Occipital arteriovenous malformations

Kupersmith, Mark J.; Vargas, M.; Yashar, A.; Madrid, Mary; Nelson, Kevin L.; Seton, A.; Berenstein, Alex

doi:10.1212/wnl.46.4.953

Cited by 63 publications

(49 citation statements)

References 5 publications

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“…The median margin dose was 19 Gy (14-25 Gy), and the maximum median dose was 36 Gy (25-50 Gy). The median number of isocenters used was 4 (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. At the conclusion of treatment, all patients received 20-40 mg of intravenous methylprednisolone.…”

Section: Results Patient Population and Avm Characteristicsmentioning

confidence: 99%

“…5,32 Previous studies have indicated that a homonymous visual field deficit occurs in 67%-81% of patients with a previous hemorrhage and in 25%-36% of unruptured AVM cases in the occipital lobe. 13,21 However, the natural history rate for visual field deficits in optic radiation AVMs is largely unavailable. In this study 36% of patients with a prior hemorrhage and 12% of those without had a visual field deficit at presentation, rates consistent with the results of Dehdashti et al 5 Microsurgical publications have documented rates of visual deficit from a prior hemorrhage as 26%-77%.…”

Section: Decision Making and Visual Fieldsmentioning

confidence: 99%

“…Visual field deficits are most apparent in the occipital lobe where homonymous field defects have been reported, occurring in up to 81% of patients with AVM hemorrhages and in 36% of patients without a hemorrhage. 13 New visual field deficits have been reported in all treatment paradigms and can occur in as many as 33% of microsurgical patients. 1,3 Unfortunately, such deficits can be a significant disability that negatively impacts quality of life and can worsen long-term rehabilitation outcomes, especially when a homonymous hemianopia has occurred.…”

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confidence: 99%

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Stereotactic radiosurgery for arteriovenous malformations of the postgeniculate visual pathway

Bowden

Kano

Caparosa

et al. 2015

JNS

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ManageMent options for arteriovenous malformations (AVMs) have expanded and evolved over time. However, the underlying goal of intervention remains complete obliteration of the AVM and maintenance of neurological function. 16,40,41 The rates of AVM occlusion after a single Gamma Knife surgery generally range from 70% to 80% over a 5-year observation period. 6,11,19,25 In addition, stereotactic radiosurgery (SRS) has a relatively low risk profile for adverse radiation effects (AREs). 23The lateral geniculate nucleus gives rise to the sublenticular and retrolenticular segments of the optic radiation that travel through the temporal and parietal lobes, respectively, on a path that terminates in the striate cortex. Because the distance and fragility of these pathways create the opportunity for disruption by an AVM, associabbreviatioNs ARE = adverse radiation effect; AVM = arteriovenous malformation; SRS = stereotactic radiosurgery. submitted January 8, 2014. accepted October 14, 2014. iNclude wheN citiNg Published online November 28, 2014; DOI: 10.3171/2014.10.JNS1453. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Dr. Lunsford is a consultant and stockholder for AB Elekta. , and 19 Gy (range 14-25 Gy) was the median margin dose. Obliteration of the AVM was confirmed in 80 patients after a single SRS procedure at a median follow-up of 74 months (range 5-297 months). The actuarial rate of total obliteration was 67% at 4 years. Arteriovenous malformations with a volume < 5 cm 3 had obliteration rates of 60% at 3 years and 79% at 4 years. The delivered margin dose proved significant given that 82% of patients receiving ≥ 22 Gy had complete obliteration. The AVM was completely obliterated in an additional 18 patients after they underwent repeat SRS. At a median of 25 months (range 11-107 months) after SRS, 9 patients developed new or worsened visual field deficits. One patient developed a complete homonymous hemianopia, and 8 patients developed quadrantanopias. The actuarial risk of sustaining a new visual deficit was 3% at 3 years, 5% at 5 years, and 8% at 10 years. Fifteen patients had hemorrhage during the latency period, resulting in death in 9 of the patients. The annual hemorrhage rate during the latency interval was 2%, and no hemorrhages occurred after confirmed obliteration. coNclusioNs Despite an overall treatment mortality of 5%, related to latency interval hemorrhage, SRS was associated with only a 5.6% risk of new visual deficit and a final obliteration rate close to 80% in patients with AVMs of the postgeniculate visual pathway.

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Section: Results Patient Population and Avm Characteristicsmentioning

confidence: 99%

Section: Decision Making and Visual Fieldsmentioning

confidence: 99%

mentioning

confidence: 99%

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Stereotactic radiosurgery for arteriovenous malformations of the postgeniculate visual pathway

Bowden

Kano

Caparosa

et al. 2015

JNS

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“…Contralateral homonymous visual field deficit is the most common neurological deficit, occurring in 67-90% of patients with occipital AVMs that have hemorrhaged. 1,8,11,14) Venous ischemia often causes neurological deficit in patients with tentorial dural AVMs associated with visual hallucinations and quadrantic hemianopsia. 6,9) One case of tentorial dural arteriovenous fistula presenting with superior quadrantic hemianopsia was due to dilated venous drainage compressing the visual pathway.…”

Section: Discussionmentioning

confidence: 99%

“…1,8,11,14) Visual field deficit caused by dilated vein was also irreversible in cases with optic atrophy caused by long-standing compression, 7) but is reversible in patients without ophthalmoscopic abnormalities. Immediate treatment is essential for these patients to cure the visual deficit.…”

Section: Discussionmentioning

confidence: 99%

Reversible Hemianopsia Caused by Mechanical Compression of the Visual Pathway by the Dilated Draining Vein of an Arteriovenous Malformation -Case Report-

Takigawa

Matsumaru

Hayakawa

et al. 2010

Neurol. Med. Chir.(Tokyo)

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A 41-year-old woman presented with progressive hemianopsia caused by compression of the lateral geniculate body by the dilated basal vein draining a contralateral frontal arteriovenous malformation (AVM). Magnetic resonance (MR) imaging revealed left frontal AVM and right lateral geniculate body compression due to the dilated basal vein. Emergent presurgical transarterial embolization and surgical removal were performed. Left hemianopsia completely recovered 3 months after surgery and MR imaging indicated improvement of the compression of the lateral geniculate body. Direct mechanical compression of the enlarged drainage vein is one of the causes of homonymous hemianopsia. Early surgical treatment is recommended to obtain a rapid recovery.

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A Questionable Cause of Intracerebral Hemorrhage—Reply

Gokhale¹

2013

JAMA Neurol

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Occipital arteriovenous malformations

Cited by 63 publications

References 5 publications

Stereotactic radiosurgery for arteriovenous malformations of the postgeniculate visual pathway

Stereotactic radiosurgery for arteriovenous malformations of the postgeniculate visual pathway

Reversible Hemianopsia Caused by Mechanical Compression of the Visual Pathway by the Dilated Draining Vein of an Arteriovenous Malformation -Case Report-

A Questionable Cause of Intracerebral Hemorrhage—Reply

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