Neurosurg Focus
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In patients with posterior fossa arteriovenous malformations (AVMs) who present with hemorrhage, feeding artery aneurysms are often the source of bleeding. The aim of this study was to evaluate the relative proportions of cases of infra- and supratentorial AVMs in which patients presented with prenidal aneurysm rupture. The management and outcome of 9 cases of posterior fossa AVMs associated with prenidal aneurysm rupture are presented. ⋯ Posterior fossa AVM hemorrhages are frequently associated with prenidal arterial aneurysms. Urgent endovascular treatment of the aneurysm was effective in this case series.
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Intracranial or brain arteriovenous malformations (BAVMs) are some of the most interesting and challenging lesions treated by the cerebrovascular neurosurgeon. It is generally believed that the combination of BAVMs and intracranial aneurysms (IAs) is associated with higher hemorrhage rates at presentation and higher rehemorrhage rates and thus with a more aggressive course and natural history. There is wide variation in the literature on the prevalence of BAVM-associated aneurysms (range 2.7%-58%), with 10%-20% being most often cited in the largest case series. ⋯ The ultimate goals of the treatment of a BAVM associated with an IA are to prevent hemorrhage, avoid stepwise neurological deterioration, and eliminate the mortality risk associated with recurrent hemorrhagic events. The treatment is only justifiable if the risks associated with an intervention are lower than or equivalent to the long-term risks of disability or mortality caused by the lesion itself. When faced with this difficult decision, a few questions need to be answered by the treating neu-rosurgeon: What is the mode of presentation? What is the symptomatic lesion? Which one of the lesions bled? What is the relationship between the BAVM and IA? Is it possible to safely treat both BAVM and IA? The objective of this review is to discuss the demographics, natural history, classification, and strategies for management of BAVMs associated with IAs.
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Seizures are a common presentation of cerebral arteriovenous malformations (AVMs). The authors evaluated the efficacy of stereotactic radiosurgery (SRS) for the management of seizures associated with AVMs and identified factors influencing seizure outcomes following SRS for AVMs. ⋯ Stereotactic radiosurgery offers favorable seizure outcomes for AVM patients presenting with seizures. Improved seizure control is significantly more likely with complete AVM obliteration.
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This Neurosurgical Focus video supplement contains detailed narrated videos of a broad range of intradural pathology such as neoplasms, including intramedullary, extramedullary, and dumbbell tumors, vascular malformations, functional disorders, and rare conditions that are often overlooked or misdiagnosed such as arachnoid cysts, ventral spinal cord herniation, and dorsal arachnoid web. The intent of this supplement is to provide meaningful educational and instructional content at all levels of training and practice. As such, the selected video submissions each provide a comprehensive detailed narrative description and coordinated video that contains the entire spectrum of relevant information including imaging, operative setup and positioning, and exposure, as well as surgical strategies, techniques, and sequencing toward the safe and effective achievement of the operative objective. ⋯ There is some redundancy in both the topics and techniques both to underscore fundamental surgical principles as well as to provide complementary perspective from different surgeons. It has been my privilege to serve as guest editor for this video supplement and I would like to extend my appreciation to Mark Bilsky, Bill Krauss, and Sander Connolly for reviewing the large number submitted videos. Most of all, I would like to thank the authors for their skill and effort in the preparation of the outstanding videos that constitute this video supplement.
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Review Meta Analysis
Stereotactic radiosurgery with and without embolization for intracranial arteriovenous malformations: a systematic review and meta-analysis.
The effectiveness and risk of stereotactic radiosurgery (SRS) in the management of partially embolized intracranial arteriovenous malformations (AVMs) remain controversial. The aim of this analysis was to assess current evidence regarding the efficiency and safety of SRS for AVM patients with and without prior embolization. ⋯ Embolization before SRS significantly decreases the AVM obliteration rate. However, there is no significant difference in the risk of hemorrhage and permanent neurological deficits after SRS alone and following embolization. Further validation by well-designed prospective or randomized cohort studies is still needed.