Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Jan 2012
ReviewSurgical treatment of cranial arteriovenous malformations and dural arteriovenous fistulas.
Microsurgical resection remains the treatment of choice for more than half of all patients with arteriovenous malformations (AVMs). It reduces the treatment window to a span of a few weeks and is curative. ⋯ When performed, however, microsurgical obliteration of DAVFs is associated with excellent outcomes as well. This article reviews the current state of microsurgical treatment of AVMs and DAVFs.
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Neurosurg. Clin. N. Am. · Jan 2012
ReviewStereotactic radiosurgery of cranial arteriovenous malformations and dural arteriovenous fistulas.
Cranial arteriovenous malformations (AVM) and cranial dural arteriovenous fistulas (AVF) carry a significant risk of morbidity and mortality when they hemorrhage. Current treatment options include surgery, embolization, radiosurgery, or a combination of these treatments. ⋯ Success in treating AVMs is variable depending on the volume of the lesion, the radiation dose, and the pattern of vascular supply and drainage. This article discusses the considerations for selecting radiosurgery as a treatment modality in patients who present with AVMs and AVFs.
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Neurosurg. Clin. N. Am. · Jan 2012
ReviewEndovascular treatment of cranial arteriovenous malformations and dural arteriovenous fistulas.
Pial arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs) are high-flow vascular lesions with abnormal communications between the arterial and venous system. AVMs are congenital lesions, whereas DAVFs are considered acquired lesions. ⋯ The primary goal of treatment is to eliminate the risk of bleeding or at least decrease it. Because the epidemiology, clinical presentation, and classification of AVMs and DAVFs have been covered in previous articles in this issue, the authors only briefly touch on these subjects as they relate to endovascular treatment.
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Neurosurg. Clin. N. Am. · Jan 2012
ReviewSelection of treatment modalities or observation of arteriovenous malformations.
This article provides management guidelines for arteriovenous malformations (AVMs). Management options include observation, surgical excision, endovascular embolization, and radiosurgery. ⋯ The article stratifies each lesion based on the AVM and patient characteristics to either observation or a single or multimodal treatment arm. The treatment of an AVM must be carefully weighed in each patient because of the risk of neurologic injury in functional areas of the brain and weighed against the natural history of hemorrhage.
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Neurosurg. Clin. N. Am. · Jan 2012
Review Case ReportsAcute management of ruptured arteriovenous malformations and dural arteriovenous fistulas.
Arteriovenous malformations of the brain (AVMs) are a major cause of stroke in young, healthy individuals and present multiple diagnostic and therapeutic challenges, particularly in the acute setting. Although the flow hemodynamics, biology, epidemiology, and natural history of AVMs have been extensively studied, little data have been published on AVM surgery in the acute setting, and acute surgery has been claimed to possibly increase the risk of persistent neurological deficits. Although it is usually preferable to defer AVM surgery for a few weeks or months, acute surgical (open and endovascular) management is essential in specific clinical and radiological settings.