Non-Invasive Follow-up Evaluation of Post-Embolized AVM with Time-Resolved MRA: A Case Report

We report the hemodynamic assessment in a patient with cerebral arteriovenous malformation using time-resolved magnetic resonance angiography (TRMRA), a non-invasive modality, and catheter-based digital subtraction angiography (DSA), before and after embolization. Comparison of the results showed that TR-MRA produced very fast dynamic images and the findings closely matched those obtained at DSA. For initial work-up and follow-up studies in patients with vascular lesions, TR-MRA and DSA are therefore comparable.

The causes and the nursing interventions of the complications due to repeated embolization therapy for huge cerebral arteriovenous malformations / 介入放射学杂志

Objective To investigate the causes of the complications occurred after repeated embolization therapy for huge cerebral arteriovenous malformations and to discuss their nursing interventions. Methods A total of 54 embolization procedures were performed in 17 patients with huge cerebral arteriovenous malformations. The clinical data were retrospectively analyzed. The causes of complications were carefully examined and the preventive measures were discussed. The prompt and necessary nursing interventions were formulated in order to prevent the complications or serious consequences. Results Among the total 17 patients, one patient gave up the treatment because of the cerebral hemorrhage which occurred two months after receiving 3 times of embolization therapy. One patient experienced cerebral vascular spasm during the procedure, which was relieved after antispasmodic medication and no neurological deficit was left behind. Two patients developed transient dizziness and headache, which were alleviated spontaneously. One patient presented with nervousness, fear and irritability, which made him hard to cooperate with the operation and the basis intravenous anesthesia was employed. No complications occurred in the remaining cases. Conclusion The predictive nursing interventions for the prevention of complications are very important for obtaining a successful repeated embolization therapy for huge cerebral arteriovenous malformations, which will ensure that the patients can get the best treatment and the complications can be avoided.

Controlled Hypotension Decreases the Cerebral Luxury Perfusion after Arteriovenous Malformation Removal / 临床麻醉学杂志

Objective: To study the effect of controlled hypotention on the prevention and treatment of cerebral swellingafter removal of giant arteriovenous malformation(AVM). Methods:8 cases with AVM( > 6cm) were selected. When Laser-Dopple flowmetry showed an increase of cerebral blood flow after excision arteriovenous malformation (AVM), intraoperativ-ely, 2.5 % thiopental 5-10mg/kg was injected. Results: The basic mean blood pressure of all cases was 77.63 + 4.27mmHgand basic cerebral blood flow value was 35-134PU. After AVM resection, cerebral blood flow was increased obviously. Thechange value 1 was 125-434PU and the increasing amplitude was 223.48% + 0.62% (P < 0. 001). With thiopental injec-tion, mean artery blood pressure was reduced by 23.00 % + 0.02 %. The cerebral blood flow value was reduced too. Thechange value 2 was 89-236PU and the decreasing amplitude was 35 % + 7.35% (P < 0.01) eampared with that beforethiopental injection. Conclusion:Controlled hypotension can decrease the increasing amplitude of cerebral blood flow and thecerebral perfusion after the giant AVM removal.

Radiologic Findings of Deep Seated Cere b ral Arteriovenous

PURPOSE: To analyze the radiologic-especially angiographic-findings of deep seated cerebral arteriovenous malformation(AVM) involving nonvisualized straight sinus. MATERIALS AND METHODS: In six patients aged between 15 and 53 years with deep seated cerebral AVM, CT and MR images were retrospectively analyzed with regard to the following features : the presence of straight sinus, the location of AVM, and the occurrence of hemorrhage. Angiograms were analyzed for venous drainage routes of AVM, the appearance of veins, the presence of falcine sinus and venous drainage from normal deep brain parenchyme. In four patients who had undergone intravascular embolization therapy, pre- and post- embolization angiograms were compared. RESULTS: CT and MR images showed neither straight sinus nor thrombosis. AVMs were deeply seated in the brain, and in all cases there was cerebral hemorrhage. Angiograms disclosed that venous drainage of all AVMs occurred via the veins of Galen. In one case, venous flow via the falcine sinus to the superior sagittal sinus was noted, but in others, retrograde flow in the deep venous system was observed. Marked collateral routes followed in response to the obstruction of straight sinus included the basal vein of Rosenthal, the internal occipital, internal cerebral, and cerebellar hemispheric veins (which are Galenic afferents), and the inferior sagittal s-inus. In all patients, contralateral routes were partially involved. Venous drainage from normal deep parenchyme through the transcerebral veins to the superficial venous system was noted, and in one case, s-traight sinus which had been observed on an angiogram five years earlier was no longer present. CONCLUSION: Angiography offers effective evaluation of the dynamic aspect of venous flow in cases involving deep-seated AVM, and of normal deep parenchyme in cases in which AVM involves nonvisualized straight sinus. Before intravascular treatment of AVM, venous flow must be carefully analyzed.

Analysis of Angiographic Findings in Cerebral Arteriovenous Malformation with Hemorrhage: Comparison between Intracerebral and Intraventricular Hemorrhage

PURPOSE: The purpose of this study was to analyze the angioarchitectures of cerebral arteriovenousmalformation(AVM) and to determine whether there was correlation between angioarchitectures and patterns ofintracranial hemorrhage(intracerebral, intraventricular, and both) in cerebral AVM. MATERIALS AND METHODS: Onehundred and twenty-eight patients who between November 1989 and December 1994 suffered supratentorial AVM withintracranial hemorrhage were studied retrospectively. Among 128 patients, intracerebral and intraventricularhemorrhage were seen in 68 (53%) and 24 patients (19%), respectively, while both types were seen in the remaining36 (28%). We analyzed the angioarchitectual characteristics of AVM. namely nidi, feeding arteries and drainingveins, in three hemorrhagic groups of patients with intracerebral hemorrhage, intraventricular hemorrhage andboth. The kappa2 test or Fisher's exact test was used for statistical analysis. RESULTS: A cortically located niduswas most common in patients with intracerebral hemorrhage, while a periventricular location was most common inthose with intraventricular hemorrhage (p<0.001). Location in the corpus callosum, choroid plexus, orintraventricular area was more frequent in the intraventricular than the intracerebral hemorrhagic group (p<0.05). Superficial venous drainage was most common in patients with intracerebral hemorrhage (p<0.001), and deep venousdrainage in those with intraventricular hemorrhage (p=0.001). CONCLUSION: The angioarchitectual characteristicsof cerebral arteriovenous malformation correlate significantly with patterns of intracranial hemorrhage, andawareness of the type of hemorrhage could help to manage patients and determine prognosis.