geoscience.net logo
+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

How to deal with incompletely treated AVMs: experience of 67 cases and review of the literature


, : How to deal with incompletely treated AVMs: experience of 67 cases and review of the literature. Acta Neurochirurgica. Supplement 112(): 123-129

Despite the availability of multimodal treatment options, some arteriovenous malformations remain difficult to treat, either for intrinsic reasons at initial presentation or for reasons evolving during the course of treatment. Frequently, such cases can be easily resolved with further therapy, but some become a continuously growing treatment dilemma while exhausting dwindling therapeutic options. A retrospective analysis was performed to identify patients with cerebral AVM who were treated unsuccessfully. Treatment was termed "not successful" if (1) postoperative angiography showed a residual AVM or missing flow reduction after palliative embolization, (2) therapy was associated with a substantial deterioration of existing neurological deficits or death, or (3) rebleeding from residual AVM occurred after therapy. Special interest was focused on the angiographic appearance of residual AVMs, their characteristic features, and their follow-up regarding second and third therapies. According to these criteria we identified 46 internal patients from our own series of 474 patients and 21 external patients who were referred from other institutions or sought a second opinion after incomplete treatment elsewhere. Out of those 67 cases, 50 patients (74.6%) were diagnosed with a residual AVM. Eleven patients (16.4%) experienced a deterioration of their clinical condition under therapy. Six patients did not show a flow reduction after palliative embolization. Twenty-five of the 67 patients were readmitted because of an ICH, either originating from an AVM residual or under palliative embolization. Thus, an increased risk of re-hemorrhage was found for palliative embolization (n = 16) in partially treated lesions (n = 10) and in patients with AVM grade IV and V located in eloquent regions (n = 22). In dealing with residual AVMs, microsurgical resection alone or in combination was found to be the most efficient therapeutic option, being successful in 58.9% of cases. An estimated 10% of AVM treatments may fail because of inadequate selection of either patients or management. Besides, for thorough decision-making, angiographic follow-up in all AVM patients is mandatory to allow an early identification of patients with an incompletely treated AVM requiring a second attempt. Major attention should be focused especially on high-risk subgroups with complex AVMs, partially treated AVMs, or those treated by only a palliative regimen.

US$19.90

PMID: 21692000

DOI: 10.1007/978-3-7091-0661-7_22


Other references

Tanabe, S.; Shishido, Y.; Furushiro, M.; Kado, K.; Hashimoto, S.; Yokokura, T.; Terasaki, T., 2003: Peptides and nootropic agent. New peptides represented by the following general formula ##STR1## (wherein X is OH or NH2, R is an amino acid residue selected from Arg, His, Lys, Methyl-Arg or Methyl-Tyr, n is an integer of 1-4, and in the case that n is 2-4, R may be identical...

Lamkin R.M.; Johnson E.R., 1985: The specific cleavage of tryptophan containing peptides by the denaturant stable enzyme streptomyces griseus protease b. Federation Proceedings 44(5): 1432

Mantas, J., 2012: Implementation of the recommendations in master's courses in health informatics. The publication of the International Medical Informatics Association revised version of the existing international recommendations in health informatics / medical informatics education was welcome positively by the educational community. The recom...

Suzen, S.; Gurkok, G.; Coban, T., 2006: Novel N-acyl dehydroalanine derivatives as antioxidants: studies on rat liver lipid peroxidation levels and DPPH free radical scavenging activity. Oxidative stress has been implicated in the development of many neurodegenerative diseases such as Parkinson and Alzhemier's disease and is also responsible for aging, artherosclerosis, rheumatoid arthritis and carcinogenesis. Olefins such as...

Pereira, S.M.; Barreto, M.L.; Pilger, D.; Cruz, A.A.; Sant'Anna, C.; Hijjar, M.A.; Ichihara, M.Y.; Santos, A.C.; Genser, B.; Rodrigues, L.C., 2012: Effectiveness and cost-effectiveness of first BCG vaccination against tuberculosis in school-age children without previous tuberculin test (BCG-REVAC trial): a cluster-randomised trial. Neonatal BCG vaccination is part of routine vaccination schedules in many developing countries; vaccination at school age has not been assessed in trials in low-income and middle-income countries. Catch-up BCG vaccination of school-age children wh...

Chakravorty, S.J.; Howie, A.J.; Cockwell, P.; Adu, D.; Savage, C.O., 1999: T lymphocyte adhesion mechanisms within inflamed human kidney: studies with a Stamper-Woodruff assay. Renal inflammatory conditions are characterized by mononuclear cell recruitment to sites of inflammation. We have developed a modified Stamper-Woodruff assay system to analyze mechanisms of functional T cell adhesion to cryostat sections of renal...

Fokstuen, S.; Sloan-Béna, Fédérique.; lrion, O., 2014: Antenatal diagnosis: the revolution of new technologies. Since ten years, the number of amniocenteses or chorionic villous sampling for maternal anxiety has decreased thanks to the first trimester screening of trisomy 21 by ultrasound and maternal serum analysis. Two new tools have recently revolutioniz...

Paine, E.; Daram, S.R.; Bhaijee, F.; Lahr, C.; Ahmed, N.; Abell, T.J.; Tang, S.J., 2012: Renal cell carcinoma with direct colonic invasion. Endoscopy 44 Suppl 2 Uctn: E82-E83

Bhalla, A., 2013: Product update. Canadian Pharmacists Journal 145(3): 110-111.E3

Shrier, L.A.; Walls, C.; Lops, C.; Kendall, A.D.; Blood, E.A., 2012: Substance use, sexual intercourse, and condom nonuse among depressed adolescents and young adults. To examine daily- and event-level associations of substance use with occurrence of sex and condom nonuse among depressed youth. Depressed, sexually active outpatients aged 15-22 years reported alcohol use, marijuana use, and sex on a personal digi...