Central Arteriovenous Malformations Research Articles

Intraosseous Embolotherapy of Central Arteriovenous Malformations in the Jaw: Long-Term Experience With 8 Cases

To investigate the long-term effects of direct intraosseous histoacryl embolotherapy on central arteriovenous malformations (AVMs) of the jaw. Eight patients with central AVMs of the jaw (3 in the maxilla and 5 in the mandible) were treated with direct intraosseous histoacryl injection. These AVMs exhibited cystic radiolucency, with (n = 5) or without (n = 3) honeycombed component. On angiography, all the AVMs exhibited a large intraosseous nidus with multiple suppliers and drainages. The intraosseous lesions were percutaneously punctured with an 18- to 20-gauge needle, and NBCA diluted 30% to 40% with iodized oil was injected during venous compression. Postembolic arteriograms showed that all the AVMs were completely or nearly completely devascularized after single or multiple injections at the initial treatment. The follow-up period ranged from 3 to 8 years. Two AVMs experienced postembolic curettage and were anatomically cured. Three AVMs were anatomically cured after 1 to 3 sessions of embolotherapy. The other 3 AVMs were clinically cured after 1 (n = 2) to 4 (n = 1) sessions of embolotherapy. There were no procedure-related severe complications. Direct intraosseous glue embolotherapy can be a simple and safe technique for endovascular management of central AVMs in the jaw and is particularly effective in an emergency. Complete reossification of the intraosseous nidus can be anticipated if a complete occlusion is obtained.

Gamma knife radiosurgery for arteriovenous malformations of basal ganglia, thalamus and brainstem—a retrospective study comparing the results with that for AVMs at other intracranial locations

The objective of this retrospective study was to study the outcome in patients with basal ganglia, thalamus and brainstem (central/deep) arteriovenous malformations (AVMs) treated with gamma knife radiosurgery (GKS) and to compare the results with that for AVMs at other intracranial locations. The results of 53 patients with central AVMs and 255 patients with AVMs at other locations treated with GKS at our center between April 1997 and March 2005 with minimum follow-up of 1 year were analyzed. CENTRAL AVMS: Forty of these 53 AVMs were Spetzler-Martin grade III, 11 were grade IV, and 2 were grade V. The mean AVM volume was 4.3 cm(3) (range 0.1-36.6 cm(3)). The mean marginal dose given was 23.3 Gy (range 16-25 Gy). The mean follow-up was 28 months (range 12-96 months). Check angiograms were advised at 2 years after GKS and yearly thereafter in the presence of residual AVM till 4 years. Presence of a residual AVM on an angiogram at 4 years after radiosurgery was considered as radiosurgical failure. Complete obliteration of the AVM was documented in 14 (74%) of the 19 patients with complete angiographic follow-up. Significantly lower obliteration rates (37% vs. 100%) were seen in larger AVMs (>3 cm(3)) and AVMs of higher (IV and V) Spetzler-Martin grades (28% vs. 100%). The 3- and 4-year actuarial rates of nidus obliteration were 68% and 74%, respectively. Eight patients (15%) developed radiation edema with a statistically significantly higher incidence in patients with AVM volume >3 cm(3) and in patients with Spetzler-Martin grade IV and V AVMs. Five patients (9.4%) had hemorrhage in the period of latency. COMPARISON OF RESULTS WITH AVMS AT OTHER LOCATIONS: Patients with central AVMs presented at a younger age (mean age 22.7 years vs. 29 years), with a very high proportion (81% vs. 63%) presenting with hemorrhage. Significantly higher incidence of radiation edema (15% vs. 5%) and lower obliteration rates (74% vs. 93%) were seen in patients with central AVMs. GKS is an effective modality of treatment for central AVMs, though relatively lower obliteration rates and higher complication rates are seen compared to AVMs at other locations.

Cerebral arteriovenous malformation presenting as visual deterioration in a child

A rare case of visual loss as the presenting feature of a central arteriovenous malformation involving the vein of Galen is reported. A 5-year-old girl with a history of deteriorating vision for the past 6 months was examined. Ocular examination showed a left hemianopia, left optic atrophy, and dilated vessels of the right optic disc. MRI revealed a massive deep-seated central arteriovenous malformation involving the vein of Galen. The mechanism of visual loss is likely to be a combination of ischaemic optic atrophy associated with a steal phenomenon and direct compression of the right optic radiation.

A preliminary study of angiographic classification and treatment of central arteriovenous malformations in jaws

To elaborate on the angiographic classification of central arteriovenous malformations (AVMs) in jaws, and to evaluate the correlation between this classification and treatment options. X-ray films and angiograms of 25 cases with AVMs in the jaw were retrospectively reviewed to evaluate the appearance of radiolucency, feeding arteries, nidus of the malformations and draining veins. Based on the findings a classification of angioarchitecture was recommended. Furthermore, the treatment results of these cases were reviewed to assess the correlation between this classification and treatment options. The angiographic pictures of 25 cases with central AVMs could be divided into five types: type I (n = 5) was with merely diffused micro-arteriovenous fistulas (AVFs); type II (n = 8) demonstrated a large venous pouch, all the feeding arteries drained into it; type III (n = 7) had a large venous pouch together with diffused micro-AVFs (I + II); type IV (n = 2) had multiple venous pouches; type V (n = 3) had multiple venous pouches and diffused micro-AVFs (I + IV). The angioarchitecture corresponded well to the radiographic appearance in all except one case. With respect to the treatment, type II, III, IV AVMs gained clinical cure in 100% of cases, whereas type I and type V AVMs obtained clinical cure only in 3 of 5 and 1 of 3 cases respectively. Central AVMs in jaws exhibited variant patterns of angioarchitecture, which could be divided into five types. Elaboration of this classification was helpful for decision-making on choosing appropriate therapy.

