Combined endovascular embolization and surgery in the management of cerebral arteriovenous malformations: experience with 101 cases

Viñuela, Fernando; Dion, Jacques E.; Duckwiler, Gary; Martin, Neil A.; Lylyk, Pedro; Fox, Allan J.; Pelz, David M.; Drake, Charles G.; Girvin, J; Debrun, Gérard

doi:10.3171/jns.1991.75.6.0856

Cited by 277 publications

(88 citation statements)

References 17 publications

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“…R. Dehdashti, et al come, have been documented in several series. 23,26 Staged embolization can reduce the risk of perfusion pressure breakthrough in patients with large AVMs and has enabled resection in some cases in which the lesion had been deemed previously untreatable. 6,23 Because of advanced techniques and devices, the rate of embolization-related complications has been dramatically reduced.…”

Section: Discussionmentioning

confidence: 99%

“…Although not without complications, the endovascular procedure has proven to be an important adjuvant to the surgical treatment of intracranial AVMs. 1,7,8,19,26,27 Preoperative embolization should facilitate surgery by occluding the AVM nidus. Reduction of AVM volume and occlusion of aneurysms and high-flow fistulas are the desired effects of endovascular embolization.…”

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confidence: 99%

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Preoperative silk suture embolization of cerebral and dural arteriovenous malformations

Ar¹,

Muster²,

Reverdin³

et al. 2001

FOC

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Object The aim of this study was to evaluate the use of silk sutures as a medical implant when applied for the embolization of cerebral and dural arteriovenous malformations (AVMs). The facility of surgery and the clinical significance of complications related to preoperative silk suture embolization were evaluated immediately after surgery and at long-term follow up. Methods Thirty-four patients harboring 29 cerebral and five dural AVMs underwent embolization in which silk alone or in association with other agents was used. Medical and radiological records obtained in these 34 patients were reviewed retrospectively. The cerebral AVMs were classified according to the Spetzler–Martin grading system and the dural AVMs to the Djindjian grading system. The facility of the resection and the adverse outcomes, including new neurological deficits, hemorrhage, and fever, as well as histopathological evidence of vessel inflammatory changes, were determined in each case. In all 23 surgical cases, the AVM could be easily manipulated and excised. New temporary neurological deficits occurred in three patients. A high Spetzler–Martin grade was not associated with a higher incidence of new neurological deficits. One delayed-onset hemorrhage was detected after embolization. Fever was present in 24% of the patients. No sign of significant vasculitis or perivascular inflammation was found on radiological or histopathological examination. Conclusions Silk sutures are safe embolic agents especially for proximal occlusion of AVM feeding vessels. New permanent neurological deficits were not encountered in this series. Fever was considered to be a minor, temporary side effect of silk suture embolization.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Preoperative silk suture embolization of cerebral and dural arteriovenous malformations

Ar¹,

Muster²,

Reverdin³

et al. 2001

FOC

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“…Según la literatura actual, la metodología a seguir en este tipo de tratamiento no queda bien establecida. Existe una gran variabilidad sobre el número de sesiones, el intervalo entre procedimientos y el porcentaje de embolización prequirúrgica en los artículos publica-394-405 dos 7,10,18,21,22,24,25,26,43,46,49 . Debido a ello, presentamos una revisión basada en nuestra experiencia y la literatura sobre los pasos a seguir a la hora de llevar a cabo el tratamiento combinado embolización más cirugía.…”

Section: Aspectos Del Tratamiento Combinado Embolización Más Cirugíaunclassified

Manejo actual de las malformaciones arteriovenosas: Estudio retrospectivo de 31 casos y revisión de la literatura

