Login Register Cart 0
Generic placeholder image

Current Neurovascular Research

Editor-in-Chief

ISSN (Print): 1567-2026
ISSN (Online): 1875-5739

Back
Journal Home About Journal Editorial Board Journal Insight Current Issue Volumes/Issues
Subscribe
Research Article

Multimodality Treatment of Deep-seated Cerebral Arteriovenous Malformations: The Experiences of One Center

Author(s): ZhenLong Ji, SiShi Xiang, JingWei Li, Jin Xu, JiaXing Yu, JiaWei Qi, GuiLin Li and HongQi Zhang*

Volume 19, Issue 5, 2022

Published on: 13 December, 2022

Page: [476 - 486] Pages: 11

DOI: 10.2174/1567202620666221114111512

Price: $65

Abstract

Objective: Treatment of deep-seated cerebral arteriovenous malformations (AVMs) remains challenging for neurosurgeons or neuroradiologists. This study aims to review the experiences of one center in using multimodality treatment for deep-seated AVMs.

Methods: The AVM database of Xuanwu Hospital, Capital Medical University was searched, and 96 patients who were diagnosed with a deep-seated cerebral AVM between 2010 and 2020 were identified. The following information was collected and analyzed: patients’ clinical features, treatment modality used, posttreatment complications, AVM obliteration rate, rebleeding rate, and functional outcome during follow-up. The patients’ posttreatment modified Rankin scale (mRS) scores were split into two groups: good outcome (mRS score ≤ 2) and poor outcome (mRS score ≥ 3). Univariate and multivariate logistic regression analyses were applied to test the predictors of clinical outcomes and AVM obliteration.

Results: Eighty-eight out of 96 patients (91.7%) presented with initial hemorrhaging. The pretreatment mRS score was ≤ 2 in 80 patients (88.3%) patients and ≥ 3 in 16 patients (16.7%). Limb weakness was present in 42 patients (43.8%). In this sample, 210 hemorrhages occurred during 2056 person-years before diagnosis, yielding an annual hemorrhage rate of 10.2% per person-year. Angiographic obliteration was achieved in 29 patients (30.2%). At the last follow-up, 80 patients (83.3%) had good clinical outcomes, whereas 16 (16.7%) had a deterioration in their clinical presentation following treatment. Multivariate analyses indicated that pretreatment limb weaknesses and a high Spetzler–Martin grade predicted poor clinical outcomes (P = 0.003 and 0.008, respectively). Fewer feeding arteries were a predictor for AVM obliteration (P = 0.034).

Conclusion: Good outcomes can be achieved through multimodal treatment of deep-seated AVMs. A single supplying artery is a predictor of AVM obliteration. Pretreatment limb weaknesses and high Spetzler-Martin grades predict poor clinical outcomes.

