Surgery for cerebral arteriovenous malformation: risks related to lenticulostriate arterial supply

Abstract

The aim of this study was to compare complications of surgery in arteriovenous malformations (AVMs) supplied by the middle cerebral artery (MCA) with and without a lenticulostriate arterial contribution. Ninety-two consecutive surgical resections of AVMs with an angiographically demonstrated MCA supply were performed between January 1989 and July 1996. Ten of these cases had a significant lenticulostriate arterial contribution. The cases were graded according to the Spetzler-Martin classification. There were no deaths and 4.3% of cases developed new major neurological deficit by the 3-month follow-up examination. All cases had angiographically confirmed obliteration of the AVM. There were no complications in 16 patients with Spetzler-Martin Grade I AVMs, one case of complications in 40 patients with Grade II AVMs, eight cases of complications in 26 patients with Grade III AVMs, and seven cases of complications in 10 patients with Grade IV and V AVMs. The supply of blood from lenticulostriate branches was associated with complications in eight of the 10 cases. The effect of the presence of a lenticulostriate arterial supply was most apparent in cases of Grade III AVMs: complications were experienced in three of 20 patients whose AVMs were not supplied by the arteries and in five of six patients whose AVMs were fed by the lenticulostriate arteries. This difference is significant (p < 0.0001). The conclusions drawn from this study are that for Grade III AVMs, the presence of a lenticulostriate arterial supply can be considered a factor predictive of an increased risk of surgical complications.

A Discriminative Prediction Model of Neurological Outcome for Patients Undergoing Surgery of Brain Arteriovenous Malformations

“…In 1 study, patients with bAVMs fed primarily by the middle cerebral artery with a lenticulostriate supply had a worse neurological outcome than those without. 20 Though our univariable analysis suggested a relationship between an arterial perforator supply and a worse outcome, this was not significant in the multivariable analysis. Deep arterial supply may interact with other variables and be accounted for by its association with these other predictors, such as deep venous drainage.…”

“…7 At 1 year, these figure were 8%, 6%, 4%, 4% and 33% for grades I-V. Thus, the SM system includes parameters that have predictive value on outcome, 4,5,7,11,20 but it stratifies patients into essentially 2 categories: low-and high-risk groups. Our data reflect a similar experience, with patients in SM Grades I-III having low, and SM grade IV having high, risk of incurring a PD outcome.…”

Observation of the Lenticulostriate Arteries in the Human Brain In Vivo Using 7.0T MR Angiography

“…Ischemic and hemorrhagic cerebral strokes often occur in the areas of the brain supplied by these perforating arteries. 1,2 Even though there is a great need for observation of microvasculature in the brain for the early detection of cerebrovascular strokes in routine clinical practice and for research purposes, 3,4 currently available angiographic techniques remain relatively inconvenient and often risky in practice because they require unusually large contrast materials, such as iodine. In this study, for the first time, we have visualized LSAs in the human brain in vivo using 7.0T MR angiography (MRA), in a totally noninvasive manner.…”

Analysis of Correlation between the Number of Lenticulostriate Arteries and Hypertension Based on High-Resolution MR Angiography Findings

“…6 Ischemic and hemorrhagic cerebral strokes often occur in the areas of the brain supplied by these perforating arteries. 7,8 Lacunar infarcts account for Ͼ20% of all strokes, and the basal ganglia are involved in 35%-44% of intracerebral hemorrhages. 9,10 Thus, in vivo imaging of LSAs could provide important insights for understanding the pathophysiology and mechanism of microvascular diseases associated with hypertension.…”