Muñoz¹,

Clavel²,

Molet³

et al. 2007

Neurocirugía

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ResumenObjetivos. Establecer unos criterios terapéuticos en las malformaciones arteriovenosas (MAVs) grados III, IV y V de Spetzler y Martin y análisis de resultados en el subgrupo de tratamiento con embolización más cirugía.Material y métodos. Estudio retrospectivo de 31 pacientes con MAVs cerebrales tratados en nuestro servicio entre 1999 y 2004. Se trata de 19 mujeres y 12 hombres, con una edad media de 31,6 años (rango de 1 a 62a). La forma de presentación fue en un 77,4% hemorragia intracraneal, en un 12,9% crisis comicial y en un 3,2% cefalea, infarto isquémico y hallazgo casual en cada uno de ellos. En 29 casos se realizó arteriografía diagnóstica y en 2 casos el diagnóstico fue anatomopatológico. Según la clasificación de Spetzler y Martin, 10,3% fueron de Grado I, 24,1% de Grado II, 37,9% de Grado Ill, 24,1% de Grado IV y 3,4% de Grado V. Se clasificaron en 6 grupos según el tratamiento realizado (cirugía, embolización, radiocirugía, embolización más cirugía, embolización más radiocirugía y tratamiento conservador).Resultados. Las MAVs grado III, IV y V (19 pacientes) fueron tratadas en su mayoría por cirugía (6 casos) y embolización más cirugía (5 casos) pero también se utilizaron otras modalidades de tratamiento (embolización, radiocirugía y conservador). Los resultados funcionales de estos 3 subgrupos muestra un 36,8% (7 casos) de asintomáticos o con mínimos síntomas (Rankin m 0-1), un 52,6% (10 casos) de discapacidad leve pero independientes (Rankin m=2), un 5,3% (1 caso) de moderada discapacidad (Rankin m=3), y un 5,3% (1 caso) de mortalidad. En el manejo combinado embolización más cirugía de malformaciones complejas, se observa un alto porcentaje de sangrado postembolización que motivó cirugía precoz con buen resultado funcional. Hubo un caso de mortalidad postquirúrgica.Conclusiones. En el tratamiento de las MAVs cerebrales se debe tener en cuenta factores como la historia natural, la forma de presentación (hemorragia), las características angioestructurales (presencia de aporte arterial profundo, aneurismas), la escala de Spetzler y Martin y el estado clínico del paciente. En el tratamiento con embolización más cirugía es recomendable obtener una embolización prequirúrgica subtotal > 50%, no ocluir más del 50% por sesión, mantener un intervalo entre sesiones de embolización entre 4 y 6 semanas y un intervalo entre última embolización y cirugía entre 1 y 3 semanas.

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“…Vinuela et al reported that out of 405 total patients, the AVM could only be cured in 9.9% of them, and those lesions that could be cured were relatively small in size [13,24]. Henkes et al have shown that endovascular embolization has succeeded in reducing the size of the nidus of AVM from 10-95% with complications only arising in 6% of 64 total patients [29].…”

Section: Presurgical Embolizationmentioning

confidence: 99%

“…Endovascular embolization prior to microsurgery is largely used when treating large AVM lesions [22][23][24][25][26]. Such a procedure has numerous advantages such as reduced blood loss, shorter surgical times, increased ability to occlude vessels difficult to control, and the benefit of staging flow reduction in the nidus [13,18].…”

Section: Presurgical Embolizationmentioning

confidence: 99%

Endovascular Management of Cerebral Arteriovenous Malformations in Pregnancy: Two Case Reports and a Review of the Literature

Agarwal

2012

J Neurol Res

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Cerebral arteriovenous malformations are rare, congenital lesions that affect the vasculature of the brain and have the possibility of rupturing. The presentation of a cerebral arteriovenous malformations in a pregnant woman warrants an even greater level of concern due to the maternal physiological changes, which may affect the structural integrity of the arteriovenous malformations and lead to hemorrhaging. A proper plan of action should be deployed to successfully treat pregnant women with cerebral arteriovenous malformations. In all cases, both the mother's and fetus's well being must be taken into consideration. Two cases and the current management options for cerebral arteriovenous malformations in pregnancy are presented. Online databases, such as PubMed provided by the United States National Library of Medicine at the National Institutes of Health, were searched for references to convey endovascular management options for cerebral arteriovenous malformations in pregnancy. Additional references were obtained from articles that were reviewed by the authors. The first case is of a 27-year-old pregnant woman with a right-sided periventricular intraparenchymal hemorrhage. She was treated with an external ventriculostomy drain. The second case is of a 26-year-old pregnant woman with a prior stage 2 embolization of a left parietal arteriovenous malformation. She did not show evidence of intracranial hemorrhage and was treated with further embolization regimens. A multifaceted approach, tailored to the individual patient may be necessary for cerebral arteriovenous malformations in pregnancy. Successful therapeutic strategies often involve close collaboration with a group of obstetricians, neuroradiologists, anesthesiologists, and neurosurgeons.

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Combined endovascular embolization and surgery in the management of cerebral arteriovenous malformations: experience with 101 cases

Cited by 277 publications

References 17 publications

Preoperative silk suture embolization of cerebral and dural arteriovenous malformations

Preoperative silk suture embolization of cerebral and dural arteriovenous malformations

Manejo actual de las malformaciones arteriovenosas: Estudio retrospectivo de 31 casos y revisión de la literatura

Endovascular Management of Cerebral Arteriovenous Malformations in Pregnancy: Two Case Reports and a Review of the Literature

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