Temporal lobe arteriovenous malformations: anatomical subtypes, surgical strategy, and outcomes and for the UCSF Brain AVM Study Project (original) (raw)
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Brain AVMs: An Endovascular, Surgical, and Radiosurgical Update
The Scientific World Journal, 2014
Brain arteriovenous malformations (bAVMs) are complex vascular lesions. Despite multiple studies, several classifications, and a great interest of the scientific community, case selection in AVM patients remains challenging. During the last few years, tremendous advancements widened therapeutic options and improved outcomes spreading indications for patients harboring lesions deemed inoperable in the past. Anatomical and biological case specific features, and natural history with a focus on presenting symptoms should be evaluated case by case and always kept in mind while planning a therapeutic management for a bAVMs. A multidisciplinary approach is strongly recommended when dealing with bAVMs and should involve physicians expertise in this kind of challenging lesions. The goal of this paper is to provide a focused review of the most recent acquisitions and therapeutic strategies regarding surgical, endovascular, and radiosurgical treatment.
Radiosurgery for arteriovenous malformations of the basal ganglia, thalamus, and brainstem
Journal of Neurosurgery, 2004
UBLISHED papers on radiosurgery of AVMs demonstrate that between 23 and 44% of patients have AVMs located in the basal ganglia, thalamus, or brainstem. 2,11,17,20,22,38,40 By comparison, only 4 to 11% of patients in recent surgical series of AVMs have harbored these lesions in deep locations. 5,14,15,27,28,35,36 Embolization of AVMs is rarely curative and is typically performed as a preoperative adjunctive therapy before resection or radiosurgery. 26 Consequently, radiosurgery is generally accepted as the best treatment for patients with deeply located AVMs. Nevertheless, there have been few studies in which a specific analysis of the results of radiosurgery for such patients has been undertaken. 4,23 In this paper, the outcomes of 56 patients who underwent stereotactic radiosurgery for AVMs located in the basal ganglia, thalamus, or brainstem are presented. Clinical Material and Methods Between January 1990 and December 1999, 58 patients with AVMs located in the basal ganglia, thalamus, or brainstem underwent stereotactic radiosurgery at the Ma-yo Clinic in Rochester, Minnesota. Two patients were lost to follow-up review. All preoperative, radiosurgical, and follow-up information on the remaining 56 patients were retrieved from a prospectively maintained database. There were 25 men and 31 women; their characteristics are outlined in Table 1. A radiosurgery-based AVM score was calculated for each patient based on the volume of the lesion, the patient's age, and the location of the lesion. 29 The AVM score was determined as follows: AVM score = (0.1)(volume of lesion in cm 3) ϩ (0.02)(patient age in years) ϩ (0.3) (location of lesion, which was assigned 0 for a frontal/temporal, 1 for a parietal/occipital/corpus callosum/cerebellar, or 2 for a basal ganglia/thalamus/brainstem location). The median AVM radiosurgery score was 1.83 (range 0.83-5.4). All radiosurgical procedures were performed using the Leksell gamma knife (Elekta Instruments, Norcross, GA). Radiosurgical dose planning was based on a combination of findings from stereotactic biplanar angiography and MR imaging. The median maximal AVM diameter was 26 mm (range 9-48 mm), and the median prescribed isodose volume was 3.8 cm 3 (range 0.3-40.2 cm 3). Two patients underwent staged-volume radiosurgery. 30 The median radiation dose delivered to the margin of the AVM was 18 Gy (range 15-25 Gy), and the median maximal dose was 36 Gy (range 22.5-50 Gy).
Journal of Laryngology and Otology, 2008
Objectives: To report the case of a spontaneous arteriovenous malformation involving the auricula, external auditory meatus, middle ear and part of the petrous apex, and also to provide updated information about its management. Case report: A 33-year-old woman presented complaining of accelerated growth of a retro-auricular swelling during her latest pregnancy, together with pain, pulsatile tinnitus and ear discharge. An arteriovenous malformation occupying the right auricula, external auditory canal, mastoid proccess of the temporal bone and the lateral half of the petrous segment was diagnosed, using temporal computerised tomography and magnetic resonance imaging. The lesion was embolised with polyvinyl alcohol particles at angiography. Excision of the arteriovenous malformation nidus was performed. Three years post-operatively, magnetic resonance imaging showed no residual lesion or recurrence at the temporal bone and petrous apex, although a few scanty, serpiginous, vascular remnants had persisted. Conclusions: In the head and neck, arteriovenous malformations usually occur intracranially; they are rare outside the cranium. To our knowledge, there have been no previously published cases of such an extensive arteriovenous malformation involving the temporal region. Apropos of our case, the definition, clinical findings, diagnostic approaches and therapeutic management of arteriovenous malformations are discussed.
Neurosurgery, 2005
OBJECTIVE: Occipital lobe arteriovenous malformations (AVMs) provide challenging management decisions because of their proximity to the visual cortex and optic radiations. Preservation of visual function throughout treatment is the mainstay of therapeutic planning. We reviewed visual field (VF) outcomes of all patients who received curative treatment for occipital AVMs at Stanford University to evaluate the efficacy of different treatment strategies. METHODS: We conducted a retrospective review of 55 patients with occipital AVMs treated at Stanford University between 1984 and 2003. Clinical presentation, AVM morphology, and treatment modality were correlated with VF function before and after therapeutic intervention. RESULTS: Of 55 patients, 48 (87.3%) underwent multimodality AVM treatment (7 patients Ͻ3 yr from radiosurgery were excluded from final analysis). One patient died from intracerebral hemorrhage 11 months post-radiosurgery, and five patients deferred further treatment. Forty-two patients (87.5%) were cured, with no residual AVM on final angiography. Curative therapeutic modalities used included embolization alone (2 patients), microsurgery alone (6 patients), microsurgery with radiosurgery (1 patient), microsurgery with embolization (23 patients), radiosurgery with embolization (4 patients), and embolization with radiosurgery and microsurgery (6 patients). Mean follow-up was 5.8 years including treatment. VF follow-up was available in all 42 patients. Twenty-eight (66.7%) patients experienced no change in VFs, six (14.3%) patients with previously abnormal VFs improved, and eight (19.0%) patients showed worsening of VFs (although none developed a new homonymous VF deficit). Duration of treatment was related to VF outcome in patients who presented without a history of AVM-related hemorrhage. CONCLUSION: Occipital AVMs can be safely cured using multimodality strategies with minimal risk to visual function despite the proximity of these lesions to the visual cortex and associated pathways.
