Reflections on the management of cerebral arteriovenous malformations

Deruty, R; Pélissou-Guyotat, I.; Morel, Christophe; Bascoulergue, Y; Turjman, Francis

doi:10.1016/s0090-3019(98)00082-2

Cited by 59 publications

(27 citation statements)

References 29 publications

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“…3,6,12,13,15,22,26 Among studies limited to patients with large or giant vascular malformations, the proportion of patients with nonhemorrhagic neurological deficits approaches 50%. 39 Although the exact mechanism underlying this mode of presentation remains unknown, many have attributed it to the concept of vascular steal.…”

Section: Discussionmentioning

confidence: 99%

Large vascular malformation in a child presenting with vascular steal phenomenon managed with pial synangiosis

Ellis¹,

Armstrong

Dirks³

2011

PED

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The management of large and giant arteriovenous malformations (AVMs) in patients presenting with nonhemorrhagic neurological deficits secondary to vascular steal phenomenon is challenging and controversial. In many cases, large AVMs cannot be completely excised or cured, leaving patients with residual or partially treated AVMs, the natural history of which is unknown. Additionally, large, diffuse vascular malformations with multiple, small feeders, slow flow, or so-called cerebral proliferative angiopathy represent a related but distinct clinical and angiographic entity that may require a different therapeutic approach than traditional brain AVMs. The current management of children with other conditions of chronic cerebral hypoperfusion, such as moyamoya disease, involves consideration of surgical revascularization to enhance blood flow to the compromised hemisphere. Here, the authors present the case of a young child with a large thalamic vascular malformation who presented with clinical and radiological features of vascular steal and ischemia. In an effort to augment flow to the hypoperfused brain and protect against future ischemia, the authors treated the child with unilateral pial synangiosis. At 12 months, postoperative angiography demonstrated robust neovascularization, and the child has not sustained any further ischemic events. The authors discuss concept of vascular malformation–related hypoperfusion and the utility of indirect revascularization for inoperable vascular malformations presenting with ischemic symptoms.

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Section: Discussionmentioning

confidence: 99%

Large vascular malformation in a child presenting with vascular steal phenomenon managed with pial synangiosis

Ellis¹,

Armstrong

Dirks³

2011

PED

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“…Endovascular treatment for brain arteriovenous malformation is performed as auxiliary treatment for surgery and radiotherapy in many cases. The complete occlusion rate achieved by endovascular treatment alone has been reported to be 6-40%, [13][14][15] which is low. Limited to the brainstem, the occlusion rate by endovascular treatment is 16-40%.…”

Section: Discussionmentioning

confidence: 96%

A Case of Brainstem Arteriovenous Malformation Cured by Transvenous Embolization with Onyx

Tsuboi

Terada

Itokawa³

et al. 2019

JNET

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Objective:We report a case of ruptured brain stem arteriovenous malformation that was successfully treated by transvenous embolization in addition to transarterial embolization using Onyx. Case Presentation:A 61-year-old woman was admitted because of consciousness disorder following sudden-onset headache. CT revealed brain stem hemorrhage and MRI revealed abnormal vessels around the brainstem. Cerebral arteriovenous malformation on the right side of the pons was identified from an angiography. Her consciousness gradually improved from conservative treatment. Thereafter, endovascular treatment was performed. First, transarterial embolization with Onyx was performed to reduce the nidus as much as possible. Then, transvenous embolization for the remaining nidus was performed to completely embolize the cerebral arteriovenous malformation. No new neurological deficits were observed after treatment and no recurrence was noted on follow-up angiography 1 month after treatment. Conclusion:We treated the brainstem arteriovenous malformation using a combination of transvenous and transarterial embolizations. In suitable cases, transvenous embolization can be an alternative treatment for deep-seated cerebral arteriovenous malformations that are difficult to treat by transarterial embolization or direct surgery.

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“…[5,[10][11][12][13] The immediate mortality in our chohort was much less (5%) and this low mortality could be related to the use of refined microsurgical technique, neuronavigation and good intensive care both peri-operative and postoperatve. The reported frequency morbidity in various series varied from 1.5 to 18.7%.…”

Section: Discussionmentioning

confidence: 99%

Surgical interventions in intracranial arteriovenous malformations: Indications and outcome analysis in a changing scenario

et al. 2009

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Reflections on the management of cerebral arteriovenous malformations

Cited by 59 publications

References 29 publications

Large vascular malformation in a child presenting with vascular steal phenomenon managed with pial synangiosis

Large vascular malformation in a child presenting with vascular steal phenomenon managed with pial synangiosis

A Case of Brainstem Arteriovenous Malformation Cured by Transvenous Embolization with Onyx

Surgical interventions in intracranial arteriovenous malformations: Indications and outcome analysis in a changing scenario

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