Clinical features and surgical treatment of small and medium-sized arteriovenous malformations of cerebral hemispheres with torpid type of clinical manifestations.
DOI:
https://doi.org/10.14739/2310-1237.2013.3.22403Keywords:
AVM of the brain hemispheres, torpid type symptoms, surgical treatmentAbstract
Arteriovenous malformations (AVM) of the brain make up 1.5-4.0 % of all the intracranial space-occupying lesions, cause 1% of strokes, 8.6% of nontraumatic subarachnoid hemorrhages. Clinical manifestation of AVM occurs most often in people of working age (20-50 years), and long-term prognosis without surgery is unfavorable: 23 % of patients die, and 48% of the disease lead to profound disability. Small and medium-sized AVM are the most accessible to surgical treatment.
Objective: To analyze the clinical features and surgical treatment of optimization technology for small and medium-sized AVM of cerebral hemispheres with torpid type of clinical course.
Materials and Methods: Retrospective analysis of complex examination and surgical treatment of 115 patients with AVM of cerebral hemispheres, which cardinal feature was the small and medium size of the kernel (I-III degree in Spetzler and Martin) at the stage of clinical manifestations of the disease, was carried out. The study included all the patients with AVMs who were treated in the clinic of vascular surgery of Institute of neurosurgery named after acad. A.Romodanov NAMS of Ukraine from 2005 to 2011.
For objectification of dynamics of symptoms and functional disorders all the patients were assigned to groups according to the modified Rankin scale (The Modified Rankin Scale (MRS) (van Swieten et al., 1988)).
Endovascular procedures were performed in 10 cases with the use of embolic compositions based on NBCA, in one case PVA with a diameter of 100-200 microns was used.
Results: After the diagnostic examination, all observations are divided into three main types according to the clinical manifestations: hemorrhagic, epileptiform , torpid (which included migraine and pseudotumor types), which is slightly different from the standard AVM grading.
Hemorrhagic type of course is observed in 68 cases (59.13 %), epileptiform in 36 (31.3%) and torpid in 11 cases (9.57 %). Given the inclusion of AVM with ischemic and pseudotumorous course into the torpid type, we note that they make up ¼ of the total. Most of malformations of this group manifested through expressed cephalgic syndrome. More often torpid type of manifestations occurred in women aged 30-39 years, manifesting through cephalgic syndrome.
The most common clinical, structural and hemodynamic characteristics of small and medium-sized AVM cerebral hemispheres with torpid type manifestations were:
1. Predominance of plexiform component in the structure of the AVM nucleus - 100%.
2. Migrainous type of manifestations is characteristic for sulcal AVM of occipital region with the supply from PCA pool - 87.5%.
3. Pseudotumorous and ischemic types of manifestations are characteristic for the sulcal or gyral AVMs of frontal, parietal or temporal localizations - 75%.
4. Medium size of the malformation site (within 3-5 cm) - 72.7 %.
5. Outflow from malformations into the superficial veins - 72.7 %.
6. Often one of the afferents is from the ECA system (50%).
All the patients with identified malformations were treated surgically.
In patients with torpid type of clinical manifestations only endovascular embolization of AVM was performed. Total and subtotal AVM embolization was achieved in 4 cases (36.4%), in one case as a result of double surgery.
Negative dynamics in neurological status during treatment is not noted in any case. Result of treatment in all the cases with torpid type course is rated as satisfactory.
Conclusion: Torpid type of course of small and medium-sized AVM cerebral hemispheres often manifested through cephalgic syndrome. Optimal method of surgical treatment is endovascular embolization with liquid embolic compositions.
References
Артериовенозные мальформации головного мозга / Д.В. Свистов, Б.В. Гайдар, В.А. Хилько [и др.] // Практическая нейрохирургия / [под ред. Б.В. Гайдара]. – СПб.: Гиппократ, 2002. – С. 329–358.
Значение магнитно-резонансной томографии и ангиографии в диагностике артериовенозных мальформации головного мозга / Б.В. Гайдар, Т.Е. Рамешвили, Г.Е. Труфанов [и др.] // Актуальные проблемы военной нейрохирургии: сб. науч. работ. – СПб., 1996. – С. 72–76.
Компьютерная томография головного мозга / [Н.В. Верещагин, Л.К. Брагина, С.Б. Вавилов и др.]. – М., 1986. – 251 с.
Корниенко В.Н. Диагностическая нейрорадиология / В.Н. Корниенко, И.Н. Пронин. – М., 2008. – Т. 1. – 454 с.
Лучевая диагностика сосудистых мальформаций и артериальных аневризм головного мозга / [Г.Е. Труфанов, Т.Е. Рамешвили, В.А. Фокин, Д.В. Свистов]. – СПб.: ЭЛБИ-СПб, 2006. – 224 с.
Никитин П.И. Принципы хирургии артериовенозных мальформаций головного мозга: автореф. дис. … д-ра мед. н. / П.И. Никитин. – СПб., 2000. – 26 с.
Свистов Д.В. Артериовенозные мальформации головного мозга: клиника, диагностика, комплексное лечение / Д.В. Свистов, Д.В. Кандыба, А.В. Савелло // Сборник учебных пособий по актуальным вопросам нейрохирургии / [под ред. В.Е. Парфенова, Д.В. Свистова]. – СПб.: Фолиант, 2002. – С. 199–260.
A discriminative prediction model of neurological outcome for patients undergoing surgery of brain arteriovenous alformations / J. Spears, K.G. Terbrugge, M. Moosavian [et al.] // Stroke. – 2006. – Vol. 37. – P. 1457–1464.
Brown R.D. Unruptured intracranial aneurysms and arteriovenous malformations and relationshipof lesions / R.D. Brown, D.O. Wiebers, G.S. Forbes // J. Neurosurgery. – 1990. – Vol. 73. – P. 859–863.
Complications of surgery for arteriovenous malformations of the brain / M.K. Morgan, I.H. Johnston, J.M. Hallinan [et al.] // J. Neurosurgery. – 1993. – Vol. 78. – P. 176–182.
Feeding artery pressure and venous drainage pattern are primary determinants of hemorrhage from cerebral arteriovenous malformations / D.H. Duong, W.L. Young, M.C. Vang [et al.] // Stroke. – 1998. – Vol. 29. – P. 1167–1176.
Kim H. Genetics and Vascular Biology of Brain Vascular Malformations / H. Kim, L. Pawlikowska, W.L. Young // Stroke. – 2011. – P. 169–186.
McCormick W.F. Pathology of vascular malformations of the brain / W.F. McCormick // Intracranial arteriovenous malformations / ed. by C.B. Wilson, B.M. Stein. – Baltimore: Williams & Wilkins, 1984. – P. 34–48.
Spetzler R.F. Grading and staged resection of cerebral arteriovenous malformations / R.F. Spetzler, J.M. Zabramsky // Clin. Neurosurg. – 1990. – Vol. 36. – P. 318–337.
Spetzler R.F. A 3-tier classifi cation of cerebral arteriovenous malformations / R.F. Spetzler, F.A. Ponce // J. Neurosurg. – 2011. – Vol. 114(3). – P. 842–849.
Yasargil M.G. Pathohlogical considerations / M.G. Yasargil // Microsurgery. AVM of the brain: History, embryology, pathologic considerations, haemodynamics, diagnostic studies, microsurgical anatomy / ed. M.G. Yasargil. – N.Y.: Thieme Medical Publichers Inc., 1987. – Vol. 3A. – P. 49–211.
Downloads
How to Cite
Issue
Section
License
Authors who publish with this journal agree to the following terms:- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (SeeThe Effect of Open Access).
