Transitory Brain Stem Edema Following Successfully Transvenous Embolization of a Posterior Fossa Arteriovenous Malformation

Trivelato, Felipe Padovani; Manzato, Luciano Bambini; Rezende, Marco Túlio Salles; Ulhôa, Alexandre Cordeiro

doi:10.1007/s00062-013-0209-y

Cited by 8 publications

(12 citation statements)

References 8 publications

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“…Second, we enrolled more patients with higher Spetzler-Martin grades, and 66.7% of our patients were classified as Spetzler-Martin grade III or even higher. The percentage of higher Spetzler-Martin grades was 58.5% in the report of Mendes et al, 21 and only 25% in the report of Trivelato et al, 11 which are architecturally more complex.…”

Section: Procedural Safetymentioning

confidence: 85%

“…2,28 In this study, 1 cerebral infarct that caused disability was thought to be due to the occlusion of the feeding artery with Onyx. Trivelato et al 11 and Mendes et al 21 reported 2 cases each of postprocedural parenchymal edema thought to be related to venous outflow obstruction, one of which caused a disability.…”

Section: Procedural Safetymentioning

confidence: 99%

“…5 Transvenous embolization can overcome these disadvantages. [6][7][8][9][10][11][12][13][14] Current indications for transvenous embolization of AVMs include deep location, unfavorable arterial access, a small nidus, and a single draining vein. [6][7][8][9][10][11][12][13][14] Because there are only a limited number of cases reported using this approach, the effectiveness and safety remain unclear.…”

mentioning

confidence: 99%

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Safety and Efficacy of Transvenous Embolization of Ruptured Brain Arteriovenous Malformations as a Last Resort: A Prospective Single-Arm Study

Ding

Bai

et al. 2019

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: The efficacy and safety of transvenous embolization for brain arteriovenous malformations remains unclear, given the very limited number of cases reported. This prospective study was performed to assess this technique in ruptured AVMs. MATERIALS AND METHODS: Twenty-one consecutive patients with ruptured brain AVMs who underwent transvenous embolization were prospectively followed between November 2016 and November 2018. The Spetzler-Martin grade was I in 3 AVMs (14.3%), II in four (19.0%), III in eleven (52.4%), and IV in three (14.3%). The complete AVM occlusion rate was calculated from 6-month follow-up DSA images. Occurrence of hemorrhage and infarction after embolization was evaluated using CT and MR imaging within 1 month after the operation. The mRS was used to assess the functional outcomes. RESULTS: Complete AVM nidus obliteration was shown in 16 (84%) of 19 patients with technically feasible AVMs immediately after embolization. One (5%) patient with a small residual nidus after treatment showed complete obliteration at 13-month follow-up. There were 5 hemorrhages and 1 infarction; 4 patients' symptoms improved gradually. The percentage of cases with mRS 2 rose from 57.1% (12/21) before embolization to 66.7% (14/21) at 1-month follow-up. Both the morbidity and mortality rates were 4.8% (1/21). CONCLUSIONS: Transvenous embolization can be performed only in highly selected hemorrhagic brain AVMs with high complete obliteration rates, improved functional outcomes, and acceptable morbidity and mortality rates, but it should not be considered as a first-line treatment. B rain arteriovenous malformations are characterized by an intervening plexus of abnormal vessels (nidus) between feeding arteries and draining veins. The most common presentations of AVMs include hemorrhages, seizures, headaches, and

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Section: Procedural Safetymentioning

confidence: 85%

Section: Procedural Safetymentioning

confidence: 99%

mentioning

confidence: 99%

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Safety and Efficacy of Transvenous Embolization of Ruptured Brain Arteriovenous Malformations as a Last Resort: A Prospective Single-Arm Study

Ding

Bai

et al. 2019

AJNR Am J Neuroradiol

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“…The literature review included 13 studies, comprising 69 patients with 70 AVMs that were treated with transvenous embolization. 2,7,26,29,35,39,40,43,44,46,48,54,56 The treated AVMs ranged between < 1 and 5 cm in maximum diameter, and the Spetzler-Martin grade (reported in 68 of 70 cases) was I in 7 AVMs (10%), II in 25 (37%), III in 24 (35%), and IV in 12 (18%). 51 Embolic agents used included Onyx, PHIL, coils, and Glubran (GEM Srl).…”

