Treatment decision for occipital arteriovenous malformations (AVMs) to achieve hemorrhagic control while maximizing visual preservation: Our experience and review of literature

Yang, Wuyang; Porras, Jose L.; Philadelphia, Eunice; Law, Jody; Garzón-Muvdi, Tomás; Caplan, Justin M.; Colby, Geoffrey P.; Coon, Alexander L.; Tamargo, Rafael J.; Huang, Judy

doi:10.1016/j.jocn.2017.10.058

Cited by 3 publications

(3 citation statements)

References 22 publications

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“…Accounting for 5% to 20% of bAVMs, occipital lobe arteriovenous malformations are associated with a high risk of visual impairment due to their intimate relation with the visual anatomical structures [ 61 , 62 , 63 , 64 ]. As much as 37% to 51% of patients with an occipital bAVM demonstrate visual impairment with lesions in the primary visual cortex that lead to a loss of conscious access to the majority of the visual information in the contralateral visual field (VF) [ 61 , 62 , 63 , 64 ]. The nidus size, involvement of the calcarine artery, the occipital gyrus O5–O6 location, and deep venous drainage have been identified as risk factors for the deterioration of visual function [ 62 ].…”

Section: Resultsmentioning

confidence: 99%

“…Although there have been only a few studies that reported visual outcomes in patients with occipital bAVMs after an endovascular embolization, Smajda et al reported post-treatment worsening of the VF in 24 of the treated patients (30%); 3 patients (9%) had ruptured bAVMs and 21 patients (46%) had unruptured bAVMs [ 61 ]. Similarly, Yang et al reported visual disturbances in 3/8 patients who underwent an endovascular embolization of occipital bAVMs [ 64 ]. Although hemorrhage control is the primary objective, it is paramount to maximize visual preservation in occipital bAVMs [ 64 ].…”

Section: Resultsmentioning

confidence: 99%

“…Similarly, Yang et al reported visual disturbances in 3/8 patients who underwent an endovascular embolization of occipital bAVMs [ 64 ]. Although hemorrhage control is the primary objective, it is paramount to maximize visual preservation in occipital bAVMs [ 64 ]. Tawk et al recommended the use of an amobarbital superselective injection prior to the embolization of occipital lobe arteriovenous malformations.…”

Section: Resultsmentioning

confidence: 99%

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State of the Art in the Role of Endovascular Embolization in the Management of Brain Arteriovenous Malformations—A Systematic Review

Pinkiewicz

Pinkiewicz²,

Walecki

et al. 2022

JCM

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As a significant cause of intracerebral hemorrhages, seizures, and neurological decline, brain arteriovenous malformations (bAVMs) are a rare group of complex vascular lesions with devastating implications for patients’ quality of life. Although the concerted effort of the scientific community has improved our understanding of bAVM biology, the exact mechanism continues to be elucidated. Furthermore, to this day, due to the high heterogeneity of bAVMs as well as the lack of objective data brought by the lack of evaluative and comparative studies, there is no clear consensus on the treatment of this life-threatening and dynamic disease. As a consequence, patients often fall short of obtaining the optimal treatment. Endovascular embolization is an inherent part of multidisciplinary bAVM management that can be used in various clinical scenarios, each with different objectives. Well-trained neuro-interventional centers are proficient at curing bAVMs that are smaller than 3 cm; are located superficially in noneloquent areas; and have fewer, larger, and less tortuous feeding arteries. The transvenous approach is an emerging effective and safe technique that potentially offers a chance to cure previously untreatable bAVMs. This review provides the state of the art in all aspects of endovascular embolization in the management of bAVMs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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State of the Art in the Role of Endovascular Embolization in the Management of Brain Arteriovenous Malformations—A Systematic Review

Pinkiewicz

Pinkiewicz²,

Walecki

et al. 2022

JCM

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Location-based clinical and angiographic profile of brain arteriovenous malformations – a single-center observational study

Basilio-Flores,

Aguilar-Melgar,

Pacheco-Fernandez Baca

2024

Acta Neurochir

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Visual Field Defect Before and After Endovascular Treatment of Occipital Arteriovenous Malformations

et al. 2020

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Abstract BACKGROUND Occipital arteriovenous malformations (AVMs) carry a high risk of postoperative morbidity because of their anatomic relation to the visual cortex and optic radiations. Data regarding endovascular management of these lesions are scant. OBJECTIVE To report our single-center experience with occipital AVMs, most of which were treated endovascularly, with a special interest for postoperative visual impairment. METHODS From a prospective database, we assessed the clinical and radiological data of all patients with an occipital AVM managed between 1997 and 2018. The extension of the nidus to the primary visual cortex was assessed and correlated to the pre- and postintervention visual symptomatology. Modified Rankin Scale and visual fields (VFs) were assessed pre- and post-treatment and at the last follow-up. RESULTS A total of 83 patients (47 males [56.6%]) with an occipital AVM were included in the study. Mean age at presentation was 33.5 ± 15.0 yr (min-max = 7-76). A total of 34 patients (41%) presented with hemorrhage related to the AVM. A total of 57 patients (68.7%) underwent endovascular treatment (EVT) alone, 20 (24.1%) underwent embolization and surgery, 3 (3.6%) underwent embolization and radiosurgery, and 3 (3.6%) were conservatively managed. A complete obliteration of the AVM was achieved in 53 patients (66.3%). A post-treatment worsening of the VF was found in 24 of the treated patients (30%), 3 patients (9%) for ruptured AVMs, and in 21 patients (46%) for unruptured AVMs. Morbidity rate was 3.7% and mortality rate was 2.5%. CONCLUSION EVT of occipital AVM carries a non-negligible rate of complications, especially regarding visual functions.

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Treatment decision for occipital arteriovenous malformations (AVMs) to achieve hemorrhagic control while maximizing visual preservation: Our experience and review of literature

Cited by 3 publications

References 22 publications

State of the Art in the Role of Endovascular Embolization in the Management of Brain Arteriovenous Malformations—A Systematic Review

State of the Art in the Role of Endovascular Embolization in the Management of Brain Arteriovenous Malformations—A Systematic Review

Location-based clinical and angiographic profile of brain arteriovenous malformations – a single-center observational study

Visual Field Defect Before and After Endovascular Treatment of Occipital Arteriovenous Malformations

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