Journal of neurosurgery, 2015
OBJECT The temporal lobe is particularly susceptible to epileptogenesis. However, the routine use of anticonvulsant therapy is not implemented in temporal lobe AVM patients without seizures at presentation. The goals of this case-control study were to determine the radiosurgical outcomes for temporal lobe AVMs and to define the effect of temporal lobe location on postradiosurgery AVM seizure outcomes. METHODS From a database of approximately 1400 patients, the authors generated a case cohort from patients with temporal lobe AVMs with at least 2 years follow-up or obliteration. A control cohort with similar baseline AVM characteristics was generated, blinded to outcome, from patients with non-temporal, cortical AVMs. They evaluated the rates and predictors of seizure freedom or decreased seizure frequency in patients with seizures or de novo seizures in those without seizures. RESULTS A total of 175 temporal lobe AVMs were identified based on the inclusion criteria. Seizure was the p...
Comparative Analysis of Endovascular and Microsurgical Treatment of Intracranial AVM
Advances in Clinical and Experimental Medicine, 2010
Background. Intracranial arteriovenous malformations (AVMs) are among the most frequent developmental anomalies of brain vessels. The most serious complication of AVM is intracranial hemorrhage. Treatment methods of intracranial AVMs include microsurgical techniques, endovascular embolization, and radiosurgery. As all these methods have their advantages and disadvantages, the choice of treatment depends mostly on the experience and capabilities of the treating hospital. Objectives. To analyze comparatively two treatment methods of AVMs: endovascular embolization and microsurgical resection. Material and Methods. Forty consecutive AVMs in 40 patients aged 4-60 years treated between 2002-2007 were analyzed retrospectively. Twenty of the patients were treated by microsurgical resection (subgroup S) and the remaining 20 (subgroup E) underwent embolization (36 sessions overall). There were 12 emergency cases (8 in subgroup S and 4 in subgroup E). Embolizations were performed with histoacrylic glue. Microsurgery included complete resection of the visible AVM and clipping of the feeding artery, in emergency cases also the removal of hematomas. The results of the treatment method were assessed on the last day of hospitalization according to the Glasgow Outcome Scale (GOS). Results. In both subgroups E and S, the most common AVMs were those with 3 points in the Spetzler-Martin classification (S-M) (6 and 9 AVMs, respectively). Mean S-M scores were 2.8 and 2.5, respectively. The most frequent feeding artery in both groups was the MCA (14 and 11, respectively). The degree of nidus embolization ranged from 33 to 100% and depended on S-M score (for S-M of 1 an average of 91.7%, of 2 88%, of 3 70.2%, of 4 65.8%, and of 5 40%). In 15 of the 20 surgical cases, AVMs were removed totally, while in 5 cases residual nidi were found in follow-up CT and/or angiography. In group E the mean GOS score at discharge from hospital was 4.35 points and in group S 3.95 points (no significant difference). In the case of elective embolization or surgery, the mean GOS was 4.7 and 4.5, respectively. The mean duration of hospitalization (in the case of multiple embolizations, hospitalizations during all the sessions were summed) was 14 days in subgroup E and substantially longer (23 days) in subgroup S (p < 0.05). Conclusions. Intravascular and microsurgical methods in many cases do not provide total cure of an AVM. A combination of these two methods and close cooperation between interventional neuroradiologists and neurosurgeons seem to be necessary to optimize the treatment results, shorten the hospitalization period, and reduce the costs of AVM therapy (Adv Clin Exp Med 2010, 19, 2, 219-226).
Neuroradiology, 2016
PURPOSE: The aim of this study was to test the hypothesis that the superficial middle cerebral vein (SMCV) is frequently absent or fails to connect with the cavernous sinus (CS) in presence of brain AVMs, a frequently reported argument for the congenital origin of brain AVMs. METHODS: The SMCV was retrospectively compared between patients with a brain AVM and a control group. The presence or absence of the SMCV, its direct or indirect connection to the CS and its termination in a laterocavernous sinus (LCS), paracavernous sinus (PCS) or directly in the CS was studied on digital subtraction angiography. RESULTS: 125 left or right side carotid angiograms from 70 patients with a brain AVM were compared to 125 angiograms from 74 controls. The SMCV was present in 88 (70.4%) cases in the brain AVM group and 96 (76.8%) cases in controls (p= 0.25). The SMCV was connected directly or indirectly to the CS in 65 (52%) cases in the brain AVM group and 65 (52%) cases in controls (p= 1). When comparing the subgroup of carotid angiograms ipsilateral to a supratentorial AVM, no statistically significant difference was found with controls. In 3/6 cases in which a SMCV drained an AVM, the vein terminated directly or indirectly in the CS. CONCLUSIONS: No difference of SMCV presence and direct or indirect connection to the CS was found between patients with AVM and a control group. SMCV anatomy does not support the congenital origin of brain AVMs.