« Previous Next »
[1]
Gross BA DE, Getch CC, Bendok BR, Batjer HH. Challenging traditional beliefs: Microsurgery for arteriovenous malformations of the basal ganglia and thalamus. Neurosurgery 2008; 63(3): 393-410.
[2]
Fleetwood IG, Marcellus ML, Levy RP, Marks MP, Steinberg GK. Deep arteriovenous malformations of the basal ganglia and thalamus: Natural history. J Neurosurg 2003; 98(4): 747-50.
[http://dx.doi.org/10.3171/jns.2003.98.4.0747] [PMID: 12691399]
[3]
Sasaki T, Kurita H, Saito I, et al. Arteriovenous malformations in the basal ganglia and thalamus: Management and results in 101 cases. J Neurosurg 1998; 88(2): 285-92.
[http://dx.doi.org/10.3171/jns.1998.88.2.0285] [PMID: 9452237]
[4]
Potts MB, Jahangiri A, Jen M, et al. Deep arteriovenous malformations in the basal ganglia, thalamus, and insula: Multimodality management, patient selection, and results. World Neurosurg 2014; 82(3-4): 386-94.
[http://dx.doi.org/10.1016/j.wneu.2014.03.033] [PMID: 24657255]
[5]
Andrade-Souza YM, Zadeh G, Scora D, Tsao MN, Schwartz ML. Radiosurgery for basal ganglia, internal capsule, and thalamus arteriovenous malformation: Clinical outcome. Neurosurgery 2005; 56(1): 56-63.
[http://dx.doi.org/10.1227/01.NEU.0000145797.35968.ED]
[6]
Kiran NAS, Kale SS, Kasliwal MK, et al. Gamma knife radiosurgery for arteriovenous malformations of basal ganglia, thalamus and brainstem-a retrospective study comparing the results with that for AVMs at other intracranial locations. Acta Neurochir (Wien) 2009; 151(12): 1575-82.
[http://dx.doi.org/10.1007/s00701-009-0335-0] [PMID: 19415175]
[7]
Yamagata S, Kikuchi H, Ihara I, et al. Intraoperative liquid embolization of an arteriovenous malformation in the basal ganglia and thalamic region. No Shinkei Geka 1987; 15(7): 717-23.
[PMID: 3670541]
[8]
Hoi Sang U, Kerber CW, Todd MM. Multimodality treatment of deep periventricular cerebral arteriovenous malformations. Surg Neurol 1992; 38(3): 192-203.
[http://dx.doi.org/10.1016/0090-3019(92)90169-N] [PMID: 1440204]
[9]
Kocer N, Kandemirli SG, Dashti R, et al. Single-stage planning for total cure of grade III–V brain arteriovenous malformations by embolization alone or in combination with microsurgical resection. Neuroradiology 2019; 61(2): 195-205.
[http://dx.doi.org/10.1007/s00234-018-2140-z] [PMID: 30488257]
[10]
Unnithan AKA. Overview of the current concepts in the management of arteriovenous malformations of the brain. Postgrad Med J 2020; 96(1134): 212-20.
[http://dx.doi.org/10.1136/postgradmedj-2019-137202] [PMID: 32015188]
[11]
Alias Q, Boulouis G, Blauwblomme T, et al. First line onyx embolization in ruptured pediatric arteriovenous malformations. Clin Neuroradiol 2021; 31(1): 155-63.
[http://dx.doi.org/10.1007/s00062-019-00861-6] [PMID: 31802150]
[12]
Wei Y, Fan XJ, Zhang MH, et al. The mechanisms of pei-yuan-tongnao capsule as a therapeutic agent against cerebrovascular disease. World J Tradit Chin Med 2020; (3): 331-40.
[13]
Sheps MC. On the person years concept in epidemiology and demography. Milbank Mem Fund Q 1966; 44(1): 69-91.
[http://dx.doi.org/10.2307/3349039] [PMID: 5901864]
[14]
Abud DG, Riva R, Nakiri GS, Padovani F, Khawaldeh M, Mounayer C. Treatment of brain arteriovenous malformations by double arterial catheterization with simultaneous injection of Onyx: Retrospective series of 17 patients. AJNR Am J Neuroradiol 2011; 32(1): 152-8.
[http://dx.doi.org/10.3174/ajnr.A2247] [PMID: 20966066]
[15]
Kessler I, Riva R, Ruggiero M, Manisor M, Al-Khawaldeh M, Mounayer C. Successful transvenous embolization of brain arteriovenous malformations using Onyx in five consecutive patients. Neurosurgery 2011; 69(1): 184-93.
[http://dx.doi.org/10.1227/NEU.0b013e318212bb34] [PMID: 21346657]
[16]
Mounayer C, Hammami N, Piotin M, et al. Nidal embolization of brain arteriovenous malformations using Onyx in 94 patients. AJNR Am J Neuroradiol 2007; 28(3): 518-23.
[PMID: 17353327]
[17]
Brown JA. Recovery of motor function after stroke. Prog Brain Res 2006; 157: 223-8.
[http://dx.doi.org/10.1016/S0079-6123(06)57015-3] [PMID: 17046674]
[18]
Paulsen RD, Steinberg GK, Norbash AM, Marcellus ML, Marks MP. Embolization of basal ganglia and thalamic arteriovenous malformations. Neurosurgery 1999; 44(5): 991-6.
[http://dx.doi.org/10.1097/00006123-199905000-00031] [PMID: 10232532]
[19]
Cohen-Inbar O, Ding D, Sheehan JP. Stereotactic radiosurgery for deep intracranial arteriovenous malformations, part 2: Basal ganglia and thalamus arteriovenous malformations. J Clin Neurosci 2016; 24: 37-42.
