Browsing by Subject "Arteriovenous malformation"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Giant diffuse cerebellar AVM: managing ultimate intraoperative challenges
    (American Association of Neurological Surgeons, 2021-01-01) Hendricks, Benjamin K.; Cohen-Gadol, Aaron A.; Neurological Surgery, School of Medicine
    Surgery within the posterior cranial fossa uniquely requires excellence in microsurgical technique, given the complexity of the neurovascular structures housed within this region. Arteriovenous malformations (AVMs) within this region represent the greatest surgical challenge because of the difficulty in resecting an AVM completely while preserving the highly eloquent surrounding structures. The AVM in this video exemplifies a surgeon's "most challenging case," a surgery that spanned two stages, including 14 hours of resection, but concluded with complete resection despite the complexity of deep arterial and dural feeders. The video can be found here: https://youtu.be/WNBuwFHSrQ0.
  • Thumbnail Image
    Item
    Preoperative Embolization With Fused CT Angiography and Tractography Facilitates Safe Resection of a Spetzler-Martin Grade IV Arteriovenous Malformation
    (Cureus, 2021-12-24) Weyhenmeyer, Jonathan; Ordaz, Josue D.; Gadol, Aaron Cohen; Shah, Mitesh; Neurological Surgery, School of Medicine
    Brain arteriovenous malformations (BAVMs) are high-flow vascular lesions that have a propensity to rupture resulting in high rates of morbidity and mortality. Microsurgical resection of BAVMs is the standard of care for high-risk, resectable lesions. Multiple imaging modalities aid in the surgical planning and resection of high-grade BAVMs, but all have hidden variables that would prove useful if available. We present a 20-year-old male with a ruptured BAVM with concern for the involvement of the corticospinal tract (CST) and basal ganglia. We describe the melding of computed tomography angiography (CTA) and diffusion tensor imaging (DTI) in addition to preoperative embolization to aid in the planning and resection of a lesion close to eloquent structures. Post-operative CTA and DTI showed a total resection of the lesion with retained CST white matter tracts, and the patient retained the functional ability of the contralateral limbs. The combination of CTA, brain DTI, and preoperative embolization provides a framework to improve the safety of resection of BAVMs that occur near eloquent brain networks.
  • Thumbnail Image
    Item
    Resolution of Radiation-Induced Necrosis in Arteriovenous Malformation with Bevacizumab: A Case Report and Review of Current Literature
    (Karger, 2021-05-27) Kwong, Forrest; Scarpelli, Daphne B.; Barajas, Ramon F.; Monaco, Debra; Tanyi, James A.; McClelland, Shearwood; Jaboin, Jerry J.; Radiation Oncology, School of Medicine
    Stereotactic radiosurgery (SRS) is a proven treatment modality for inoperable arteriovenous malformations (AVMs). However, the rate of radiation-induced necrosis (RIN) is as high as 10%. A 6-year-old female patient presented with severe headache, emesis, and syncope, and workup revealed a Spetzler-Martin grade 4 AVM with intraventricular hemorrhage and hydrocephalus. The patient underwent a right frontal ventriculostomy followed by a linear accelerator-based SRS of 16.9 Gy. At 19 years, she developed progressive neurological symptoms. Diagnostic magnetic resonance imaging (MRI) revealed a recurrent parietal AVM nidus. We delivered the linear accelerator-based SRS of 18.5 Gy to the AVM nidus. Within 9 months, she experienced episodic headaches and left-sided weakness and spasticity; symptoms were initially managed with dexamethasone. Follow-up MRI was notable for edema and nondetectable blood flow, consistent with RIN and AVM obliteration. The second course of steroids did not provide the symptom control. Persistent RIN was noted on MRI, and she had stigmata of steroid toxicity (centripetal obesity, depression, and sleep disorder). Two infusions of bevacizumab (5 mg/kg) were administered concurrently with a tapering dose of dexamethasone. The patient noted a near immediate improvement in her headaches, and 2 months following the second bevacizumab infusion, she reported a near-complete resolution of her symptoms and displayed improved ambulation. The development of RIN remains a noteworthy concern post-SRS of AVMs. While steroids aid with initial management of RIN, for persistent and recurrent symptoms, bevacizumab infusions serve as a viable treatment course, with the added benefit of reducing the likelihood of adverse effects resulting from prolonged steroid therapy.
  • Thumbnail Image
    Item
    An unusual arteriovenous malformation involving the cervical vessels treated with endovascular repair
    (Elsevier, 2019-04-28) Miladore, Julia N.; Sawchuk, Alan P.; Surgery, School of Medicine
    We present an unusual and complex arteriovenous malformation involving the vertebral artery, subclavian artery, and internal jugular vein in a 31-year-old man with no history of trauma or catheterization. The repair was done using endovascular techniques to minimize complications from nerve or vascular injury. The massively dilated jugular vein has remained diminished in size and the patient has remained asymptomatic at 8 months. We discuss the occurrence of this rare malformation as well as treatment options along with their risks and benefits.