Multiple stage treatment arteriovenous malformations rupture with intracerebral hematoma formations: a case report

Yuris L. Dzenis, Karlis J. Kupchs, Zanda Y. Arajuma

Abstract


This article describes a clinical case of arteriovenous malformation (AVM) associated with aneurism in a young woman. Its rupture caused intracerebral hematoma (ICH) in left parietal lobar of the brain. The initial condition of the patient was severe: coma, 5 scores by Glasgow Coma Scale and respiratory malfunction.

Surgical therapy included microsurgical ICH evacuation with afferent blood vessel coagulation and ICP-sensor implantation, AVM embolization and autocranioplasty.

Hemiplegia developed after the first microsurgical operation. At an early stage, antioxidants were included into the therapy complex. In twelve months the patient was still having local weakness in right foot, which didn`t disturb the movement (Glasgow Outcome Scale 5).


Keywords


intracranial hematoma; arteriovenous malformation; associated with aneurism; microsurgery; embolization; autocranioplasty

References


1. Krylov VV, Dash’yan VG, Dmitriev AY. Klinika i diagnostika arteriovenoznykh mal’formatsiy. In: Krylov VV, editor. Khirurgiya anevrizm golovnogo mozga. V. 3. Moscow: Novoe vremya; 2012. p.172-209. Russian.

2. Spetzler RF, Ponce FA. A 3-tier classification of cerebral arteriovenous malformations. Clinical article. J Neurosurg. 2011 Mar;114(3):842-9. [CrossRef] [PubMed]

3. D’Aliberti G, Talamonti G, Cenzato M, La Camera A, Debernardi A, ValvassoriL,Mariangela P, Nichelatti M. Arterial and venous aneurysms associated with arteriovenous malformations. World Neurosurg. 2015 Feb;83(2):188-96. [CrossRef] [PubMed]

4. Redekop G, TerBrugge K, Montanera W, Willinsky R. Arterial aneurysmsassociated with cerebral arteriovenous malformations: classification, incidence, and risk of hemorrhage. J Neurosurg. 1998 Oct;89(4):539-46. [CrossRef] [PubMed]

5. CagnazzoF, BrinjikjiW, LanzinoG. Arterial aneurysms associated with arteriovenous malformations of the brain: classification, incidence, risk of hemorrhage, and treatment - a systematic review. ActaNeurochir (Wien). 2016Nov;158(11):2095-2104. [CrossRef] [PubMed]

6. Alexander MD, Cooke DL, Hallam DK, Kim H, Hetts SW, Ghodke BV. Less can be more: Targeted embolization of aneurysms associated with arteriovenous malformations unsuitable for surgical resection. IntervNeuroradiol. 2016 Aug;22(4):445-51. [CrossRef] [PubMed]

7. Signorelli F, Gory B, Pelissou-Guyotat I, Guyotat J, Riva R, DaillerF,Turjman F. Ruptured brain arteriovenous malformations associated with aneurysms: safety and efficacy of selective embolization in the acute phase of hemorrhage. Neuroradiology. 2014 Sep;56(9):763-9. [CrossRef] [PubMed]

8. Bendok BR, El Tecle NE, El Ahmadieh TY, Koht A, Gallagher TA, Carroll TJ, Markl M, Sabbagha R, Sabbagha A, Cella D, Nowinski C, Dewald JP, Meade TJ, Samson D, Batjer HH. Advances and innovations in brain arteriovenous malformation surgery. Neurosurgery. 2014 Feb; 74 Suppl 1:S60-73. [CrossRef] [PubMed]

9. Plasencia AR, Santillan A. Embolization and radiosurgery for arteriovenous malformations. SurgNeurol Int. 2012;3(Suppl 2):S90-S104. [CrossRef] [PubMed]

10. Starke RM, Komotar RJ, Hwang BY, Fischer LE, Otten ML, Merkow MB, Garrett MC, Isaacson SR, Connolly ES Jr. A comprehensive review of radiosurgery for cerebral arteriovenous malformations: outcomes, predictive factors, and grading scales. StereotactFunctNeurosurg. 2008;86(3):191-9. [CrossRef] [PubMed]

11. Krylov VV, Gel’fenbeyn MS. Sovremennye podkhody k diagnostike i lecheniyu arterial’nykh anevrizm i arteriovenoznykh mal’formatsiy (po materialam XI Vsemirnogo kongressa neyrokhirurgov). The Russian Journal of Neurosurgery. 1998;(2):43-54. Russian. Available from: http://therjn.com/ru-ru/Files/Pdf/1998/2/43.pdf.