Section: Indicationsmentioning

confidence: 99%

“…Trivelato et al reported a case of transient right cranial nerve V1 hypoesthesia with right lateral pontine surface edema on MRI following transvenous embolization of an 8-mm right middle cerebellar peduncle AVM supplied by a duplicated right superior cerebellar artery and right internal auditory artery arising from the basilar trunk. 54 The venous drainage was into the right superior petrosal sinus via the superior petrosal vein. The microcatheter was navigated through the superior petrosal sinus and vein, and eventually positioned in the AVM nidus.…”

Section: Complicationsmentioning

confidence: 99%

Transvenous embolization of brain arteriovenous malformations: a review of techniques, indications, and outcomes

Chen

Norat

Ding

et al. 2018

Neurosurgical Focus

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Endovascular embolization of brain arteriovenous malformations (AVMs) is conventionally performed from a transarterial approach. Transarterial AVM embolization can be a standalone treatment or, more commonly, used as a neoadjuvant therapy prior to microsurgery or stereotactic radiosurgery. In contrast to the transarterial approach, curative embolization of AVMs may be more readily achieved from a transvenous approach. Transvenous embolization is considered a salvage therapy in contemporary AVM management. Proposed indications for this approach include a small (diameter < 3 cm) and compact AVM nidus, deep AVM location, hemorrhagic presentation, single draining vein, lack of an accessible arterial pedicle, exclusive arterial supply by perforators, and en passage feeding arteries. Available studies of transvenous AVM embolization in the literature have reported high complete obliteration rates, with reasonably low complication rates. However, evaluating the efficacy and safety of this approach is challenging due to the limited number of published cases. In this review the authors describe the technical considerations, indications, and outcomes of transvenous AVM embolization.

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Tratamento endovascular de fístulas arteriovenosas durais tentoriais: uso da via arterial como estratégia de primeira linha

Rezende¹

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meu orientador. Ao longo das últimas décadas exerceu com excelência a atividade assistencial e o ensino, além de fomentar incessantemente a pesquisa. Tornou-se o maior neurorradiologista intervencionista do Brasil. Ao me receber como aluno, propiciou-me avançar em minha carreira acadêmica. Ao colega Alexandre Cordeiro Ulhôa, meu primeiro mestre e estimado amigo. Pioneiro da Neurorradiologia Intervencionista mineira, possibilitou o despertar do meu interesse pela área. Ao meu colega e amigo, Felipe Padovani Trivelato. Sua ajuda na construção do projeto foi muito importante. Aos colaboradores do estudo, Luís Henrique Castro Afonso e Caio Molina. A Ludmila, por seu carinho e compreensão. Aos meus irmãos, Ary César e Lydice. A todos que direta ou indiretamente contribuíram no tratamento dos pacientes e na realização deste trabalho. Agradeço a Coordenação de Aperfeiçoamento de Pessoal de Nível Superior -Brasil (CAPES), pelo apoio prestado nas atividades e no desenvolvimento desse estudo de doutorado. RESUMO REZENDE, Marco Túlio Salles. Tratamento endovascular de fístulas arteriovenosas durais tentoriais: uso da via arterial como estratégia de primeira linha. 2021. 184 f. Tese (Doutorado

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Transitory Brain Stem Edema Following Successfully Transvenous Embolization of a Posterior Fossa Arteriovenous Malformation

Cited by 8 publications

References 8 publications

Safety and Efficacy of Transvenous Embolization of Ruptured Brain Arteriovenous Malformations as a Last Resort: A Prospective Single-Arm Study

Safety and Efficacy of Transvenous Embolization of Ruptured Brain Arteriovenous Malformations as a Last Resort: A Prospective Single-Arm Study

Transvenous embolization of brain arteriovenous malformations: a review of techniques, indications, and outcomes

Tratamento endovascular de fístulas arteriovenosas durais tentoriais: uso da via arterial como estratégia de primeira linha

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