Onyx Embolization Before the Surgical Treatment of Grade III Spetzler-Martin Brain Arteriovenous Malformations: Single-Center Experience and Technical Nuances

Luzzi, Sabino; Maestro, Mattia Del; Bongetta, Daniele; Zoia, Cesare; Giordano, Aldo Victor; Trovarelli, Donatella; Dehcordi, Sohelia Raysi; Galzio, Renato

doi:10.1016/j.wneu.2018.04.203

Cited by 65 publications

(34 citation statements)

References 39 publications

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“…They are also one of the main causes of disability, resulting in high direct and indirect costs [3]. Therefore, correct and quick identification of the cause of bleeding, as well as neglected coagulopathies, is of great importance for the correct management of several surgical pathologies [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Trauma Coagulopathy and Its Outcomes

et al. 2020

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Background and Objectives: Trauma coagulopathy begins at the moment of trauma. This study investigated whether coagulopathy upon arrival in the emergency room (ER) is correlated with increased hemotransfusion requirement, more hemodynamic instability, more severe anatomical damage, a greater need for hospitalization, and hospitalization in the intensive care unit (ICU). We also analyzed whether trauma coagulopathy is correlated with unfavorable indices, such as acidemia, lactate increase, and base excess (BE) increase. Material and Methods: We conducted a prospective, monocentric, observational study of all patients (n = 503) referred to the Department of Emergency and Acceptance, IRCCS Fondazione Policlinico San Matteo, Pavia, for major trauma from 1 January 2018 to 30 January 2019. Results: Of the 503 patients, 204 had trauma coagulopathy (group 1), whereas 299 patients (group 2) did not. Group 1 had a higher hemotransfusion rate than group 2. In group 1, 15% of patients showed hemodynamic instability compared with only 8% of group 2. The shock index (SI) distribution was worse in group 1 than in group 2. Group 1 was more often hypotensive, tachycardic, and with low oxygen saturation, and had a more severe injury severity score than group 2. In addition, 47% of group 1 had three or more body districts involved compared with 23% of group 2. The hospitalization rate was higher in group 1 than in group 2 (76% vs. 58%). The length of hospitalization was >10 days for 45% of group 1 compared with 28% of group 2. The hospitalization rate in the ICU was higher in group 1 than in group 2 (22% vs. 14.8%). The average duration of ICU hospitalization was longer in group 1 than in group 2 (12.5 vs. 9.78 days). Mortality was higher in group 1 than in group 2 (3.92% vs. 0.98%). Group 1 more often had acidemia and high lactates than group 2. Group 1 also more often had BE <−6. Conclusions: Trauma coagulopathy patients, upon arrival in the ER, have greater hemotransfusion (p = 0.016) requirements and need hospitalization (p = 0.032) more frequently than patients without trauma coagulopathy. Trauma coagulopathy seems to be more present in patients with a higher injury severity score (ISS) (p = 0.000) and a greater number of anatomical districts involved (p = 0.000). Head trauma (p = 0.000) and abdominal trauma (p = 0.057) seem related to the development of trauma coagulopathy. Males seem more exposed than females in developing trauma coagulopathy (p = 0.018). Upon arrival in the ER, the presence of tachycardia or alteration of SI and its derivatives can allow early detection of patients with trauma coagulopathy.

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Section: Introductionmentioning

confidence: 99%

Trauma Coagulopathy and Its Outcomes

et al. 2020

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“…All the aforementioned aspects make piezosurgery a very good tool for most of the complex skull and spinal neurosurgical approaches [47][48][49][50][51][52][53][54][55][56][57][58][59].…”

Section: Discussionmentioning

confidence: 99%

Minimal Invasive Piezoelectric Osteotomy in Neurosurgery: Technic, Applications, and Clinical Outcomes of a Retrospective Case Series

