The rare case of a large complex intraosseous cranial arteriovenous malformation with successful multidisciplinary management

Al-Smadi, Anas S.; Shokuhfar, Tahaamin; Johnston, Andrew D.; Alden, Tord D.; Bowman, Robin; Shaibani, Ali

doi:10.3171/2017.7.peds17161

Cited by 6 publications

(3 citation statements)

References 15 publications

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“…Interestingly, the endothelial wall of these AVMs also expresses high levels of VEGF compared with normal endothelium, which could lead to the enlargement or regrowth of AVMs. 11,12 Spinal arteriovenous shunts can be either congenital or acquired, with congenital lesions more often manifesting in childhood 13,14 or early adulthood. Traditionally, type I (dural) AVFs are considered to be acquired lesions, whereas types II (glomus), III, and IV (pial) are considered congenital lesions.…”

Section: Discussionmentioning

confidence: 99%

Metachronous spinal pial arteriovenous fistulas: case report

Abdalla

Shokuhfar

Hurley

et al. 2021

Journal of Neurosurgery: Spine

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Spinal pial arteriovenous fistulas (spAVFs) are believed to be congenital lesions, and the development of a de novo spAVF has not been previously described. A 49-year-old female with a childhood history of vascular malformation–induced right lower-extremity hypertrophy presented in 2004 with progressive pain in her right posterior thigh and outer foot. Workup revealed 3 separate type IV spAVFs, which were treated by combined embolization and resection, with final conventional angiography showing no residual spinal vascular lesion in 2005. Ten years later, the patient returned with new right lower-extremity weakness, perineal pain, and left plantar foot numbness. Repeat spinal angiography demonstrated 2 de novo intertwined conus medullaris spAVFs.

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Section: Discussionmentioning

confidence: 99%

Metachronous spinal pial arteriovenous fistulas: case report

Abdalla

Shokuhfar

Hurley

et al. 2021

Journal of Neurosurgery: Spine

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“…[29][30][31] Surgical excision of intraosseous AVMs offers the highest likelihood of cure; however, surgery can be quite morbid, especially in cases with extensive involvement, and may require future reconstruction of the residual defect. 11,19,32 In cases of small intraosseous AVMs, surgery alone has been successful in achieving complete resolution of symptoms. 19 Molina et al described a case in which a 1 cm intraosseous AVM of the spine was resected en bloc, leading to resolution of the patient's symptoms and improvement of his scoliosis 32 months following the procedure.…”

Section: Discussionmentioning

confidence: 99%

A Case of an Aggressive Intraosseous Arteriovenous Malformation in the Lower Extremity: Special Considerations for Diagnosis and Management

Stribling

Abu‐Ghname

Trost

et al. 2020

Vasc Endovascular Surg

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Background: Arteriovenous malformations (AVMs) are rare, congenital vascular anomalies. Intraosseous AVMS most frequently arise in the head and neck, with only a small fraction occurring in the extremities. Herein, we report the findings of a combined soft tissue and intraosseous AVM involving the lower extremity of a 13-year-old child. This case highlights the necessity of an interdisciplinary approach for the effective treatment and management of these rare vascular anomalies. Case Description: A 13-year-old female presented with a 4-year history of intermittent pain and swelling over her right lateral malleolus. The patient was evaluated with radiologic imaging revealing an AVM involving the right distal leg, ankle, and hindfoot with intraosseous involvement of the distal tibia and talus. She was then referred to Vascular and Plastic Surgery and an angiogram was performed demonstrating shunting from the anterior tibial, peroneal, and posterior tibial arteries to the AVM. Venous drainage was to the anterior tibial and greater saphenous veins. Three embolizations were performed over the course of 6 months. Following the third embolization, the patient was taken to the operating room where Plastic and Orthopedic Surgery performed total resection of the nidus and involved bone which was then grafted with injectable synthetic bone graft. Results: Successful resection of the nidus was achieved, and the patient had an uncomplicated recovery. Within 6 months postoperatively, the patient demonstrated full range of lower extremity motion and was able to participate in age appropriate gross motor activities. Radiologic evaluation 7 months postoperatively showed no evidence of nidus recurrence. Conclusion: Intraosseous involvement of AVMS is rare and presents a therapeutic challenge due to its invasive potential and high incidence of recurrence. Wide local excision with bone grafting and interdisciplinary management are paramount for complete resection.

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“…Multiple studies have concluded that common femoral artery (CFA) access should be standard for pediatric angiographic procedures. 1,9,12 Among the closure devices approved for adult use, pertinent disadvantages may include an incompatible device size relative to the small CFA diameter in children, a mural or transmural attachment with a cicatricial action, and retained intraluminal biomaterial after completion of the procedure. 12 The MynxGrip device (AccessClosure Inc.) achieves hemostasis through the delivery of an extravascular, nonadhesive, expansile, water-soluble foam plug that fully resorbs over 1 month.…”

Section: T Shokuhfar Et Almentioning

confidence: 99%

MynxGrip vascular closure device use in pediatric neurointerventional procedures

Shokuhfar¹,

Hurley

Al-Smadi³

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEThe aim of this paper was assess the efficacy and safety of using the MynxGrip arterial closure device in pediatric neuroendovascular procedures where the use of closure devices remains off-label despite their validation and widespread use in adults.METHODSA retrospective review of all pediatric patients who underwent diagnostic or interventional neuroendovascular procedures at the authors’ institution was performed. MynxGrip use was predicated by an adequate depth of subcutaneous tissue and common femoral artery (CFA) diameter. Patients remained on supine bedrest for 2 hours after diagnostic procedures and for 3 hours after therapeutic procedures. Patient demographics, procedural details, hemostasis status, and complications were recorded.RESULTSOver 36 months, 83 MynxGrip devices were deployed in 53 patients (23 male and 30 female patients; mean age 14 years) who underwent neuroendovascular procedures. The right-side CFA was the main point of access for most procedures. The mean CFA diameter was 6.24 mm and ranged from 4 mm to 8.5 mm. Diagnostic angiography comprised 46% of the procedures. A single device failure occurred without any sequelae; the device was extracted, and hemostasis was achieved by manual compression with the placement of a Safeguard compression device. No other immediate or delayed major complications were recorded.CONCLUSIONSMynxGrip can be used safely in the pediatric population for effective hemostasis and has the advantage of earlier mobilization.

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The rare case of a large complex intraosseous cranial arteriovenous malformation with successful multidisciplinary management

Cited by 6 publications

References 15 publications

Metachronous spinal pial arteriovenous fistulas: case report

Metachronous spinal pial arteriovenous fistulas: case report

A Case of an Aggressive Intraosseous Arteriovenous Malformation in the Lower Extremity: Special Considerations for Diagnosis and Management

MynxGrip vascular closure device use in pediatric neurointerventional procedures

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