[http://dx.doi.org/10.1016/j.jocn.2015.11.006] [PMID: 26732284]
[20]
Malik GM, Umansky F, Patel S, Ausman JI. Microsurgical removal of arteriovenous malformations of the basal ganglia. Neurosurgery 1988; 23(2): 209-17.
[http://dx.doi.org/10.1227/00006123-198808000-00014] [PMID: 3185881]
[21]
Deruty R, Pelissou-Guyotat I, Mottolese C, Bascoulergue Y, Amat D. The combined management of cerebral arteriovenous malformations experience with 100 cases and review of the literature. Acta Neurochir (Wien) 1993; 123(3-4): 101-12.
[http://dx.doi.org/10.1007/BF01401864] [PMID: 8237486]
[22]
Nicolato A, Foroni R, Crocco A, et al. Gamma knife radiosurgery in the management of arteriovenous malformations of the Basal Ganglia region of the brain. Minim Invasive Neurosurg 2002; 45(4): 211-23.
[http://dx.doi.org/10.1055/s-2002-36200] [PMID: 12494356]
[23]
Lawton MT, Hamilton MG, Spetzler RF. Multimodality treatment of deep arteriovenous malformations: Thalamus, basal ganglia, and brain stem. Neurosurgery 1995; 37(1): 29-35.
[http://dx.doi.org/10.1097/00006123-199507000-00004]
[24]
Crowley RW, Ducruet AF, McDougall CG, Albuquerque FC. Endovascular advances for brain arteriovenous malformations. Neurosurgery 2014; 74 (Suppl. 1): S74-82.
[http://dx.doi.org/10.1227/NEU.0000000000000176] [PMID: 24402496]
[25]
Cheng CH, Crowley RW, Yen CP, Schlesinger D, Shaffrey ME, Sheehan JP. Gamma Knife surgery for basal ganglia and thalamic arteriovenous malformations. J Neurosurg 2012; 116(4): 899-908.
[http://dx.doi.org/10.3171/2011.12.JNS11542] [PMID: 22264181]
[26]
Altschul D, Paramasivam S, Ortega-Gutierrez S, Fifi JT, Berenstein A. Safety and efficacy using a detachable tip microcatheter in the embolization of pediatric arteriovenous malformations. Childs Nerv Syst 2014; 30(6): 1099-107.
[http://dx.doi.org/10.1007/s00381-014-2404-9] [PMID: 24671157]
[27]
Consoli A, Renieri L, Nappini S, Limbucci N, Mangiafico S. Endovascular treatment of deep hemorrhagic brain arteriovenous malformations with transvenous onyx embolization. AJNR Am J Neuroradiol 2013; 34(9): 1805-11.
[http://dx.doi.org/10.3174/ajnr.A3497] [PMID: 23557955]
[28]
Martinez-Galdamez M, Saura P, Saura J, Muniz J, Albisua J, Perez-Higueras A. Transvenous Onyx embolization of a subependymal deep arteriovenous malformation with a single drainage vein: technical note. BMJ Case Rep 2013; 2013: 010603.
[http://dx.doi.org/10.1136/bcr-2012-010603]
[29]
Pereira VM, Marcos-Gonzalez A, Radovanovic I, et al. Transvenous embolization of a ruptured deep cerebral arteriovenous malformation. A technical note. Interv Neuroradiol 2013; 19(1): 27-34.
[http://dx.doi.org/10.1177/159101991301900104] [PMID: 23472720]
[30]
Renieri L, Consoli A, Scarpini G, Grazzini G, Nappini S, Mangiafico S. Double arterial catheterization technique for embolization of brain arteriovenous malformations with onyx. Neurosurgery 2013; 72(1): 92-8.
[http://dx.doi.org/10.1227/NEU.0b013e318276b2c0] [PMID: 23096412]
[31]
Mendes GAC, Silveira EP, Caire F, et al. Endovascular management of deep arteriovenous malformations. Neurosurgery 2016; 78(1): 34-41.
[http://dx.doi.org/10.1227/NEU.0000000000000982] [PMID: 26317676]
[32]
Saatci I, Geyik S, Yavuz K, Cekirge HS. Endovascular treatment of brain arteriovenous malformations with prolonged intranidal Onyx injection technique: Long-term results in 350 consecutive patients with completed endovascular treatment course. J Neurosurg 2011; 115(1): 78-88.
[http://dx.doi.org/10.3171/2011.2.JNS09830] [PMID: 21476804]
[33]
Nguyen TN, Chin LS, Souza R, Norbash AM. Transvenous embolization of a ruptured cerebral arteriovenous malformation with en-passage arterial supply: Initial case report. J Neurointerv Surg 2010; 2(2): 150-2.
[http://dx.doi.org/10.1136/jnis.2009.001289] [PMID: 21990597]
[34]
Liu KD LL. Microsurgical treatment of deep arteriovenous malformations--basal ganglia and thalamus. Zhonghua Yi Xue Za Zhi 2001; 64: 23-30.
[35]
Madhugiri VS, Teo MKC, Westbroek EM, et al. Multimodal management of arteriovenous malformations of the basal ganglia and thalamus: factors affecting obliteration and outcome. J Neurosurg 2019; 131(2): 410-9.
[http://dx.doi.org/10.3171/2018.2.JNS172511] [PMID: 30117771]
[36]
Batjer HH, Sampsom D, Tedeschi H dOE, Tzu WH, Rhoton AL, Eds. Intracranial arteriovenous malformations Surgical Anatomy. New York: Infroma Helthcare. Stieg, PE 2007; pp. 1-19.

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy