Sabino Luzzi1, Mattia Del Maestro2, Daniele Bongetta3, Cesare Zoia4, Aldo V Giordano5, Donatella Trovarelli6, Sohelia Raysi Dehcordi7, Renato J Galzio8. 1. Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Emergency and Organ Transplantation, University of Bari "Aldo Moro", Bari, Italy. 2. Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy. 3. Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy. Electronic address: danielebongetta@hotmail.com. 4. Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. 5. Diagnostic and Interventional Radiology, Department of Applied Clinical Science and Biotechnology, University of L'Aquila, L'Aquila, Italy. 6. Department of Anesthesiology, San Salvatore Hospital, L'Aquila, Italy. 7. Department of Life, Health and Environmental Sciences (MESVA), University of L'Aquila, L'Aquila, Italy; Neurosurgery Unit, San Salvatore Hospital, L'Aquila, Italy. 8. Neurosurgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.
Abstract
BACKGROUND: Grade III Spetzler-Martin brain arteriovenous malformations (AVMs) are a specific set of AVMs with high variability in terms of site, size, angioarchitecture, flow dynamics, and involvement of eloquent areas. Surgery preceded by preoperative embolization has been reported as a useful treatment option for these lesions. The aim of this study is to report outcomes and personal experience of combined preoperative Onyx embolization and surgical resection on a consecutive series of grade III brain AVMs. METHODS: Between 2005 and 2017, 27 grade III AVMs were treated by means of a staged Onyx embolization and subsequent surgical treatment. Site and size of the AVMs, embolization, and surgical specifics as well as complications and outcomes were retrospectively reviewed. RESULTS: All AVMs were supratentorial, 13 of which were hemorrhagic. Mean nidal volume was 19.5 mL. Average embolization sessions were 1.6. Mean embolization-related obliteration rate and morbidity were 28.8% and 3.7%, respectively. Surgery was performed within 3.7 days on average. In our experience, Onyx embolization made the nidus excision easier, facilitated the hemostasis, and contributed to the early identification of the lesion in cases of small or racemose nidus. The surgical obliteration rate was 92.6%. A good overall outcome (modified Rankin Scale score 0-2) was achieved in 70.4% of patients. CONCLUSIONS: In our experience, preoperative Onyx embolization helped the surgical management of grade III Spetzler-Martin brain AVMs. Careful evaluation of the angioarchitecture, a tailored strategy in the embolization process, and full cooperation within the neurosurgical-neuroendovascular team are mandatory.
BACKGROUND: Grade III Spetzler-Martin brain arteriovenous malformations (AVMs) are a specific set of AVMs with high variability in terms of site, size, angioarchitecture, flow dynamics, and involvement of eloquent areas. Surgery preceded by preoperative embolization has been reported as a useful treatment option for these lesions. The aim of this study is to report outcomes and personal experience of combined preoperative Onyx embolization and surgical resection on a consecutive series of grade III brain AVMs. METHODS: Between 2005 and 2017, 27 grade III AVMs were treated by means of a staged Onyx embolization and subsequent surgical treatment. Site and size of the AVMs, embolization, and surgical specifics as well as complications and outcomes were retrospectively reviewed. RESULTS: All AVMs were supratentorial, 13 of which were hemorrhagic. Mean nidal volume was 19.5 mL. Average embolization sessions were 1.6. Mean embolization-related obliteration rate and morbidity were 28.8% and 3.7%, respectively. Surgery was performed within 3.7 days on average. In our experience, Onyx embolization made the nidus excision easier, facilitated the hemostasis, and contributed to the early identification of the lesion in cases of small or racemose nidus. The surgical obliteration rate was 92.6%. A good overall outcome (modified Rankin Scale score 0-2) was achieved in 70.4% of patients. CONCLUSIONS: In our experience, preoperative Onyx embolization helped the surgical management of grade III Spetzler-Martin brain AVMs. Careful evaluation of the angioarchitecture, a tailored strategy in the embolization process, and full cooperation within the neurosurgical-neuroendovascular team are mandatory.
Authors: Marian T Park; Muhammed Amir Essibayi; Visish M Srinivasan; Joshua S Catapano; Christopher S Graffeo; Michael T Lawton Journal: Neurosurg Rev Date: 2022-09-27 Impact factor: 2.800
Authors: Joshua S Catapano; Fabio A Frisoli; Candice L Nguyen; D Andrew Wilkinson; Neil Majmundar; Tyler S Cole; Jacob F Baranoski; Alexander C Whiting; Helen Kim; Andrew F Ducruet; Felipe C Albuquerque; Daniel L Cooke; Robert F Spetzler; Michael T Lawton Journal: Neurosurgery Date: 2021-04-15 Impact factor: 4.654
Authors: Gabriele Savioli; Iride Francesca Ceresa; Sarah Macedonio; Sebastiano Gerosa; Mirko Belliato; Giorgio Antonio Iotti; Sabino Luzzi; Mattia Del Maestro; Gianluca Mezzini; Alice Giotta Lucifero; Elvis Lafe; Anna Simoncelli; Federica Manzoni; Lorenzo Cobianchi; Mario Mosconi; Fabrizio Cuzzocrea; Francesco Benazzo; Giovanni Ricevuti; Maria Antonietta Bressan Journal: Medicina (Kaunas) Date: 2020-04-24 Impact factor: 2.430
Authors: Sabino Luzzi; Alberto Maria Crovace; Mattia Del Maestro; Alice Giotta Lucifero; Samer K Elbabaa; Benedetta Cinque; Paola Palumbo; Francesca Lombardi; Annamaria Cimini; Maria Grazia Cifone; Antonio Crovace; Renato Galzio Journal: Heliyon Date: 2019-11-26