available LEAs. The aim of the study was to summarize our initial experience with a recently introduced non-adhesive ethylene vinyl alcohol (EVOH) copolymer based LEA (Menox 18) in the endovascular treatment of cerebral arteriovenous malformations. METHODS: From April 2018 to November 2018, 24 patients harboring cerebral arteriovenous malformations underwent endovascular embolization with Menox 18. Clinical features, angiographic results, procedural details, complications, and follow-up details were prospectively collected and retrospectively analyzed. RESULTS: Curative embolization in one endovascular session was achieved in 14/24 (58.3%) of the treated patients. Partial embolization was achieved in 10 patients (42.6%) in whom staged treatment with radiosurgery or microsurgical resection was planned. No mortality was recorded in our series. Clinical complications after embolization occurred in 1/24 (4.66%) patients. No technical complications were noted CONCLUSIONS: Our pilot study suggests that the Menox embolization system offers similar technical and clinical results in comparison with the other currently available LEAs. Further studies with larger cohorts and long term follow-up data are needed to fully evaluate its efficacy.


Assuntos
Fístula Arteriovenosa/terapia , Embolização Terapêutica/métodos , Procedimentos Endovasculares/métodos , Malformações Arteriovenosas Intracranianas/terapia , Polivinil/administração & dosagem , Adolescente , Adulto , Idoso , Fístula Arteriovenosa/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
J Clin Neurosci ; 68: 333-335, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31196613

RESUMO

The optimal management of complex, Spetzler-Martin Grade 5 arteriovenous malformations (AVMs) remains a challenge, despite the availability of endovascular, surgical and radiosurgical treatment options. In cases requiring treatment due to progressive neurological deficit or recurrent hemorrhage, preoperative embolization may be an extremely useful adjunct to definitive surgical resection, and is usually accomplished via the transarterial route using liquid embolysate. However, this treatment approach often mandates access to distal arterial pedicles that can be technically challenging by standard endovascular approaches. This video describes a left parietal craniotomy for direct access microcatheterization and embolization of an otherwise endovascularly inaccessible Spetzler-Martin Grade 5 AVM prior to definitive surgical resection. The case was performed in the hybrid operative suite with biplane intraoperative angiography. Technical considerations, operative nuances and outcomes are reviewed.


Assuntos
Embolização Terapêutica/métodos , Malformações Arteriovenosas Intracranianas/terapia , Procedimentos Neurocirúrgicos/métodos , Cateterismo/métodos , Craniotomia/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
14.
World Neurosurg ; 131: 371-384, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31247351

RESUMO

BACKGROUND: Navigated transcranial magnetic stimulation (nTMS) provides a reliable identification of "eloquent" cortical brain areas. Moreover, it can be used for diffusion tensor imaging fiber tracking of eloquent subcortical tracts. We describe the use of nTMS-based cortical mapping and diffusion tensor imaging fiber tracking for defining the "eloquence" of areas surrounding brain arteriovenous malformations (BAVMs), aiming to improve patient stratification and treatment. METHODS: We collected data of BAVMs suspected to be in eloquent areas treated between 2017 and 2019, and submitted to nTMS-based reconstruction of motor, language, and visual pathways for the definition of the eloquence of the surrounding brain areas. We describe the nTMS-based approach and analyze its impact on patient stratification and allocation to treatment in comparison with the standard assessment of eloquence based on anatomical landmarks. RESULTS: Ten patients were included in the study. Preliminarily, 9 BAVMs were suspected to be located in an eloquent area. After nTMS-based mapping, only 5 BAVMs were confirmed to be close to eloquent structures, thus leading to a change of the score for eloquence and of the final BAVMs grading in 60% of patients. Treatment was customized according to nTMS information, and no cases of neurological worsening were observed. Radiological obliteration was complete in 7 cases microsurgically treated, and accounted for about 70% in the remaining 3 patients 1 year after radiosurgical treatment. CONCLUSIONS: The nTMS-based information allows an accurate stratification and allocation of patients with BAVMs to the most effective treatment according to a modern, customized, neurophysiological identification of the adjacent eloquent brain networks.


Assuntos
Malformações Arteriovenosas Intracranianas/terapia , Estimulação Magnética Transcraniana/métodos , Adulto , Idoso , Pontos de Referência Anatômicos/fisiologia , Mapeamento Encefálico/métodos , Imagem de Tensor de Difusão , Feminino , Lateralidade Funcional/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Motor/fisiologia , Planejamento de Assistência ao Paciente , Cuidados Pré-Operatórios/métodos , Resultado do Tratamento , Vias Visuais/fisiologia
17.
J Clin Neurosci ; 64: 116-121, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30948310

RESUMO

OBJECTIVE: Hydrocephalus is an uncommon presentation of unruptured brain arteriovenous malformations (AVMs). The goal of this case series and literature review is to present possible pathological mechanisms, management strategies and outcomes in patients with hydrocephalus due to unruptured AVMs. METHODS: Three consecutive patients with hydrocephalus caused by unruptured AVMs as well as all cases previously reported in the literature were retrospectively reviewed to determine clinical symptoms, AVM location, nidus size, venous drainage, mechanism of hydrocephalus, level/cause of obstruction, and degree of hydrocephalus. Management of hydrocephalus, AVM treatment, and follow-up length were evaluated. RESULTS: Of 350 patients unruptured AVMs, 3 presented with hydrocephalus (0.8%). In the literature review we found an additional 22 patients for a total of 25 cases. Eighteen patients had mechanical obstruction by the draining vein or the AVM nidus, usually at the level of the aqueduct (52%). Impaired cerebrospinal fluid resorption secondary to venous congestion led to hydrocephalus in 7 patients. Ten patients were treated for both the AVM and hydrocephalus, 13 patients underwent treatment of either hydrocephalus, or the AVM alone. Treatment of hydrocephalus, with or without associated treatment of the brain AVM, resulted in improvement of symptoms in 92% of patients. No rupture of the AVM was reported at follow-up. CONCLUSIONS: The most common cause of hydrocephalus in unruptured brain AVMs is mechanical obstruction by the draining vein if it is located in a strategic position. Treatment of hydrocephalus alone or with associated treatment of the AVM is safe and effective.


