Neuroimaging clinics of North America
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Neuroimaging Clin. N. Am. · Nov 2013
ReviewEndovascular treatment of cerebral arteriovenous malformations.
Treatment of arteriovenous malformations of the central nervous system requires a multidisciplinary approach with input from vascular neurosurgeons, endovascular interventionalists, and radiation oncologists. Treatment paradigms based on a thorough understanding of the natural history of the lesion and the cumulative risks of multimodality treatment maximize the likelihood of a positive outcome. This article outlines the role of endovascular embolization in the treatment of arteriovenous malformations with specific emphasis on decision making during treatment planning. Technical considerations when treating arteriovenous malformations are discussed, including the choice of embolic agents, potential intraprocedural and periprocedural complications, and postprocedural management of patients.
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Neuroimaging Clin. N. Am. · Nov 2013
ReviewEndovascular treatment of cerebral dural and pial arteriovenous fistulas.
Dural arteriovenous fistulas (DAVFs) are arteriovenous shunts from a dural arterial supply to a dural venous channel, typically supplied by pachymeningeal arteries and located near a major venous sinus. Pial arteriovenous fistulas (PAVFs) are composed of one or more arterial feeders draining into a single vein in the absence of an intervening nidus. Fistulas manifesting features of high risk for rupture should be treated aggressively, the spectrum of treatment varies from endovascular, surgical resection, and stereotactic radiosurgery. This article describes the natural history, clinical presentation, and treatment of dural and pial fistulas, with emphasis on endovascular treatment.
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Neuroimaging Clin. N. Am. · Nov 2013
ReviewEndovascular methods for the treatment of vascular anomalies.
Vascular malformations are congenital lesions secondary to errors in the development of arteries, capillaries, veins, or lymphatics. Most of these lesions are sporadic; however, a certain percentage present with syndromes. ⋯ The percutaneous/endovascular treatment of each of the vascular anomalies is described, and surgical and additional treatment options are discussed briefly. The clinical outcomes of the main forms of treatment and level of evidence are presented.
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Pediatric spinal arteriovenous shunts are rare and, in contrast to those in adults, are often congenital or associated with underlying genetic disorders. These are thought to be a more severe and complete phenotypic spectrum of all spinal arteriovenous shunts seen in the overall spinal shunt population. The pediatric presentation thus accounts for its association with significant morbidity and, in general, a more challenging treatment process compared with the adult presentation.
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Neuroimaging Clin. N. Am. · Nov 2013
ReviewEndovascular treatment of adult spinal arteriovenous lesions.
Spinal arteriovenous lesions (SAVLs) are rare disorders, the diagnosis of which can be established using various imaging modalities. To discern the various types of SAVL, spinal angiography of the entire neural axis is required. ⋯ The classification, pathophysiology, epidemiology, clinical presentation, natural history, and pathophysiology of SAVLs in adults are reviewed. Finally, endovascular treatment of these lesions is discussed.