Risk Assessment of Hemorrhage of Posterior Inferior Cerebellar Artery Aneurysms in Posterior Fossa Arteriovenous Malformations

Hung, Alice L.; Yang, Wuyang; Braileanu, Maria; Garzón-Muvdi, Tomás; Caplan, Justin M.; Colby, Geoffrey P.; Coon, Alexander L.; Tamargo, Rafael J.; Huang, Judy

doi:10.1093/ons/opx120

Cited by 5 publications

(10 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Kaptain et al presented 81% of the PICA aneurysms associated with AVMs located in the distal segments of PICA 154 , David's study showed distal PICA aneurysms were frequently related to small AVMs 160 . Furthermore, as proved, the risk of aneurysms rupture of PICA was significantly higher than AVMs rupture in PICA-AVM-aneurysm complex 157 . Besides aneurysms, dissection of the PICA distal segment causing subarachnoid hemorrhage (SAH) associated with AVM was also reported.…”

Section: Arteriovenous Malformationmentioning

confidence: 61%

“…Strikingly, feeding arteries aneurysms associated with AMVs drew attention due to the increasing risk of rupture and hemorrhage. It was supposed that the formation of aneurysms was probably associated with the high flow, which resulted from AVMs or the congenital impaired vessel walls 154 , 157 , 158 . The PICA is more prone to form aneurysms associated with AVMs because its tortuous anatomic course more likely leads to hemodynamic abnormity 159 .…”

Section: Arteriovenous Malformationmentioning

confidence: 99%

“…Some studies demonstrated AVM should be treated primarily because the associated diseases would cure after the removal of AVM 154 , 155 , 161 . Other studies proposed the treatment of aneurysms should be prior due to the higher risk of rupture 154 , 157 , 162 . In some cases, the PICA aneurysm and AVM could be treated simultaneously, with surgery or endovascular embolization 158 , 162 .…”

Section: Arteriovenous Malformationmentioning

confidence: 99%

See 2 more Smart Citations

Clinical Importance of the Posterior Inferior Cerebellar Artery: A Review of the Literature

Miao¹,

Zhang²,

Wang³

et al. 2020

Int. J. Med. Sci.

View full text Add to dashboard Cite

The posterior inferior cerebellar artery (PICA), with its unique anatomical complexity, is of great clinical importance and involved in many diseases including aneurysm, ischemic stroke, neurovascular compression syndrome (NVCS), arteriovenous malformation (AVM), and brain tumor. However, a comprehensive systematic review of the importance of the PICA is currently lacking. In this study, we perform a literature review of PICA by searching all the associated papers in the PUBMED database hoping to provide a better understanding of the artery. The PICA has tortuous and variable course and territory, divided into 5 segments. Various aneurysms involving PICA were not uncommon, of which the treatment is challenging. The PICA infarct typically manifests lateral medullary syndrome (LMS) and is more likely to cause mass effects. The PICA frequently compresses the medulla and the cranial nerves resulting in various neurovascular compression syndromes (NVCS). Arteriovenous malformation (AVM) fed by PICA are associated with aneurysm and dissection which have high risk of rupture and worse outcome. PICA injured by head trauma can cause fatal SAH. VA terminating in PICA probably cause Bow hunter's syndrome (BHS). The PICA supplies many brain tumors and can be used in intracerebellar chemotherapy. The PICA can be exposed and injured during surgeries especially in telovelar approach, and it also plays an important role in bypass surgeries, hinting the surgical importance of PICA. In conclusion, PICA is very important in clinical practice.

show abstract

Section: Arteriovenous Malformationmentioning

confidence: 61%

Section: Arteriovenous Malformationmentioning

confidence: 99%

Section: Arteriovenous Malformationmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Importance of the Posterior Inferior Cerebellar Artery: A Review of the Literature

Miao¹,

Zhang²,

Wang³

et al. 2020

Int. J. Med. Sci.

View full text Add to dashboard Cite

show abstract

“…15 The size of the AA is determinant because flow-dependent AAs with a certain size and location are more likely to rupture. 17,18 The ARUBA Paradox…”

Section: Discussion Posterior Fossa Avms: a Specific Entitymentioning

confidence: 99%

Posterior Fossa Arteriovenous Malformations: Experience with 14 Patients and a Systematic Review of the Literature