Assuntos
Hidrocefalia/etiologia , Hidrocefalia/patologia , Malformações Arteriovenosas Intracranianas/complicações , Malformações Arteriovenosas Intracranianas/patologia , Adulto , Idoso , Feminino , Humanos , Hidrocefalia/terapia , Malformações Arteriovenosas Intracranianas/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
18.
Neurosurg Rev ; 42(2): 409-416, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30980204

RESUMO

Although brain arteriovenous malformations (bAVMs) account for a very small proportion of cerebral pathologies in the pediatric population, they are the cause of roughly 50% of spontaneous intracranial hemorrhages. Pediatric bAVMs tend to rupture more frequently and seem to have higher recurrence rates than bAVMs in adults. Thus, the management of pediatric bAVMs is particularly challenging. In general, the treatment options are conservative treatment, microsurgery, endovascular therapy (EVT), gamma knife radiosurgery (GKRS), proton-beam stereotactic radiosurgery (PSRS), or a combination of the above. In order to identify the best approach to deep-seated pediatric bAVMs, we performed a systematic review, according to the PRISMA guidelines. None of the options seem to offer a clear advantage over the others when used alone. Microsurgery provides the highest obliteration rate, but has higher incidence of neurological complications. EVT may play a role when used as adjuvant therapy, but as a stand-alone therapy, the efficacy is low and the long-term side effects of radiation from the multiple sessions required in deep-seated pediatric bAVMs are still unknown. GKRS has a low risk of complication, but the obliteration rates still leave much to be desired. Finally, PSRS offers promising results with a more accurate radiation that avoids the surrounding tissue, but data is limited due to its recent introduction. Overall, a multi-modal approach, or even an active surveillance, might be the most suitable when facing deep-seated bAVM, considering the difficulty of their management and the high risk of complications in the pediatric population.


Assuntos
Malformações Arteriovenosas Intracranianas/terapia , Encéfalo/cirurgia , Criança , Terapia Combinada , Tratamento Conservador , Procedimentos Endovasculares , Humanos , Malformações Arteriovenosas Intracranianas/complicações , Hemorragias Intracranianas/etiologia , Microcirurgia , Terapia com Prótons , Radiocirurgia
19.
Diagn Interv Imaging ; 100(6): 353-361, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30857993

RESUMO

PURPOSE: To evaluate clinical and imaging features before embolization, data of embolization procedure and outcome in patients with ruptured or unruptured intracranial arteriovenous malformation (AVM) who were treated by endovascular embolization using detachable-tip microcatheters and Onyx 18®. MATERIAL AND METHODS: Forty-three patients treated with endovascular embolization using a detachable-tip microcatheter and Onyx18® between January 2008 and April 2016 were evaluated. There were 27 men and 16 women with a mean age of 35.9±14.1years (range: 10-68years). Clinical and imaging features, embolization details and post-treatment findings were analyzed. Patients were divided into ruptured AVM and unruptured AVM groups. Death, complications and total embolization rates of each group were assessed. RESULTS: Fifty-one embolization sessions were performed in 43 patients. Total embolization rate was 40% (17/43). There were significant relationships between AVM diameter and total embolization success and AVM diameter and complication rates. The degree of embolization was partial in all patients who had complications. Catheter retention and iatrogenic rupture were not observed in any procedure. No major neurologic deficit was seen in patients who had unruptured AVM and complications after treatment. CONCLUSIONS: Our results show the efficacy of endovascular embolization of AVM using detachable-tip microcatheters and Onyx 18®. A new AVM classification system based on AVM diameter for this embolization technique may be more predictive in terms of total embolization success and complication development.


Assuntos
Cateteres , Embolização Terapêutica/métodos , Malformações Arteriovenosas Intracranianas/terapia , Polivinil/uso terapêutico , Tantálio/uso terapêutico , Adolescente , Adulto , Idoso , Criança , Combinação de Medicamentos , Desenho de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
Ophthalmic Plast Reconstr Surg ; 35(3): e57-e59, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30844909

RESUMO

Intraorbital arteriovenous fistula is a rare vascular disease characterized by an acquired arteriovenous communication without direct cavernous sinus involvement. Intraorbital arteriovenous fistula may develop slowly and present similarly to other insidious orbitopathies, such as carotid-cavernous fistula. The authors present a case of a superficial temporal artery to superior ophthalmic vein fistula arising in the absence of trauma or prior surgery. This is the first report of a spontaneous intraorbital arteriovenous fistula arising between these vessels and further describes the rare occurrence of intraorbital arteriovenous fistula.


Assuntos
Fístula Arteriovenosa/diagnóstico , Seio Cavernoso/anormalidades , Malformações Arteriovenosas Intracranianas/diagnóstico , Artérias Temporais/anormalidades , Idoso de 80 Anos ou mais , Fístula Arteriovenosa/terapia , Angiografia Cerebral , Embolização Terapêutica/métodos , Feminino , Humanos , Malformações Arteriovenosas Intracranianas/terapia , Tomografia Computadorizada por Raios X
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA