Differentiated neurosurgical treatment of cerebral arteriovenous malformations with epileptic seizures
Keywords:symptomatic epilepsy, cerebral arteriovenous malformation, endovascular embolization, Gamma-knife surgery
Introduction. Intracranial hemorrhages and epileptic seizures are the most common clinical manifestations of cerebral arteriovenous malformations (AVM). The study purpose — to assess efficiency of different surgical methods of symptomatic epilepsy in patients with cerebral AVM.
Materials and methods. 67 patients with symptomatic epilepsy brain AVM were included in study. Microsurgical resection (MSR) was performed in 22 patients, endovascular embolization (EE) — in 21, radiosurgical gamma-knife (GK) intervention — in 24. Follow-up period — from 6 months to 10 years, mean — 4.2 years.
Results. Complete MSR of AVM was performed in all 22 patients. There were postoperative neurological complications in 6 (27.3%) patients. Total EE of AVM was achieved in 2 (9.5%) patients. Postoperative morbidity observed in 4 (19.1) patients. After GK treatment complete obliteration of AVM was achieved in 17 (70.9%) patients, in 5 patients (20.8%) we observed subtotal occlusion of nidus and 2 (20.8%) patients refused from follow-up instrumental exam. Seizures control of was mostly effective after MSR of AVM — in 19 (86.4%) patients and after GK surgery — in 20 (83.3%), after EE such positive results was achieves just in 6 (28.6%) patients.
Conclusions. AVM’s complete resection provides effective control of epileptic seizures. Combined treatment using all methods let to achieve the maximum positive effect in complex brain AVM treatment.
2. Courville C. Pathology of the central nervous system. Mountainview: Pacific Press, 1945. 450 p.
3. McCormick W. Pathology of vascular malformations of the brain. In: Wilson C, Stein B, editors. Intracranial Arteriovenous Malformations. Baltimore: Williams & Wilkins, 1984. P.44–63.
4. Stieg PE, Batjer HH, Samson D. Intracranial arteriovenous malformations. N.Y.: Informa Healthcare, 2006. 496 p.
6. Turjman F, Massoud T, Sayre J. Epilepsy associated with cerebral arteriovenous malformations: a multivariate analysis of angioarchitectural characteristics. Am J Neuroradiol. 1995;16(2):345-350. [CrossRef] [PubMed]
7. Hofmeister C, Stapf C, Hartmann A et al. Demographic, Morphological, and Clinical Characteristics of 1289 Patients With Brain Arteriovenous Malformation. Stroke. 2000;31(6):1307-1310. [CrossRef] [PubMed]
8. Thorpe M, Cordato D, Morgan M, Herkes G. Postoperative seizure outcome in a series of 114 patients with supratentorial arteriovenous malformations. Journal of Clinical Neuroscience. 2000;7(2):107-111. [CrossRef] [PubMed]
12. Zhao J, Wang S, Li J, Qi W, Sui D, Zhao Y. Clinical characteristics and surgical results of patients with cerebral arteriovenous malformations. Surgical Neurology. 2005;63(2):156-161. [CrossRef] [PubMed]
14. Chandra P, Sinha S, Gupta A et al. Surgical interventions in intracranial arteriovenous malformations: Indications and outcome analysis in a changing scenario. Neurol India. 2009;57(6):749. [CrossRef] [PubMed]
16. Blackburn S, Ashley W, Rich K et al. Combined endovascular embolization and stereotactic radiosurgery in the treatment of large arteriovenous malformations. Journal of Neurosurgery. 2011;114(6):1758-1767. [CrossRef] [PubMed]
18. Kinouchi H, Mizoi K, Takahashi A, Ezura M, Yoshimoto T. Combined embolization and microsurgery for cerebral arteriovenous malformation. Neurologia medico-chirurgica. 2002;42(9):372-379. [CrossRef] [PubMed]
19. Perrini P, Scollato A, Cellerini M et al. Results of surgical and endovascular treatment of intracranial micro-arteriovenous malformations with emphasis on superselective angiography. Acta Neurochir. 2004;146(8):755-766. [CrossRef] [PubMed]
20. Shtraus N, Schifter D, Corn B et al. Radiosurgical treatment planning of AVM following embolization with Onyx: possible dosage error in treatment planning can be averted. J Neurooncol. 2010;98(2):271-276. [CrossRef] [PubMed]
21. Jayaraman M, Marcellus M, Hamilton S et al. Neurologic Complications of Arteriovenous Malformation Embolization Using Liquid Embolic Agents. American Journal of Neuroradiology. 2008;29(2):242-246. [CrossRef] [PubMed]
22. Florio F, Lauriola W, Nardella M, Strizzi V, Vallone S, Trossello MP. Endovascular treatment of intracranial arterio-venous malformations with Onyx embolization: preliminary experience. Radiol Med. 2003 Nov-Dec;106(5-6):512-20. English, Italian. [PubMed]
25. Weber W, Kis B, Siekmann R, Kuehne D. Endovascular treatment of intracranial arteriovenous malformations with onyx: technical aspects. AJNR Am J Neuroradiol. 2007;28(2):371-377. [Publisher Abstract/Full Text] [PubMed]
27. Khan S, Rahman K, Siddiqui M et al. Successful Treatment of Life Threatening Intracranial AVM by Endovascular Embolization in Dhaka Medical College Hospital. J Medicine. 2010;11(1). [CrossRef] [PubMed]
28. Cockroft K, Hwang S, Rosenwasser R. Endovascular treatment of cerebral arteriovenous malformations: indications, techniques, outcome, and complications. Neurosurgery Clinics of North America. 2005;16(2):367-380. [CrossRef] [PubMed]
