Intraoperative cerebral angiography in arteriovenous malformation resection in children: a single institutional experience

Gaballah, Marian; Storm, Phillip B.; Rabinowitz, Deborah; Ichord, Rebecca; Hurst, Robert W.; Krishnamurthy, Ganga; Keller, Marc S.; McIntosh, Adeka; Cahill, Anne Marie

doi:10.3171/2013.10.peds13291

Cited by 33 publications

(25 citation statements)

References 42 publications

(46 reference statements)

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“…While intraoperative and 24-hour postresection angiography represent the gold-standard surgical adjunct, the combination is expensive, invasive, and unavailable at many institutions, such as ours. A recent paper from Gaballah et al 9 demonstrated a 5% complication rate and 14% AVM recurrence rate using intraoperative angiography in the pediatric population. There is, however, a learning curve in using intraoperative Doppler ultrasonography as well as the associated neuronavigation and microscope software to their full potential, and the initial cost of the technology may be prohibitive at some institutions.…”

Section: Discussionmentioning

confidence: 99%

“…Complete resection rates are all high in the published series, ranging from 80% to 100%. 5,9,13,16,21 We believe the use of intraoperative ultrasound in combination with neuronavigation and integrated operative microscopy is a safe and reliable technique to aid AVM resection in pediatric patients. There are clear advantages in being able to position a smaller craniotomy directly over the intended target lesion: it minimizes blood loss from the craniotomy site and reduces incision length.…”

Section: Discussionmentioning

confidence: 99%

“…1,14,22 Intraoperative angiography and indocyanine green video-angiography have also been used in conjunction with intraoperative Doppler ultrasound to aid AVM resection in the adult population. 2,19,27 Several authors have reported the use of multimodality treatment in the pediatric population, 3,5,9,11,13,16,17,19,25 including neuronavigation, ultrasound, or intraoperative angiography. Complete resection rates are all high in the published series, ranging from 80% to 100%.…”

Section: Discussionmentioning

confidence: 99%

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Use of intraoperative Doppler ultrasound with neuronavigation to guide arteriovenous malformation resection: a pediatric case series

Walkden¹,

Zádor²,

Herwadkar³

et al. 2015

PED

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OBJECT Over the last 20 years, several intraoperative adjuncts, including ultrasonography, neuronavigation, and angiography, have been said to aid the intraoperative localization and resection of cerebral arteriovenous malformations (AVMs). The authors assessed the value of intraoperative Doppler ultrasonography in conjunction with neuronavigation during surgery for cerebral AVMs in the pediatric population. METHODS The authors reviewed all cranial AVM resections performed by a single surgeon at their institution in the period from 2007 to 2013 and here describe their experience and results in a series of 20 consecutive AVM resections in 19 pediatric patients. Intraoperative Doppler ultrasonography had been used in conjunction with preoperative CT or neuronavigational MRI. Preoperative and postoperative clinical findings, patient age, and Spetzler-Martin AVM grade were identified in all patients. RESULTS All patients, whose ages ranged from 2 to 16 years, underwent craniotomy and excision of an AVM, which was supratentorial in 18 cases and infratentorial in 2. Patients in 11 cases underwent preoperative embolization, and all other patients underwent cerebral angiography prior to surgery, except for 2 patients who were urgently surgically treated because of low Glasgow Coma Scale scores and associated hematoma. Spetzler-Martin Grades I (3 cases), II (6), III (7), and IV (4) AVMs were represented in this series. Intraoperative Doppler ultrasound provided high-quality images in all cases and demonstrated the location, size, and flow characteristics of the AVM and any associated hematoma. Delayed postoperative cerebral angiography demonstrated successful AVM resection in all cases. An assessment of clinical outcomes revealed no new long-term neurological deficits at 3 months postoperatively. CONCLUSIONS Intraoperative Doppler ultrasonography is a reliable and useful tool for intraoperative localization and guidance for AVM resection in the pediatric population. When used in conjunction with neuronavigation equipment and modern microscopes, this technique has shown a very high complete resection rate with extremely low associated morbidity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Use of intraoperative Doppler ultrasound with neuronavigation to guide arteriovenous malformation resection: a pediatric case series

Walkden¹,

Zádor²,

Herwadkar³

et al. 2015

PED

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“…1,9,16 Concern regarding the safety of radiation exposure in children has caused a shift away from studies involving the use of ionizing radiation, such as angiography and CT. 7,22 Recent estimates have placed the mean radiation dose to the skin from a single diagnostic angiogram in a child under the age of 21 at 239.4 mGy, while the dose absorbed by the brain is lower. Infants experience a slightly higher dose due to skull thickness, but the total is still less than 1 Gy.…”

Section: Discussionmentioning

confidence: 99%

“…1,2,9,10,16,23,29 Although the underlying cause of this apparently different biology is unclear, 26 it is an important factor to consider in the management and postoperative follow-up of pediatric patients with AVMs. In addition to patient age, deep venous drainage and diffuse nidus have been identified as potential risk factors for recurrence.…”

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confidence: 99%

Postoperative imaging for detection of recurrent arteriovenous malformations in children

Morgenstern

Hoffman

Kocharian

et al. 2016

PED

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OBJECT The optimal method for detecting recurrent arteriovenous malformations (AVMs) in children is unknown. An inherent preference exists for MR angiography (MRA) surveillance rather than arteriography. The validity of this strategy is uncertain. METHODS A retrospective chart review was performed on pediatric patients treated for cerebral AVMs at a single institution from 1998 to 2012. Patients with complete obliteration of the AVM nidus after treatment and more than 12 months of follow-up were included in the analysis. Data collection focused on recurrence rates, associated risk factors, and surveillance methods. RESULTS A total of 45 patients with a mean age of 11.7 years (range 0.5–18 years) were treated for AVMs via surgical, endovascular, radiosurgical, or combined approaches. Total AVM obliteration on posttreatment digital subtraction angiography (DSA) was confirmed in 27 patients, of whom the 20 with more than 12 months of follow-up were included in subsequent analysis. The mean follow-up duration in this cohort was 5.75 years (median 5.53 years, range 1.11–10.64 years). Recurrence occurred in 3 of 20 patients (15%). Two recurrences were detected by surveillance DSA and 1 at the time of rehemorrhage. No recurrences were detected by MRA. Median time to recurrence was 33.6 months (range 19–71 months). Two patients (10%) underwent follow-up DSA, 5 (25%) had DSA and MRI/MRA, 9 (45%) had MRI/MRA only, 1 (5%) had CT angiography only, and 3 (15%) had no imaging within the first 3 years of follow-up. After 5 years posttreatment, 2 patients (10%) were followed with MRI/MRA only, 2 (10%) with DSA only, and 10 (50%) with continued DSA and MRI/MRA. CONCLUSIONS AVM recurrence in children occurred at a median of 33.6 months, when MRA was more commonly used for surveillance, but failed to detect any recurrences. A recurrence rate of 15% may be an underestimate given the reliance on surveillance MRA over angiography. A new surveillance strategy is proposed, taking into account exposure to diagnostic radiation and the potential for catastrophic rehemorrhage.

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Arteriovenous malformation

泉田¹

2004

Dermatology Therapy

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Intraoperative cerebral angiography in arteriovenous malformation resection in children: a single institutional experience

Cited by 33 publications

References 42 publications

Use of intraoperative Doppler ultrasound with neuronavigation to guide arteriovenous malformation resection: a pediatric case series

Use of intraoperative Doppler ultrasound with neuronavigation to guide arteriovenous malformation resection: a pediatric case series

Postoperative imaging for detection of recurrent arteriovenous malformations in children

Arteriovenous malformation

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