A preliminary study of angiographic classification and its correlation to treatment of central arteriovenous malformation in the jaw

To elaborate on the classification of central arteriovenous malformations (AVMs) in the jaw based on angioarchitecture and to evaluate the correlation of this classification with treatment options. X-ray films and digital subtraction angiograms (DSA) of 25 cases with AVMs in the jaw were retrospectively reviewed to evaluate the appearance of bone resorption, feeding arteries, nidus of the malformations, and draining veins. Based on the findings a classification of angioarchitecture was recommended. Furthermore, the treatment results of these cases were reviewed to assess the correlation of this classification system with treatment options. The angiographic pictures of 25 cases with central AVMs could be divided into 5 types: Type I (n = 5) had diffused microarteriovenous fistulas (AVFs); type II (n = 8) had 1 large venous pouch with all the feeding arteries draining into it; type III (n = 7) had a large venous pouch as well as diffused microAVFs (I+II); type IV (n = 2) had multiple venous pouches; and type V (n = 3) had multiple venous pouches and diffused microAVFs (I + IV). The angioarchitecture corresponded well to the x-ray appearance in all cases except 1 (96%). With respect to the treatment outcomes, type II, III, and IV AVMs gained clinical cure in 100% of the cases, whereas type I and type V AVMs obtained clinical cure only in 60% and 33.3% of the cases, respectively. Central AVMs in the jaw contained variant patterns of angioarchitecture and could be divided into 5 types. This angiographic classification was helpful for decision making about appropriate therapy.

Treatment of central arteriovenous malformation of the mandible via resection and immediate replantation of the segment: A case report

Treatment of central arteriovenous malformation of the mandible via resection and immediate replantation of the segment: A case report

Deep central arteriovenous malformations of the brain: the role of endovascular treatment.

Cerebral deep central arteriovenous malformations (AVMs) are uncommon lesions associated with considerable difficulty in treatment. The authors report a series of 14 deep central AVMs treated by endovascular methods and examine the present role of endovascular treatment. This treatment used alone resulted in complete obliteration of AVMs in approximately 15% of case and reduction in 50% to a size permitting treatment by means of radiosurgery. Reversal of previous neurological signs and symptoms occurred in 35.7% of embolized patients. Overall, nearly 80% of patients had either complete obliteration of the lesion, reduction to a size allowing radiosurgical treatment, or reversal of previous neurological deficits. There were treatment complications in 14.3% of the cases. Endovascular treatment methods may make a significant contribution to the therapy of AVMs that have a particularly poor course and are difficult to treat by other means.

Central arteriovenous malformations of the maxillofacial skeleton: Case report

Central arteriovenous malformation of the maxillofacial skeleton, though rare, is a well-documented entity. Past treatments have usually included some form of surgical intervention. Surgical resection as an attempt to cure has been effective but costly, ie, in relationship to patient morbidity and hospital expenditures. A case of vascular malformation is presented in which selective angiography and embolization as a primary treatment were used rather than ablative surgery. The patient tolerated the procedures well, with complete resolution of bleeding.

Arterio-inferior Sagittal Sinus Fistulae: Case Report

Abstract The management of the case of a 9-year-old boy with progressive cognitive impairment due to arteriovenous fistulae at the apex of the inferior sagittal sinus is reported. This represents a unique location for an extraparenchymal deep central arteriovenous malformation. The patient underwent staged ablation of the lesion by surgery. The postoperative course was complicated by expansion of an aneurysmal vein of Galen undergoing thrombosis and hyperperfusion syndrome, but the patient ultimately made a satisfactory recovery.

Treatment of a central arteriovenous malformation of the mandible with cyanoacrylate

Treatment of a central arteriovenous malformation of the mandible with cyanoacrylate

Treatment of a central arteriovenous malformation of the mandible with cyanoacrylate: A 4-year follow-up

Large arteriovenous malformations of the jaws are relatively rare, potentially life-threatening lesions. When the lesion is not suspected, extraction of teeth can be fatal. The occurrence and treatment of arteriovenous vascular communications in the head and neck region have traditionally presented most perplexing problems. Traditional treatment has usually involved the obtaining of proximal and distal vascular control and surgical removal of the lesions, when feasible. This article presents a case that is of particular interest because it illustrates the successful use of cyanoacrylate as the only treatment for a large arteriovenous malformation of the left side of the mandible. A 4-year follow-up shows no evidence of the lesion and demonstrates complete regeneration of bone in the same area.