Corniola

Meling

Bijlenga

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

View full text Add to dashboard Cite

Background The optimal management of posterior fossa arteriovenous malformations (pfAVMs) is a matter of debate. To advance this discussion, we present our clinical series and the results of a systematic literature review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Methods Fourteen consecutive patients with pfAVMs were admitted between 2007 and 2018. Preoperative status, radiologic parameters, and outcome were assessed. A systematic literature review was performed according to the PRISMA-P guidelines. Results Ten patients presented with rupture (71%), of whom three had associated aneurysms (AAs). The treatments were microsurgery (n = 4), endovascular (n = 3), radiosurgery (n = 2), a combination of two or three treatment modalities (n = 3), or conservative (n = 2). At discharge, all four patients (100%) with unruptured pfAVMs had a good outcome (modified Rankin Scale [mRS]: 0–2). In contrast, in ruptured pfAVM cases, mRS was 0 to 2 in four patients (40%), mRS 3 to 4 in two (20%), mRS 5 in three (30%), and one patient (10%) died within 30 days after gamma knife treatment due to pancreatitis secondary to chronic alcohol abuse. At discharge, four patients (29%) had persistent preinterventional cranial nerve and/or focal neurologic deficits. The literature review identified 63 articles with 1,753 pfAVM patients. Overall, 66% of pfAVMs presented with rupture, and AAs were found in 20% of the cases, which is higher than in supratentorial AVMs (stAVMs). Conclusions Because pfAVMs are associated with higher rates of hemorrhagic presentation, higher rates of morbidity and mortality when ruptured, and have a higher incidence of AAs compared with stAVMs, early curative treatment is recommended as soon as the diagnosis is established, regardless of rupture status.

show abstract

“…35 Four articles described anatomical classifications for cerebellar AVMs, designed to aid treatment decision-making; none outlined prognostic parameters. 11,16,35,49 There are no cerebellar-specific, prognostic, clinically applicable, AVM grading systems present in the literature (Table 4).…”

Section: Literature Reviewmentioning

confidence: 99%

A novel proposed grading system for cerebellar arteriovenous malformations

Nisson

Fard

Walter

et al. 2020

Journal of Neurosurgery

View full text Add to dashboard Cite

ABBREVIATIONS AUROC = area under the receiver operating characteristic curve; AVM = arteriovenous malformation; CI = confidence interval; GKS = Gamma Knife surgery; LY = Lawton-Young; mRS = modified Rankin Scale; OR = odds ratio; PoNS = postoperative neurological status; PrNS = preoperative neurological status; SM = Spetzler-Martin; SP = Spetzler-Ponce. OBJECTIVEThe objective of this study was to evaluate the existing Spetzler-Martin (SM), Spetzler-Ponce (SP), and Lawton-Young (LY) grading systems for cerebellar arteriovenous malformations (AVMs) and to propose a new grading system to estimate the risks associated with these lesions. METHODS Data for patients with cerebellar AVMs treated microsurgically in two tertiary medical centers were retrospectively reviewed. Data from patients at institution 1 were collected from September 1999 to February 2013, and at institution 2 from October 2008 to October 2015. Patient outcomes were classified as favorable (modified Rankin Scale [mRS] score 0-2) or poor (mRS score 3-6) at the time of discharge. Using chi-square and logistic regression analysis, variables associated with poor outcomes were assigned risk points to design the proposed grading system. The proposed system included neurological status prior to treatment (poor, +2 points), emergency surgery (+1 point), age > 60 years (+1 point), and deep venous drainage (deep, +1 point). Risk point totals of 0-1 comprised grade 1, 2-3 grade 2, and 4-5 grade 3. RESULTS A total of 125 cerebellar AVMs of 1328 brain AVMs were reviewed in 125 patients, 120 of which were treated microsurgically and included in the study. With our proposed grading system, we found poor outcomes differed significantly between each grade (p < 0.001), while with the SM, SP, and LY grading systems they did not (p = 0.22, p = 0.25, and p = 1, respectively). Logistic regression revealed grade 2 had 3.3 times the risk of experiencing a poor outcome (p = 0.008), while grade 3 had 9.9 times the risk (p < 0.001). The proposed grading system demonstrated a superior level of predictive accuracy (area under the receiver operating characteristic curve [AUROC] of 0.72) compared with the SM, SP, and LY grading systems (AUROC of 0.61, 0.57, and 0.51, respectively). CONCLUSIONS The authors propose a novel grading system for cerebellar AVMs based on emergency surgery, venous drainage, preoperative neurological status, and age that provides a superior prognostication power than the formerly proposed SM, SP, and LY grading systems. This grading system is clinically predictive of patient outcomes and can be used to better guide vascular neurosurgeons in clinical decision-making. https://thejns.org/doi/abs/

show abstract

Risk Assessment of Hemorrhage of Posterior Inferior Cerebellar Artery Aneurysms in Posterior Fossa Arteriovenous Malformations

Abstract: In addition to relatively higher risk of AVM rupture from infratentorial location and prenidal aneurysm, a higher risk of aneurysm rupture rather than AVM rupture was observed in patients with PICA-AVM-anr complex.

Cited by 5 publications

References 39 publications

Clinical Importance of the Posterior Inferior Cerebellar Artery: A Review of the Literature

Clinical Importance of the Posterior Inferior Cerebellar Artery: A Review of the Literature

Posterior Fossa Arteriovenous Malformations: Experience with 14 Patients and a Systematic Review of the Literature

A novel proposed grading system for cerebellar arteriovenous malformations

Contact Info

Product

Resources

About