¿Coartación de aorta en el recién nacido? No siempre es lo que parece: a propósito de un caso / Coarctation of aorta in a neonate? It is not always what it seems: an illustrative case

La coartación de aorta en neonatos se puede manifestar como insuficiencia cardíaca según el grado de obstrucción. Hay situaciones que pueden simular una coartación de aorta en los recién nacidos. Limitarse a la imagen típica de muesca aórtica en la ecocardiografía para diagnosticar una coartación de aorta puede inducir a error y demorar el diagnóstico adecuado. Se presenta el caso de un recién nacido con insuficiencia cardíaca con diagnóstico inicial de coartación de aorta y, posteriormente, de malformación arteriovenosa cerebral. Se debe considerar la malformación arteriovenosa en el diagnóstico diferencial de un recién nacido con insuficiencia cardíaca.

Coarctation of the aorta in neonates can manifest as heart failure when there is a certain degree of obstruction. There are some situations that can simulate a coarctation of the aorta in newborns. Diagnosis of coarctation of the aorta based solely on the typical aortic arch image on echocardiography can be misleading and delay an accurate diagnosis. We describe an unusual case of a newborn with heart failure who was initially diagnosed with coarctation of the aorta and then with cerebral arteriovenous malformation. We must consider the cerebral arteriovenous malformation in the differential diagnosis of a newborn with heart failure.

The changes of plasma VEGFin cerebral arteriovenous malformations / 实用医学杂志

Objective Todetectthe level of plasma VEGF before and after treatment of arteriovenous mal-formationpatients,and the pathophysiological role of VEGF in arteriovenous malformationpatientswas also studied. Methods The blood samples of 17 arteriovenous malformation patients were collected according to the following three groups:group before operation(AVM),group 24 hours after operation(AVM24h)and group 30 days after operation(AVM30d).As a control(Con),22 blood samples were collected from lumbar laminectomypatients.The level of plasma VEGF was determined by ELISA assay. Results Compared with the control group,the plasma VEGF was significantly decreased in AVM group and AVM24h group(P < 0.05),while the plasma VEGF in AVM30d groupwas similarto that of the control group. Conclusions Abnormal blood vessel plays an important pathophysiological role in cerebral arteriovenous malformation,and the metabolism of VEGF is involved in the pro-cess of arteriovenous malformation.

Preliminary application of multiple angiographic patterns in the hybrid surgery of cerebral and spinal arteriovenous malformations / 中国脑血管病杂志

Objectives To investigate the application modes of indocyanine green (ICG) angiography,digital subtraction angiography (DSA) and methylene blue angiography in the hybrid surgery of cerebral and spinal arteriovenous malformations (AVMs) and to compare the application value of different intraoperative angiographic methods.Methods From July 2013 to December 2015,55 patients treated with hybrid surgery of cerebral and spinal AVMs in Xuanwu Hospital,Capital Medical University were analyzed retrospectively,including 8 patients with cerebral AVM(Spetzler-Martin grade ≥Ⅲ) and 47 with spinal AVM.Their mean age was 33.8±15.6 years.Intraoperative DSA was performed in a hybrid operation room and methylene blue angiography was performed via the feeding artery.ICG angiography was performed in 4 cases in the initial stage as a comparison.Anatomic cure was confirmed by DSA at 3 months after surgery and the results were assessed.Results All 55 patients performed intraoperative DSA,32 underwent methylene blue angiography and 4 performed intraoperative ICG angiography.The frequency of intraoperative DSA was 3.6±1.3 times for each case.After the resection of the first lesion,the residual lesions revealed by DSA accounted for 27.3% (15/55).85.5% (47/55) patients achieved anatomic cure,in which the patients with midbrain AVM (8/8) and spinal AVM 83.0% (39/47) achieved anatomic cure.Three patients were lost to follow up at 1 year after procedure.The median modified Rankin scale (mRS) score of the cerebral AVMs was 2.0 (0.0-3.8).Compared with 3.5 (2.0-4.0) before procedure,there was significant difference (Z=-2.264,P0.05).The patients with function preservation (function score equal or better than pre-operation) accounted for 88.5% (46/52).Conclusions Intraoperative DSA could precisely localize the nidi and verify the complete resection.Intraoperative methylene blue angiography could selectively reveal the feeding artery supplied nidi in the operative field and identify the angioarchitecture.ICG angiography could reveal the structures of nidi on the surface of the operation area.The intraoperative methylene blue angiography could replace ICG angiography and achieve the treatment target of anatomical cure of the hybrid surgery of the cerebral and spinal cord vascular malformations.

Research progress in embolization treatment for cerebral arteriovenous malformations via transvenous approach / 介入放射学杂志

Clinically,arteriovenous malformations (AVM) is a common intracranial vascular disease.Traditional treatments for cerebral AVM include microsurgical resection,endovascular embolization and radiotherapy.However,there are some unusual AVM lesions that are difficult to be cured by traditional methods.Multiple case reports that have been published recently indicate that embolization therapy via transvenous approach is very effective for these unusual AVM lesions,especially for small hemorrhagic AVMs.These lesions often have single vein drainage and are located at deep cerebral function area.with their blood supply being from fine arteries.This paper aims to review the existing literature and to make a summary about the indications,method of operation,risks and prevention,etc.of embolization therapy via transvenous approach for cerebral AVM.

Control study on skull to boneless head CTA by surface shaded display technique and volume computed tomographic digital subtraction angiography in diagnosing AVM / 重庆医学

Objective To investigate the diagnostic value of technologies for arteriovenous malformation(AVM ) ,which are skull to boneless head CTA by surface shaded display technique (hereinafter referred to as the SSD‐CTA technology) .Methods Totally 27 patients of the First Affiliated Hospital of Chongqing Medical University were selected ,which were diagnosed with AVM by VCTDSA .The original data to our hospital CT workstation were imported ,SSD‐CTA technology to bone reconstruction were performed ,and the data of the two groups were compared .Another 5 patients in our hospital which were diagnosed with AVM by SSD‐CTA examination were selected ,and compared the results with DSA .Results The quality score of SSD‐CTA reconstructed image was less than that of VCTDSA ,but the diagnosis of the two technologies for AVM had no significant statistical difference (P>0 .05) .The number of AVM patients from our hospital wsa too less to do the statistical analysis .The detail resolution of SSD‐CTA was less than DSA ,but the diagnosis of SSD‐CTA was consistent with DSA .Conclusion SSD‐CTA has clinical practical val‐ue ,can be used as a check ,intracranial venous malformation diagnosis .

Clinical application value of whole-brain CTA-CTP imaging in cerebral arteriovenous malformation / 实用放射学杂志

Objective To explore the clinical application value of whole-brain CTA-CTP imaging in cerebral arteriovenous malformation (cAVM).Methods Fifteen patients diagnosed with cAVM by CTA-CTP imaging were included in this retrospective analysis study. The angioarchitecture of cAVM lesions were recorded from 4D-CTA images.Using DSA as the golden standard,the diagnostic accuracy of 4D-CTA was evaluated in 13 cases.The perfusion patterns of vessel nidus and peritumoral tissues were analyzed from the CTP images.Bleeding ratios of patients with different angioarchitecture and perfusion patterns were compared.Results 4D-CTA could dynamically display the angioarchitecture details of cAVM lesions and show the whole process of the contrast agent in and out of the vessel nidus.Although the result of 4D-CTA was consistent with that of DSA in most cases,a few fine feeding arteries and draining veins were missed.The nidus in thirteen cases was with high perfusion and the peritumoral tissues were with low perfusion.Another two cases were with low perfusion due to the presence of hematoma.Nine cAVMs suffered from small size,single feeding artery,deep venous drainage and vessel nidus with increased MTT,peritumoral tissues with decreased MTT were more likely to suffer a hemorrhage (P<0.05).Conclusion Whole-brain CTA-CTP imaging could be a valuable adjunct in noninvasive diagnosis of cAVM and predicting the bleeding risk factors.

Fractionated embolization for the treatment of large cerebral arteriovenous malformation：clinical experience in 35 cases / 介入放射学杂志

Objective To discuss the therapeutic methods and strategies of fractionated embolization in treating large cerebral arteriovenous malformation (cAVM). Methods During the period from May 2005 to May 2013 at authors’ hospital, endovascular fractionated embolization was performed in 35 cases with large cAVM. The lesions were located in the frontal lobe (n = 11), the parietal lobe(n = 8), the temporal lobe (n = 6), the occipital lobe (n = 4), the lateral temporal area (n = 2) and the deep white matter and basal ganglia (n = 4). The longest diameter of the lesions was 6 - 12 cm, with a mean of 7.23 cm. The number of supply vessels was 2 - 5. The lesions were drained by superficial veins in 13 cases, by deep veins in 9 cases and by both superficial and deep veins in 17 cases. The exit stenosis of the draining vein was seen in 3 cases, while the dilatation of the draining vein was found in 6 cases. Angiography showed that the lesions were situated at the right side in 16 cases and at the left side in 19 cases. Results A total of 297 times of embolization operating-process were carried out in the 35 patients, of which NBCA was used in 107, ONYX in 153 with, FuAiLe medical adhesive in 15, combination use of NBCA and ONYX in 9 and combination use of ONYX and FuAiLe medical adhesive in 13. No death occurred after treatment. After the first embolization, the residual malformation volume usually decreased to 80%embolization) in 9 patients. Good recovery was achieved in all patients. After fractionated embolization, the volume of the cAVMs was decreased gradually and ultimate clinical cure was achieved, which laid the foundation for conducting further micro - neruosurgery or radiation therapy. Conclusion For the treatment of large cerebral arteriovenous malformation, fractionated embolization has reliable therapeutic effect. Therefore, this technique should be recommended in clinical practice.

