Endovascular treatment of cerebral arteriovenous malformations: indications, techniques, outcome, and complications

Cockroft, Kevin M.; Hwang, Sung Kyun; Rosenwasser, Robert H.

doi:10.1016/j.nec.2004.08.001

Cited by 23 publications

(9 citation statements)

References 66 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Previous data highlight the favorable clinical outcomes of multimodality therapy for carefully selected patients. 3,4,6,11,19 Presurgical embolization can safely decrease the size of AVMs and decrease the apparent risk of rupture in high-risk lesions such as highflow aneurysms or remote fistulas. 28 Du and colleagues 9 have shown that diffuseness and deep perforating artery supply are subtle features of an AVM that predict worse outcomes after microsurgical resection, since deep perforators are friable, poorly visualized, and located in eloquent white matter tracts.…”

Section: Preoperative Embolizationmentioning

confidence: 99%

Microsurgery for cerebral arteriovenous malformations: postoperative outcomes and predictors of complications in 264 cases

Theofanis

Chalouhi

Dalyai

et al. 2014

FOC

Self Cite

View full text Add to dashboard Cite

Object The authors conducted a study to assess the safety and efficacy of microsurgical resection of arteriovenous malformations (AVMs) and determine predictors of complications. Methods A total of 264 patients with cerebral AVMs were treated with microsurgical resection between 1994 and 2010 at the Jefferson Hospital for Neuroscience. A review of patient data was performed, including initial hemorrhage, clinical presentation, Spetzler-Martin (SM) grade, treatment modalities, clinical outcomes, and obliteration rates. Univariate and multivariate analyses were used to determine predictors of operative complications. Results Of the 264 patients treated with microsurgery, 120 (45%) patients initially presented with hemorrhage. There were 27 SM Grade I lesions (10.2%), 101 Grade II lesions (38.3%), 96 Grade III lesions (36.4%), 31 Grade IV lesions (11.7%), and 9 Grade V lesions (3.4%). Among these patients, 102 (38.6%) had undergone prior endovascular embolization. In all patients, resection resulted in complete obliteration of the AVM. Complications occurred in 19 (7.2%) patients and resulted in permanent neurological deficits in 5 (1.9%). In multivariate analysis, predictors of complications were increasing AVM size (OR 3.2, 95% CI 1.5–6.6; p = 0.001), increasing number of embolizations (OR 1.6, 95% CI 1.1–2.2; p = 0.01), and unruptured AVMs (OR 2.7, 95% CI 1–7.2; p = 0.05). Conclusions Microsurgical resection of AVMs is highly efficient and can be undertaken with low rates of morbidity at high-volume neurovascular centers. Unruptured and larger AVMs were associated with higher complication rates.

show abstract

Section: Preoperative Embolizationmentioning

confidence: 99%

Microsurgery for cerebral arteriovenous malformations: postoperative outcomes and predictors of complications in 264 cases

Theofanis

Chalouhi

Dalyai

et al. 2014

FOC

Self Cite

View full text Add to dashboard Cite

show abstract

“…Embolization of AVMs is typically used to reduce nidal size in advance of surgical resection or radiosurgery. [1][2][3][4][5][6][7][8] Embolization can also be used to reduce hemorrhage risk by attempting to eliminate specific areas at high risk for hemorrhage such as intranidal aneurysms, 9 or less commonly, by attempting to completely obliterate the nidus. Recent advances in the embolization technique during the past decade include the development of softer flow-directed microcatheters and the increased use of liquid embolic agents, including cyanoacrylate derivatives to assure nidal penetration during embolization.…”

mentioning

confidence: 99%

“…14 Several recent series have reported the complication rates with AVM embolization, 2,5,6,8,[15][16][17] with treatment-related morbidity ranging from 3% to 11%. An embolization protocol using continuous neurophysiologic testing, superselective provocative testing, conscious sedation instead of general anesthesia whenever possible to allow direct clinical examination, staged embolization during several sessions, and strict postprocedure blood pressure control has been adopted at our institution.…”

mentioning

confidence: 99%

Neurologic Complications of Arteriovenous Malformation Embolization Using Liquid Embolic Agents

Jayaraman¹,

Marcellus²,

Hamilton³

et al. 2008

American Journal of Neuroradiology

105

View full text Add to dashboard Cite

show abstract

“…Angiographically confirmed obliteration is the ultimate goal, but it is often difficult to obtain because many small feeding vessels cannot be catheterized. A cure is only achieved in 5 to 14% of patients, 4,11 most of whom have small lesions. The benefits of embolizing AVMs as a preoperative treatment are well known.…”

Section: Treatment Goalsmentioning

confidence: 99%

The evolution of endovascular treatment for intracranial arteriovenous malformations

Bristol

Albuquerque

McDougall

2006

FOC

View full text Add to dashboard Cite

✓ Endovascular therapy for arteriovenous malformations (AVMs) remains a relatively new approach. Beginning in the 1960s with the use of flow-directed techniques for selective embolization, hemodynamic alterations have been used to treat these lesions. In every aspect of treatment, technological advances, including catheters, embolic materials, angiography suites, and pharmacological agents, have improved outcomes while lowering the risk to patients. In this article, the authors review the technical evolution of endovascular AVM therapy. Developments in embolic materials, beginning with foreign bodies and autografts and continuing through to highly engineered contemporary substances, are discussed. Finally, changes in treatment paradigms that have occurred over the years are traced. Within neurosurgery, this specialty has shown some of the fastest growth and development in recent decades. As minimally invasive approaches are embraced in all areas of medicine, it is clear that this treatment modality will continue to be refined.

show abstract

Endovascular treatment of cerebral arteriovenous malformations: indications, techniques, outcome, and complications

Cited by 23 publications

References 66 publications

Microsurgery for cerebral arteriovenous malformations: postoperative outcomes and predictors of complications in 264 cases

Microsurgery for cerebral arteriovenous malformations: postoperative outcomes and predictors of complications in 264 cases

Neurologic Complications of Arteriovenous Malformation Embolization Using Liquid Embolic Agents

The evolution of endovascular treatment for intracranial arteriovenous malformations

Contact Info

Product

Resources

About