Endovascular treatment of brain-stem arteriovenous malformations: safety and efficacy
Tóm tắt
Our purpose was to evaluate the safety and efficacy of endovascular treatment of brain-stem arteriovenous malformations (AVMs), reviewing six cases managed in the last 5 years. There were four patients who presented with bleeding, one with a progressive neurological deficit and one with obstructive hydrocephalus. Of the six patients, one showed 100%, one 90%, two 75% and two about 50% angiographic obliteration of the AVM after embolisation; the volume decreased about 75% on average. Five patients had a good outcome and one an acceptable outcome, with a mild postprocedure neurological deficit; none had further bleeding during midterm follow-up. Endovascular management of a brain-stem AVM may be an alternative to treatment such as radiosurgery and microsurgery in selected cases. It may be not as risky as previously thought. Embolisation can reduce the size of the AVM and possibly make it more treatable by radiosurgery and decrease the possibility of radiation injury.
Tài liệu tham khảo
Drake CG, Friedman AH, Peerless SJ (1986) Posterior fossa malformations. J Neurosurg 64: 1–10
Batjer H, Samson D (1986) Arteriovenous malformations of the brain: natural history study. J Neurosurg 64: 849–856
Samson D, Batjer H (1985) Arteriovenous malformations of the cerebellar vermis. Neurosurgery 16: 341–349
Monaco RG, Alvarez H, Goulão A, Pruvost PH, Lasjaunias P (1990) Posterior fossa arteriovenous malformations: angioarchitecture in relation to their hemorrhagic episodes. Neuroradiology 31: 471–475
Matsumura H, Makita Y. Someda K, Kondo A (1977) Arteriovenous malformations in the posterior fossa. J Neurosurg 47: 50–56
McCormick WF, Hardman JM, Boulter TR (1968) Vascular malformations ("angiomas") of the brain, with special reference to those occurring in the posterior fossa. J Neurosurg 28: 241–251
Green JR, Vaughan RT (1972) Blood vessel tumors and hematomas of the posterior fossa in adolescence. Angiology 1972;23: 474–487
Chou SN, Erickson DL, Ortiz-Suarez HJ (1975) Surgical treatment of vascular lesions in the brain stem. J Neurosurg 42: 23–31
Drake CG (1975) Surgical removal of arteriovenous malformations from the brain stem and cerebellopontine angle. J Neurosurg 43: 661–670
Batjer H, Samson D (1986) Arteriovenous malformations of the posterior fossa: clinical presentation, diagnostic evaluation, and surgical treatment. J Neurosurg 64: 849–856
Forster DMC, Steiner L, Hakanson S (1972) Arteriovenous malformations of the brain. A long-term clinical study. J Neurosurg 37: 562–570
Graf CJ, Perret GE, Torner JC (1983) Bleeding from cerebral arteriovenous malformations as part of their natural history. J Neurosurg 58: 331–337
Crawford P, West C, Chadwick D, Shaw M (1986) Arteriovenous malformations of the brain: natural history in unoperated patients. J Neurol Neurosurg Psychiatry 49: 1–10
Heros R, Karosue K, Diebold P(1990) Surgical excision of cerebral arteriovenous malformation: late results. Neurosurgery 26; 570–577
Mast H, Young WL, Koennecke H-C, et al (1997) Risk of spontaneous haemorrhage after diagnosis of cerebral arteriovenous malformation. Lancet 350: 1065–1068
Ondra SL, Troupp H, George ED, Schwab K (1990) The natural history of symptomatic arteriovenous malformations of the brain: a 24 year follow-up assessment. J Neurosurg 73: 387–391
Lawton MT, Hamilton MG, Spetzler RF (1995) Multimodality treatment of deep arteriovenous malformations: thalamus, basal ganglia, and brain stem. Neurosurgery 37: 29–36
Spetzler RF, Hargraves RW, McCormick PW, Zabramski JM, Flom RA, Zimmerman RS (1992) Relationship of perfusion pressure and size to risk of hemorrhage from arteriovenous malformations. J Neurosurg 76: 918–923
Meisel HJ, Mansmann U, Alvarez H, Rodesch G, Brock M, Lasjaunias P (2002) Effect of partial targeted n-butyl-cyanoacrylate embolization in brain AVM. Acta Neurochir 144: 879–888
Kurita H, Kawamoto S, Sasaki T, et al (2000) Results of radiosurgery for brain stem arteriovenous malformations. J Neurol Neurosurg Psychiatry 68: 563–570
Massager N, Regis J, Kondziolka D, Njee T, Levivier M (2000) Gamma knife radiosurgery for brainstem arteriovenous malformation: preliminary results. J Neurosurg [Suppl 3]; 93: 102–103
Duma CM, Lunsford LD, Kondziolka D, Bissonette DJ, Somaza S, Flickinger JC (1993) Radiosurgery for vascular malformations of the brain stem. Acta Neurochir [Suppl 58]: 92–97
Flickinger JC, Lunsford LD, Kondziolka D, et al (1992) Radiosurgery and brain tolerance: an analysis of neurodiagnostic imaging changes after gamma knife radiosurgery for arteriovenous malformation. Int J Radiat Oncol Biol Phys 23: 19–26
Kondziolka D, Lunsford LD, Flickinger JC (1993) Intraparenchymal brain stem radiosurgery. Neurosurg Clin North Am 4: 469–479
Alexander III E, Loeffler JS (1992) Radiosurgery for intracranial vascular malformation: technique, results and complications. Clin Neurosurg 31: 273–291