Cesárea en una paciente con gran malformación arteriovenosa cerebral: consideraciones anestésicas.

RESUMEN Se presenta el caso clínico de una paciente de 26 años, portadora de malformación arteriovenosa cerebral (MAV) gigante frontal izquierda diagnosticada hace 12 años por epilepsia sintomática secundaria, coordinada para cesárea de segunda gestación de 39 semanas, realizándose anestesia combinada raquídea peridural sin incidentes y con buenos resultados materno fetales.

SUMMARY We report the clinical case of a 26 years old, with cerebral arteriovenous malformation (AVM) giant left frontal diagnosed 12 years ago by symptomatic epilepsy secondary, cesarean coordinated second gestation of 39 weeks, performing combined spinal epidural anesthesia without incident and maternal fetal successfully.

RESUMO Apresenta-se o caso clinico de uma paciente de 26 anos, portadora de uma malformação arteriovenosa cerebral gigante frontal esquerda, diagnosticada por epilepsia sintomática á 12 anos prévio a esta situação e coordenada para cesariana com 39 semanas de gestação. Foi realizada anestesia combinada raqui-peridural sem incidente e com bons resultados materno-fetais.

Autodestrucción espontánea de una malformación arteriovenosa cerebral / Spontaneous self-destruction of a cerebral arteriovenous malformation

Se presenta una paciente que fue investigada y operada en el Hospital Universitario Gral Calixto García, portadora de una malformación arteriovenosa cerebral, que desapareció espontáneamente después de un cuadro neurológico de intensa gravedad. Arteriográficamente se comprobó que estaba asociada a un aneurisma arterial en su mismo sistema vascular cerebral. La paciente había sufrido 3 eventos neurológicos en orden ascendente de gravedad, y fue el último motivo de ingreso en la Unidad de Terapia Intensiva, con un nivel de 5 en la escala de Glasgow para el coma y sin signos meníngeos evidenciables. La lesión valorada como malformación arteriovenosa cerebral en las tomografías axiales cumputarizadas previas, no se evidenció en la panangiografía cerebral realizada en la fase de mejoría clínica relativa después de su etapa más crítica. Dicha angiografía demostró un aneurisma arterial homolateral a la malformación arteriovenosa ya desaparecida, el cual fue excluido de la circulación por presillamiento de su cuello sin eventos transoperatorios ni posoperatorios relevantes. Se realiza una revisión de la literatura al respecto(AU)

Authors present the case of a patient researched and operated on in the General Calixto García University Hospital presenting with a cerebral arteriovenous malformation disappeared spontaneously after a neurologic picture of intense severity. From the arteriographic point of view it was verified that it was associated with an arterial aneurysm present in her same cerebral vascular system. The patient has had three neurological events in rising order of severity which was the last reason for admission in the Intensive Therapy Unit (ITU) with a level of 5 in the Glasgow scale for the coma and without obvious meningeal signs. The injury classified as a cerebral arteriovenous malformation according to the previous computerized axial tomographies was not evidenced in the cerebral panangiograpy carried out in the clinical phase improvement after its more critical stage. Such angiography demonstrated the presence of a arterial aneurysm homolateral to the already disappeared arteriovenous malformation, which was excluded of the circulation by means of stitching of neck without transoperative and postoperative significant events. In this respect, author made a literature review(AU)

A glance at Live Interventional Neuroradiology & Neurosurgery Course 2009 / 介入放射学杂志

The annual Live Interventional Neuroradiology & Neurosurgery Course (LINNC) is one of the most important congresses in the neurosurgery and neuroradiology field. LINNC 2009 was held on May 25th this year and lasted for 3 days. In this article, the authors introduced the main points of the congress The congress mainly discussed some hot topics at present time, including both the clinical and fundamental studies of cerebral arteriovenous malformation. Ischemic cerebral disease and intracranial aneurysm, etc. Both neurological and neuroradiological case demonstrations related to the topics, and the main course of the congress were altemately performed. Recent advances in imaging technique and clinical application, such as Dyna-CT and Xper-CT, were also presented on the congress.