12. Russell SM, Woo HH, Joseffer SS, Jafar JJ. Role of frameless stereotaxy in thesurgical treatment of cerebral arteriovenous malformations: technique and outcomes in a controlled study of 44 consecutive patients. Neurosurgery. 2002Nov;51(5):1108-16; discussion 1116-8. [CrossRef] [PubMed]

13. Utsuki S, Kurata A, Miyasaka Y, Takano M, Ootaka H, Fujii K. Multiple arteriovenous malformations with hemorrhage. ActaNeurochir (Wien). 2002J an;144(1):97-101. [CrossRef] [PubMed]

14. Wong SH, Tan J, Yeo TT, Ong PL, Hui F. Surgical excision of intracranial arteriovenous malformations after preoperative embolisation with N-butylcyanoacrylate. Ann Acad MedSingapore. 1997 Jul;26(4):475-80. [PubMed]

15. Hongo K, Koike G, Isobe M, Watabe T, Morota N, Nakagawa H. Surgical resection of cerebral arteriovenous malformation combined with pre-operative embolisation. J ClinNeurosci. 2000 Sep;7Suppl 1:88-91. [CrossRef] [PubMed]

16. Hemphill JC 3rd, Greenberg SM, Anderson CS, Becker K, Bendok BR, Cushman M, Fung GL, Goldstein JN, Macdonald RL, Mitchell PH, Scott PA, Selim MH, Woo D; American Heart Association Stroke Council.; Council on Cardiovascular and Stroke Nursing.; Council on Clinical Cardiology. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke. 2015Jul;46(7):2032-60. [CrossRef] [PubMed]

17. Krylov VV, Dash’yan VG, Dmitriev AY. Khirurgiya arteriovenoznykh mal’formatsiy. In: Krylov VV, editor. Khirurgiya anevrizm golovnogo mozga. V.3. Moscow: Novoe vremya; 2012. p. 210-230. Russian.

18. Kuznetsova SM, Lukach OI. Cerebrum compositum v reabilitatsii bol’nykh, perenesshikh ishemicheskiy insul’t. Biologicheskaya terapiya. 2002;(3):20-25. Russian.

19. Jennett B, Bond M. Assessment of outcome after severe brain damage. Lancet.1975 Mar 1;1(7905):480-4. [CrossRef] [PubMed]

20. Unsgеrd G, Rao V, Solheim O, Lindseth F. Clinical experience with navigated 3D ultrasound angiography (power Doppler) in microsurgical treatment of brain arteriovenous malformations. ActaNeurochir (Wien). 2016 May;158(5):875-83. [CrossRef] [PubMed]

21. Ryabukhin VE, Klimov AB, Orlov KY, Krylov V V. Endovaskulyarnoe lechenie arteriovenoznykh mal’formatsiy golovnogo mozga. In: Krylov VV, editor. Khirurgiya anevrizm golovnogo mozga. V. 3.Moscow: Novoe vremya; 2012. p. 231-268. Russian.

22. Hartmann A, Pile-Spellman J, Stapf C, Sciacca RR, Faulstich A, Mohr JP, Schumacher HC, Mast H. Risk of endovascular treatment of brain arteriovenous malformations. Stroke. 2002 Jul;33(7):1816-20. [CrossRef] [PubMed]

23. Haw CS, terBrugge K, Willinsky R, Tomlinson G. Complications of embolizationof arteriovenous malformations of the brain. J Neurosurg. 2006 Feb;104(2):226-32. [CrossRef] [PubMed]

24. Taylor CL, Dutton K, Rappard G, Pride GL, Replogle R, Purdy PD, White J,Giller C, Kopitnik TA Jr, Samson DS. Complications of preoperative embolization of cerebral arteriovenous malformations. J Neurosurg. 2004 May;100(5):810-2. [CrossRef] [PubMed]

25. Rumyantseva SA, Bolevich SB, Silina EV, Fedin AI. Antioksidantnaya terapiya gemorragicheskogo insul’ta. Moscow: Meditsinskaya kniga; 2007. Russian.

26. Afanas’ev V.V. Tsitoflavin v intensivnoy terapii. St. Petersburg; 2005. Russian.

27. Guekht A, Skoog I, Edmundson S, Zakharov V, Korczyn AD. ARTEMIDA Trial (A randomized Trial of Efficacy, 12 Months International Double-Blind Actovegin): A Randomized Controlled Trial to Assessthe Efficacy of Actoveginin Poststroke Cognitive Impairment. Stroke. 2017 ay;48(5):1262-1270. [CrossRef] [PubMed]

28. Zhu Y, Zhang G, Zhao J, Li D, Yan X, Liu J, Liu X, Zhao H, Xia J, Zhang X, Li Z, Zhang B, Guo Z, Feng L, Zhang Z, Qu F, Zhao G. Efficacy and safety of Mildronate for acute ischemic stroke: a randomized, double-blind, active-controlled phase II multicenter trial. Clin Drug Investig. 2013 Oct;33(10):755-60. [CrossRef] [PubMed]


GOST Style Citations






DOI: https://doi.org/10.25305/unj.112107

Copyright (c) 2017 Yuris L. Dzenis, Karlis J. Kupchs, Zanda Y. Arajuma

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.