Ling-Feng Lai1, Jia-Xiang Chen1, Kuang Zheng1, Xu-Ying He1, Xi-Feng Li1, Xin Zhang1, Qiu-Jing Wang1, Chuan-Zhi Duan2, Min Chen1. 1. The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, 510282, Guangzhou, China. 2. The National Key Clinical Specialty, The Engineering Technology Research Center of Education Ministry of China, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University, 510282, Guangzhou, China. duanchuanz@163.com.
Abstract
BACKGROUND: Posterior fossa brain arteriovenous malformations (PFbAVM) are relatively rare brain disorders but have a high risk of hemorrhage. Endovascular embolization to reduce the lesion size before treatment may improve the outcome of PFbAVM. The purposes of this study were to identify risk factors associated with hemorrhage in PFbAVM and to assess clinical outcomes in patients receiving initial endovascular embolization. MATERIAL AND METHODS: From 1999 to 2013 a total of 63 patients with PFbAVMs were treated (31 males and 32 females, 14.1 % of all AVM cases). A retrospective examination of patient demographics, clinical presentation, angiographic features, treatment modalities, complications and outcomes was carried out. The re-hemorrhage rate, obliteration rate and modified Rankin scale (MRS) were used as measures of outcome. RESULTS: Of the 63 PFbAVM patients 54 (85.7 %) exhibited hemorrhage and 15 had confirmed aneurysms. The cerebellar location (P = 0.007) and deep venous drainage (P = 0.012) were independent predictors of hemorrhage in multivariate analyses. The mean estimated devascularization was 46.9 % (range 10-100 %) in the 20 patients (31.7 %) treated by endovascular embolization. The 16 patients with residual niduses were further treated by radiosurgery, microsurgery or embolization. Complete obliteration was attained in 12 patients (67 %) while 2 (5.7 %) were left with persisting neurological deficits and 1 had a re-hemorrhage 3 years later (annual rate of 4.6 %). Favorable outcome (MRS ≤ 2) was obtained in the 20 patients receiving initial endovascular embolization (P = 0.039 versus preoperative MRS). CONCLUSION: Cerebellar location and deep venous drainage are predictors of hemorrhage in PFbAVM. Adjuvant endovascular embolization is useful and safe for PFbAVM prior to microsurgery or radiosurgery.
BACKGROUND: Posterior fossa brain arteriovenous malformations (PFbAVM) are relatively rare brain disorders but have a high risk of hemorrhage. Endovascular embolization to reduce the lesion size before treatment may improve the outcome of PFbAVM. The purposes of this study were to identify risk factors associated with hemorrhage in PFbAVM and to assess clinical outcomes in patients receiving initial endovascular embolization. MATERIAL AND METHODS: From 1999 to 2013 a total of 63 patients with PFbAVMs were treated (31 males and 32 females, 14.1 % of all AVM cases). A retrospective examination of patient demographics, clinical presentation, angiographic features, treatment modalities, complications and outcomes was carried out. The re-hemorrhage rate, obliteration rate and modified Rankin scale (MRS) were used as measures of outcome. RESULTS: Of the 63 PFbAVMpatients 54 (85.7 %) exhibited hemorrhage and 15 had confirmed aneurysms. The cerebellar location (P = 0.007) and deep venous drainage (P = 0.012) were independent predictors of hemorrhage in multivariate analyses. The mean estimated devascularization was 46.9 % (range 10-100 %) in the 20 patients (31.7 %) treated by endovascular embolization. The 16 patients with residual niduses were further treated by radiosurgery, microsurgery or embolization. Complete obliteration was attained in 12 patients (67 %) while 2 (5.7 %) were left with persisting neurological deficits and 1 had a re-hemorrhage 3 years later (annual rate of 4.6 %). Favorable outcome (MRS ≤ 2) was obtained in the 20 patients receiving initial endovascular embolization (P = 0.039 versus preoperative MRS). CONCLUSION: Cerebellar location and deep venous drainage are predictors of hemorrhage in PFbAVM. Adjuvant endovascular embolization is useful and safe for PFbAVM prior to microsurgery or radiosurgery.
Entities:
Keywords:
Cerebral hemorrhage; Endovascular embolization; Intracranial aneurysm; Outcome; Retrospective study
Authors: Adib A Abla; Jeffrey Nelson; W Caleb Rutledge; William L Young; Helen Kim; Michael T Lawton Journal: Neurosurg Focus Date: 2014-09 Impact factor: 4.047
Authors: Juha A Hernesniemi; Reza Dashti; Seppo Juvela; Kristjan Väärt; Mika Niemelä; Aki Laakso Journal: Neurosurgery Date: 2008-11 Impact factor: 4.654
Authors: Chun-Xue Wu; Li Ma; Xu-Zhu Chen; Xiao-Lin Chen; Yu Chen; Yuan-Li Zhao; Christopher Hess; Helen Kim; Heng-Wei Jin; Jun Ma Journal: World Neurosurg Date: 2018-05-30 Impact factor: 2.104
Authors: Peyton L Nisson; Salman A Fard; Christina M Walter; Cameron M Johnstone; Michael A Mooney; Ali Tayebi Meybodi; Michael Lang; Helen Kim; Heidi Jahnke; Denise J Roe; Travis M Dumont; G Michael Lemole; Robert F Spetzler; Michael T Lawton Journal: J Neurosurg Date: 2019-03-08 Impact factor: 5.115
Authors: Silvio Sarmento Lessa; Juan Alberto Paz-Archilla; Bruno Loof Amorim; Jose Maria Campos Filho; Christiane Monteiro de Siqueira Campos; Leonardo de Deus Silva; Richard Gonzalo Parraga Choque; Marcos Devanir Silva da Costa; Feres Chaddad-Neto Journal: Surg Neurol Int Date: 2021-05-10