Clinical Results from Single-Fraction Stereotactic Radiosurgery (SRS) of Brain Arteriovenous Malformation: Single Center Experience / 의학물리

The purpose of this study was to analyze the effect of single-fraction stereotactic radiosurgery (SRS) for the treatment of 15 cases of cerebral arteriovenous malformations (AVMs). Between 2002 and 2009, of the 25 patients who had SRS for the treatment of cerebral AVM, 15 patients (6 men, 9 women) taken a digital subtraction angiography (DSA) over 12 months after SRS were included. We retrospectively evaluated the size, location, hemorrhage of nidus, angiographic changes on follow-up on the MR angiography and DSA, and clinical complications during follow-up periods. At a median follow-up of 24 months (range 12-89), complete obliteration of nidus was observed in all patients (100%) while residual draining veins was observed in 3 patients (20%). There was no clinical complication during the follow-up period except seizure in 1 patient. The mean nidus volume was 4.7cc (0.5~11.7 cc, SD 3.7 cc). The locations of nidus were in cerebral hemisphere in 11 patients, cerebellum in 2 patients, basal ganglia in 1 patient, and pons in 1 patient respectively. 9 cases were hemorrhagic, and 6 cases were non-hemorrhagic AVMs. The SRS with LINAC is a safe and effective treatment for cerebral AVMs when the follow up period is over 4 years. However, it is recommended to continue to follow up until the draining vein on arterial phase of follow up DSA disappears completely.

The Rare Association of Moyamoya Disease and Cerebral Arteriovenous Malformations: a Case Report

A 36-year-old man was diagnosed with a right temporal lobe grade II cerebral arteriovenous malformation (cAVM) and was treated with radiosurgery. At nine months after the cAVM radiosurgery, the patient began to develop bilateral focal narrowing at the M1 segments of the bilateral middle cerebral arteries. The narrowing progressively deteriorated as was demonstrated on longitudinal serial follow-up MR imaging. X-ray angiography performed at 51 months after radiosurgery confirmed that the cAVM was cured and a diagnosis of moyamoya disease. To the best of our knowledge, this is the first case of cAVM-associated moyamoya disease that developed after radiosurgery. Given the chronological sequence of disease development and radiation dose distribution of radiosurgery, it is proposed that humoral or unknown predisposing factors, rather than direct radiation effects, are the cause of moyamoya disease associated with cAVM.

Radiosurgery for Intracranial Disorders

Stereotactic radiosurgery offers a broad spectrum armamentarium for the safe treatment of various lesions within the central nervous system. Radiosurgery uses stereotactic targeting methods to precisely deliver highly focused, large doses of radiation to small intracranial tumors and arteriovenous malformations (AVMs). It is widely used for the treatment of metastatic brain tumors, non-resectable tumors, residual or recurrent benign and malignant tumors as well as for the treatment of AVMs, functional diseases, and pain disorders. Although radiosurgery has the potential to produce complications, the majority of patients experience clinical improvement with less morbidity and mortality than those occur in surgical resection.

The Pathogenesis of Cerebral Arteriovenous Malformations / 国际脑血管病杂志

Cerebral arteriovenous malformation is a common cerebrovascular disease.Its exact pathogenesis remains unclear.At present,it is thought that this disease is caused by kinds of factors,including congenital and acquired factors.

Nursing about patients with cerebral arteriovenous malformation received Onyx endovascular embolization / 中国康复理论与实践

@#ObjectiveTo explored the nursing about the patients received Onyx embolization. Methods14 patient with cerebral arteriovenous malformation received Onyx embolization were analyzed retrospectively.ResultsThere was no long-term complication occurred, and all the patients left hospital 3～6 d after operation. ConclusionIntensive nursing on lowered blood-pressure control was the most important process to keep embolization effect successfully.

Radiosurgery with Linac Based Photon Knife in Cerebral Arteriovenous Malformation / 대한방사선종양학회지

