A Systematic Review of Non-Galenic Pial Arteriovenous Fistulas

Lim, Jaims; Kuo, Cathleen C.; Waqas, M.; Cappuzzo, Justin M; Monteiro, André; Baig, Ammad A; Snyder, Kenneth V.; Davies, Jason M.; Levy, Elad I.; Siddiqui, Adnan H.

doi:10.1016/j.wneu.2022.09.007

Cited by 7 publications

(3 citation statements)

References 89 publications

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“…The researchers found that, of the 982 patients who received tailored intervention, the rate of favorable outcome was 94.1% for endovascular intervention (16/17 patients), 57.3% for CCBs (500/872 patients), and 54.8% for dopamine-induced hypertension (51/93 patients). However, the comparatively small sample size of the endovascular intervention group precludes any strong conclusions from being drawn [ 53 ]. Thus, further studies should be performed to best determine the optimal management for these patients, especially given the wide spectrum of clinical sequelae associated with vasospasm.…”

Section: Post-traumatic Vasospasmmentioning

confidence: 99%

Neuroendovascular Surgery Applications in Craniocervical Trauma

Kim,

Subah,

Cooper

et al. 2023

Biomedicines

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Cerebrovascular injuries resulting from blunt or penetrating trauma to the head and neck often lead to local hemorrhage and stroke. These injuries present with a wide range of manifestations, including carotid or vertebral artery dissection, pseudoaneurysm, occlusion, transection, arteriovenous fistula, carotid-cavernous fistula, epistaxis, venous sinus thrombosis, and subdural hematoma. A selective review of the literature from 1989 to 2023 was conducted to explore various neuroendovascular surgical techniques for craniocervical trauma. A PubMed search was performed using these terms: endovascular, trauma, dissection, blunt cerebrovascular injury, pseudoaneurysm, occlusion, transection, vasospasm, carotid-cavernous fistula, arteriovenous fistula, epistaxis, cerebral venous sinus thrombosis, subdural hematoma, and middle meningeal artery embolization. An increasing array of neuroendovascular procedures are currently available to treat these traumatic injuries. Coils, liquid embolics (onyx or n-butyl cyanoacrylate), and polyvinyl alcohol particles can be used to embolize lesions, while stents, mechanical thrombectomy employing stent-retrievers or aspiration catheters, and balloon occlusion tests and super selective angiography offer additional treatment options based on the specific case. Neuroendovascular techniques prove valuable when surgical options are limited, although comparative data with surgical techniques in trauma cases is limited. Further research is needed to assess the efficacy and outcomes associated with these interventions.

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Section: Post-traumatic Vasospasmmentioning

confidence: 99%

Neuroendovascular Surgery Applications in Craniocervical Trauma

Kim,

Subah,

Cooper

et al. 2023

Biomedicines

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“…Common data elements reduce bias associated with missing results. This shortcoming is exaggerated in similar reviews of rare pathologies in the neurosurgical literature that by nature involve small sample size [ 6 ]. Another limitation is publication bias intrinsic to systematic reviews.…”

Section: Discussionmentioning

confidence: 99%

“…The majority of diagnoses occur either shortly after birth due to heart failure or cerebral venous congestion/neurologic decline or following spontaneous intracranial hemorrhage later in life [ 5 ]. The molecular pathophysiology underlying pAVF formation in utero is not well characterized, but thought to involve perturbations in angiogenic growth factors and embryonic vascular morphogenesis [ 6 – 8 ]. The most frequently associated genetic mutations involve the hereditary hemorrhagic telangiectasia (HHT) genes (ENG, ACVRL and SMAD4) and RASA1 -- which are also implicated in brain AVM and VOGM, respectively [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Pediatric non-galenic pial arteriovenous fistula’s characteristics and outcomes: a systematic review

Thrash,

Hale,

Feldman

et al. 2024

Childs Nerv Syst

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Introduction Pediatric non-galenic pial arteriovenous fistulas (pAVFs) are rare vascular malformations that are characterized by a pial arterial-venous connection without an intervening capillary bed. Outcomes and treatment strategies for pAVFs are highly individualized, owing to the rarity of the disease and lack of large-scale data guiding optimal treatment approaches. Methods We performed a systematic review of pediatric patients (< 18 years at diagnosis) diagnosed with a pAVF by digital subtraction angiogram (DSA). The demographics, treatment modalities, and outcomes were documented for each patient and clinical outcome data was collected. Descriptive information stratified by outcome scores were classified as follows: 1 = excellent (no deficit and full premorbid activity), 2 = good (mild deficit and full premorbid activity), 3 = fair (moderate deficit and impaired activity), 4 = poor (severe deficit and dependent on others), 5 = death. Results A total of 87 studies involving 231 patients were identified. Median age at diagnosis was 3 years (neonates to 18 years). There was slight male preponderance (55.4%), and 150 subjects (81.1%*) experienced excellent outcomes after treatment. Of the 189 patients treated using endovascular approaches, 80.3% experienced excellent outcomes and of the 15 patients surgically treated subjects 75% had an excellent outcome. The highest rate of excellent outcomes was achieved in patients treated with Onyx (95.2%) and other forms of EvOH (100%). High output heart failure and comorbid vascular lesions tended to result in worse outcomes, with only 54.2% and 68% of subjects experiencing an excellent outcome, respectively. *Outcomes were reported in only 185 patients. Conclusion pAVFs are rare lesions, necessitating aggregation of patient data to inform natural history and optimal treatment strategies. This review summarizes the current literature on pAVF in children, where children presenting with heart failure as a result of high flow through the lesion were less likely to experience an excellent outcome. Prospective, large-scale studies would further characterize pediatric pAVFs and enable quantitative analysis of outcomes to inform best treatment practices.

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