30. Ganz J.C. Gamma Knife Surgery: a Guide for Referring Physicians. Wien; New York: Springer–Verlag, 1993. 163 p.
31. Nanda A, Javalkar V, Pillai P, Vannemreddy P, Caldito G, Ampil F. Gamma knife radiosurgery for arteriovenous malformations located in eloquent regions of the brain. Neurol India. 2009;57(5):617-621. [CrossRef] [PubMed]
32. Pan D, Kuo Y, Guo W et al. Gamma Knife surgery for cerebral arteriovenous malformations in children: a 13-year experience. Journal of Neurosurgery: Pediatrics. 2008;1(4):296-304. [CrossRef] [PubMed]
33. Pollock B, Gorman D, Coffey R. Patient Outcomes after Arteriovenous Malformation Radiosurgical Management: Results Based on a 5- to 14-year Follow-up Study. Neurosurgery. 2003;52(6):1291-1297. [CrossRef] [PubMed]
34. Sanchez-Mejia R, McDermott M, Tan J, Kim H, Young W, Lawton M. RADIOSURGERY FACILITATES RESECTION OF BRAIN ARTERIOVENOUS MALFORMATIONS AND REDUCES SURGICAL MORBIDITY. Neurosurgery. 2009;64(2):231-240. [CrossRef] [PubMed]
35. Liscák R, Vladyka V, Simonová G, Urgosík D, Novotný J Jr, Janousková L, Vymazal J. Arteriovenous malformations after Leksell gamma knife radiosurgery: rate of obliteration and complications. Neurosurgery. 2007;60(6):1005-1016. [CrossRef] [PubMed]
36. Pan D, Guo W, Chung W. Gamma knife radiosurgery as a single treatment modality for large cerebral arteriovenous malformations. J Neurosurg. 2000;93(3):113-119. [Publisher Abstract/Full Text].[PubMed]
37. Shin M, Maruyama K, Kurita H et al. Analysis of nidus obliteration rates after gamma knife surgery for arteriovenous malformations based on long-term follow-up data: the University of Tokyo experience. Journal of Neurosurgery. 2004;101(1):18-24. [CrossRef] [PubMed]
38. Flickinger J, Kondziolka D, Maitz A, Dade Lunsford L. An analysis of the dose–response for arteriovenous malformation radiosurgery and other factors affecting obliteration. Radiotherapy and Oncology. 2002;63(3):347-354. [CrossRef] [PubMed]
40. Yen C, Sheehan J, Schwyzer L, Schlesinger D. Hemorrhage Risk of Cerebral Arteriovenous Malformations Before and During the Latency Period After Gamma Knife Radiosurgery. Stroke. 2011;42(6):1691-1696. [CrossRef] [PubMed]
42. Gojko O. Praktychne Vykorystannya Paketa STATISTICA Dlya Analizu Medyko-Biolohichnykh Danykh: Navch. Posibnyk [Practical Application Package STATISTICA To Analyze Biomedical Data: Teach. Manual]. Kiev: KMAPO im. P.L. Shupyka; 2004. Ukrainian.
43. Mintser O, Voronenko Y, Vlasov V. Obroblennya Klinichnykh I Eksperymentalnykh Danykh U Medytsyni: Navch. Posibnyk [Treatment Of Clinical And Experimental Data In Medicine, Teach. Manual]. Kiev: Vyshcha shk.; 2003. Ukrainian.
44. Statham P, Macpherson P, Johnston R, Forster D, Adams J, Todd N. Cerebral radiation necrosis complicating stereotactic radiosurgery for arteriovenous malformation. Journal of Neurology, Neurosurgery & Psychiatry. 1990;53(6):476-479. [CrossRef] [PubMed]
How to Cite
Copyright (c) 2012 Vitaliy Tsymbaliuk, Roman Liscak, Orest Tsimeyko, Leonid Yakovenko, Mykhaylo Kostiuk, Kostyantyn Kostiuk, Mikhail Orlov, Volodymyr Moroz
This work is licensed under a Creative Commons Attribution 4.0 International License.
Ukrainian Neurosurgical Journal abides by the CREATIVE COMMONS copyright rights and permissions for open access journals.
Authors, who are published in this Journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the Journal under the terms of Creative Commons Attribution License, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this Journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form of which it has been published by the Journal (for example, to upload the work to the online storage of the Journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this Journal is included.