PURPOSE: The purpose of this study was to analyze the effect of a Linear accelerator based Photon Knife Radiosurgery System developed by the staff of Keimyung University Dongsan Medical Center for the treatment of cerebral arteriovenous malformation. Material and Methods:Between December 1993 and October 2000, 30 patients with cerebral arteriovenous malformation (AVM) were treated with the Linac based Photon Knife Radiosurgery System in the Department of Therapeutic Radiology at Keimyung University Dongsan Medical Center. The median age was 34, ranging from 7 to 63 years, with a 2:1 male to female ratio. The locations of the AVM nidi were the frontal lobe (motor cortex), parietal lobe, and the thalamus, in that order. The diameters of the AVM nidi ranged 1.2 to 5.5 cm with a mean of 2.9 cm, and target volumes of between 0.5 and 20.6 cc, with a mean of 6.8 cc. The majority of patients received radiation doses of between 1,500 and 2,500 cGy, with a mean of 2,000 cGy, at 80% the isodose line. Twenty-five patients were treated with one isocenter, 4 with two, and 1 with four. The follow-up radiological evaluations were performed with cranial computed tomogram (CT) or MRI between 6 month and one year interval, and if the AVM nidus had completely disappeared in the CT or MRI, we confirmed this was a complete obliteration, with a cerebral or magnetic resonance angiogram (MRA). The median follow-up period was 39 months with a range of 10 to 103 months. RESULTS: Twenty patients were radiologically followed up for over 20 months, with complete obliteration observed in 14 (70%). According to the maximal diameter, all four of the small AVM (3 cm), only one showed complete obliteration, and 5 showed partial obliteration, but 3 of these underwent further radiosurgery 3 years later. One who followed up for 20 months following further radiosurgery eventually showed complete obliteration. Ten patients with seizure symptoms had no recurrent seizure due to radiosurgery and medication. One of the eleven patients who suffered intracranial bleeding developed further bleeding at 9 and 61 months following the radiosurgery although complete obliteration was evevtually observed and the patient was managed in hospital then recovered. No patient suffered severe complications following the radiosurgery. CONCLUSION: The radiosurgery with Linac-based Photon Knife radiosurgery system, developed by the staff at our hospital, is a safe and effective treatment for AVM patients having diameters or volumes of less than 3 cm or 10 cm3, respectively, located in inoperable areas or who refused neurosurgery. We suggest that staged AVM radiosurgery may initially be considered, if the AVM target volume is above 10 cm3.

Study on relationship between angioarchitectural factors of cerebral arteriovenous malformations and epilepsy and the effect of embolization treatment / 临床神经病学杂志

6 cm AVMs(57.1%)were much higher than that with 0.05).Seizure was found in forty-three patients.After embolization the seizure in 20 patients disappeared,11 patients had been improved greatly.The total effective power was 72.1%.Conclusions The size and location of AVM is significantly associated with the onset of seizure.The number of feeding artery has no relation with the seizure.Endovascular embolization for the AVMs has got better cure effect.

Evaluation of the hemorrhagic risk factors of cerebral arterioverous malformation on angioarchitecture / 介入放射学杂志

Objective To investigate the hemorrhagic risk factors of cerebral arteriovenous malformations (AVM) on angioarchitecture. Methods 201 cases with AVM diagnosed by digtial subtraction angiography (DSA), including 60 cases by superselective DSA, were devided into two groups. The bleeding group consisted of 138 (68.66%) cases, with ages ranging from 7 to 60 years (average 26 years). The nonbleeding group had 63 (31.34%) cases, whose ages ranged from 11 to 68 years (average 37 years). 14 risk factors with 45 levels were studied by SAS Statistical package. Results The proportion of the total value of square of mean diameters was in partial distribution between the supplying arteries and drainage veins (∑D 2 A/∑D 2 v) in the two groups. Rank sum tests showed significant difference ( P

Thrombosed Cerebral Arteriovenous Malformation (AVM): Operative Case Report / 대한뇌혈관학회지

Spontaneously thrombosed cerebral arteriovenous malformations (AVM) are infrequently reported. Its pathophysiology, and natural course, however, are still not clarified yet. Authors report a case of symptomatic, spontaneously thrombosed cerebral AVM in a 34-year-old male with a follow-up of 16-year duration, which was surgically extirpated due to repeated bleeding and intractable seizure disorder, and histopathologically confirmed. Relevant literatures are reviewed and discussed.

Surgical treatment of 8 patients with cerebral atteriovenous malformation

Most of arteriovenous malformations have the congenital origin and are formed from the mesoderm. They usually are seen under the 40 age and can be ruptured during any time. Sometimes they are also related to stress. Cerebral angiography keeps to play an important role in the diagnosis of AVM Digital Subtraction Angiography is a new advance in AVM diagnosis, it reveals AVM exactly and clearly. So, it helps the neurosurgeons to assess the treatment procedure appropriately. The characteristics of the surgical indications:* AVM in the surface of the cortex or under the cortex.* Size under 6 cm in diameter. * Noneloquent areas.* Without other diseases. Prevention of seizure with phenytoine is nesessary for pre and post operation. Nowadays, gamma knife is applied in spreading around the world with small and deep AVM or eloquent areas.