Crovace

Luzzi

Lacitignola

et al. 2020

Veterinary Sciences

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Objective: To report the physical and technical principles, clinical applications, and outcomes of the minimal invasive piezoelectric osteotomy in a consecutive veterinary neurosurgical series. Methods: A series of 292 dogs and 32 cats underwent an osteotomy because a neurosurgical pathology performed with a Mectron Piezosurgery® bone scalpel (Mectron Medical Technology, Genoa, Italy) was retrospectively reviewed. Efficacy, precision, safety, and blood loss were evaluated intraoperatively by two different surgeons, on a case-by-case basis. Postoperative Rx and CT scans were used to assess the selectivity and precision of the osteotomy. A histological study on bony specimens at the osteotomized surface was carried out to evaluate the effects of piezoelectric cutting on the osteocytes and osteoblasts. All the patients underwent a six-months follow-up. A series of illustrative cases was reported. Results: All the osteotomies were clear-cut and precise. A complete sparing of soft and nervous tissues and vasculature was observed. The operative field was blood- and heat-free in all cases. A range of inserts, largely different in shape and length, were allowed to treat deep and difficult-to-reach sites. Two mechanical complications occurred. Average blood loss in dogs’ group was 52, 47, and 56 mL for traumatic, degenerative, and neoplastic lesions, respectively, whereas it was 25 mL for traumatized cats. A fast recovery of functions was observed in most of the treated cases, early on, at the first sixth-month evaluation. Histology on bone flaps showed the presence of live osteocytes and osteoblasts at the osteotomized surface in 92% of cases. Conclusions: Piezosurgery is based on the physical principle of the indirect piezo effect. Piezoelectric osteotomy is selective, effective, and safe in bone cutting during neurosurgical veterinary procedures. It can be considered a minimal invasive technique, as it is able to spare the neighboring soft tissues and neurovascular structures.

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“…За останнє десятиліття відбулася еволюція всіх методів лікування цієї патології. Нині проводять безпечне видалення АВМ, які раніше вважали інкурабельними [3].…”

Section: оригінальні дослідженняunclassified

“…Повідомляють про значне поліпшення результатів лікування АВМ у пацієнтів із доопераційною емболізацією [5][6][7], яка сприяє зменшенню кровотоку в АВМ, особливо в глибоких живильних судинах, полегшуючи хірургічне видалення мальформації [3].…”

Section: оригінальні дослідженняunclassified

Combined (microsurgical and endovascular) treatment of cerebral arteriovenous malformations

Shchehlov¹,

Gudym²,

Svyrydiuk³

et al. 2020

Endovasc. Neurorad.

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Objective – to analyze the results of combined microsurgical and endovascular treatment of brain arteriovenous malformations (AVM).Materials and methods. Radiological and clinical data of 19 patients who underwent preoperative endovascular embolization and resection of the AVM at the SO «Scientific-practical Center of endovascular neuroradiology NAMS of Ukraine» in 2014–2019 were analyzed. Among patients were 11 (57.9 %) women and 8 (42.1 %) men. The average age of patient was 28.4 year (from 15 to 54 years). All AVMs were I–III grade according to the Spetzler–Martin scale.Results. The average AVM size in its maximum dimension was 3.2 cm (range 3.1–6.8 cm). 14 (73.7 %) AVMs were supratentorial and 5 (26.3 %) – subtentorial, in 9 (47.4 %) cases AVMs were located in eloquent areas of the brain, in 1 (5.3 %) – in the motor area. Cerebral or subarachnoid hemorrhage were observed in 12 (63.2 %) cases, seizures – in 4 (21.1 %), headache not associated with bleeding – in 2 (10.5 %) and neurological deficiency not related to the bleeding – in 1 (3.7 %). In 16 (84.2 %) patients total AVM resection was achieved, 3 (15.8 %) patients underwent subtotal resection. Fourteen (73.7 %) patients had good results at discharge (10 (52.6 %) patients had 0 or 1 according to modified Rankin score, and 4 (21.1%) patients had 2), 5 (26.3 %) – 3 and 4. There were no mortality cases after combined endovascular and microsurgical treatment. Onset of new neurological deficits occurred in 5 (26.3 %) patients, and in 3 (15.8 %) cases it regress at discharge and in 2 (10.5 %) cases was permanent.Conclusions. Combined treatment (endovascular embolization and microsurgical resection) of AVMs of the low grade AVM (I–III grade of the Spetzler–Martin scale) allows achieving good treatment results. The use of preoperative endovascular embolization reduces blood flow through the AVM and prevents postoperative hemodynamic overload, intraoperative and/or postoperative bleeding.

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Onyx Embolization Before the Surgical Treatment of Grade III Spetzler-Martin Brain Arteriovenous Malformations: Single-Center Experience and Technical Nuances

Cited by 65 publications

References 39 publications

Trauma Coagulopathy and Its Outcomes

Trauma Coagulopathy and Its Outcomes

Minimal Invasive Piezoelectric Osteotomy in Neurosurgery: Technic, Applications, and Clinical Outcomes of a Retrospective Case Series

Combined (microsurgical and endovascular) treatment of cerebral arteriovenous malformations

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