Brain AVMs: An Endovascular, Surgical, and Radiosurgical Update
Identifieur interne : 000151 ( Pmc/Checkpoint ); précédent : 000150; suivant : 000152Brain AVMs: An Endovascular, Surgical, and Radiosurgical Update
Auteurs : Simone Peschillo [Italie] ; Alessandro Caporlingua [Italie] ; Claudio Colonnese [Italie] ; Giulio Guidetti [Italie]Source :
- The Scientific World Journal [ 2356-6140 ] ; 2014.
Abstract
Brain arteriovenous malformations (bAVMs) are complex vascular lesions. Despite multiple studies, several classifications, and a great interest of the scientific community, case selection in AVM patients remains challenging. During the last few years, tremendous advancements widened therapeutic options and improved outcomes spreading indications for patients harboring lesions deemed inoperable in the past. Anatomical and biological case specific features, and natural history with a focus on presenting symptoms should be evaluated case by case and always kept in mind while planning a therapeutic management for a bAVMs. A multidisciplinary approach is strongly recommended when dealing with bAVMs and should involve physicians expertise in this kind of challenging lesions. The goal of this paper is to provide a focused review of the most recent acquisitions and therapeutic strategies regarding surgical, endovascular, and radiosurgical treatment.
Url:
DOI: 10.1155/2014/834931
PubMed: 25401156
PubMed Central: 4221901
Affiliations:
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last="Caporlingua">Alessandro Caporlingua</name><affiliation wicri:level="3"><nlm:aff id="I2">Department of Neurology and Psychiatry, Neurosurgery, “Sapienza” University of Rome, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Neurology and Psychiatry, Neurosurgery, “Sapienza” University of Rome, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Colonnese, Claudio" sort="Colonnese, Claudio" uniqKey="Colonnese C" first="Claudio" last="Colonnese">Claudio Colonnese</name><affiliation wicri:level="1"><nlm:aff id="I3">Department of Neurology and Psychiatry, Neuroradiology, “Sapienza” University of Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Neurology and Psychiatry, Neuroradiology, “Sapienza” University of Rome</wicri:regionArea><wicri:noRegion>“Sapienza” University of 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Neurosurgery/Interventional Neuroradiology, “Sapienza” University of Rome, Viale del Policlinico 155, 00100 Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Caporlingua, Alessandro" sort="Caporlingua, Alessandro" uniqKey="Caporlingua A" first="Alessandro" last="Caporlingua">Alessandro Caporlingua</name><affiliation wicri:level="3"><nlm:aff id="I2">Department of Neurology and Psychiatry, Neurosurgery, “Sapienza” University of Rome, Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Neurology and Psychiatry, Neurosurgery, “Sapienza” University of Rome, Rome</wicri:regionArea><placeName><settlement type="city">Rome</settlement><region nuts="2">Latium</region></placeName></affiliation></author><author><name sortKey="Colonnese, Claudio" sort="Colonnese, Claudio" uniqKey="Colonnese C" first="Claudio" last="Colonnese">Claudio Colonnese</name><affiliation wicri:level="1"><nlm:aff id="I3">Department of Neurology and Psychiatry, Neuroradiology, “Sapienza” University of Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Neurology and Psychiatry, Neuroradiology, “Sapienza” University of Rome</wicri:regionArea><wicri:noRegion>“Sapienza” University of Rome</wicri:noRegion></affiliation></author><author><name sortKey="Guidetti, Giulio" sort="Guidetti, Giulio" uniqKey="Guidetti G" first="Giulio" last="Guidetti">Giulio Guidetti</name><affiliation wicri:level="1"><nlm:aff id="I4">Department of Neurology and Psychiatry, Interventional Neuroradiology, “Sapienza” University of Rome, Italy</nlm:aff><country xml:lang="fr">Italie</country><wicri:regionArea>Department of Neurology and Psychiatry, Interventional Neuroradiology, “Sapienza” University of Rome</wicri:regionArea><wicri:noRegion>“Sapienza” University of Rome</wicri:noRegion></affiliation></author></analytic><series><title level="j">The Scientific World Journal</title><idno type="ISSN">2356-6140</idno><idno type="eISSN">1537-744X</idno><imprint><date when="2014">2014</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>Brain arteriovenous malformations (bAVMs) are complex vascular lesions. Despite multiple studies, several classifications, and a great interest of the scientific community, case selection in AVM patients remains challenging. During the last few years, tremendous advancements widened therapeutic options and improved outcomes spreading indications for patients harboring lesions deemed inoperable in the past. Anatomical and biological case specific features, and natural history with a focus on presenting symptoms should be evaluated case by case and always kept in mind while planning a therapeutic management for a bAVMs. A multidisciplinary approach is strongly recommended when dealing with bAVMs and should involve physicians expertise in this kind of challenging lesions. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">ScientificWorldJournal</journal-id><journal-id journal-id-type="iso-abbrev">ScientificWorldJournal</journal-id><journal-id journal-id-type="publisher-id">TSWJ</journal-id><journal-title-group><journal-title>The Scientific World Journal</journal-title></journal-title-group><issn pub-type="ppub">2356-6140</issn><issn pub-type="epub">1537-744X</issn><publisher><publisher-name>Hindawi Publishing Corporation</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25401156</article-id><article-id pub-id-type="pmc">4221901</article-id><article-id pub-id-type="doi">10.1155/2014/834931</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review Article</subject></subj-group></article-categories><title-group><article-title>Brain AVMs: An Endovascular, Surgical, and Radiosurgical Update</article-title></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0002-3920-8517</contrib-id><name><surname>Peschillo</surname><given-names>Simone</given-names></name><xref ref-type="aff" rid="I1"><sup>1</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author"><name><surname>Caporlingua</surname><given-names>Alessandro</given-names></name><xref ref-type="aff" rid="I2"><sup>2</sup></xref></contrib><contrib contrib-type="author"><name><surname>Colonnese</surname><given-names>Claudio</given-names></name><xref ref-type="aff" rid="I3"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Guidetti</surname><given-names>Giulio</given-names></name><xref ref-type="aff" rid="I4"><sup>4</sup></xref></contrib></contrib-group><aff id="I1"><sup>1</sup>Department of Neurology and Psychiatry, Endovascular Neurosurgery/Interventional Neuroradiology, “Sapienza” University of Rome, Viale del Policlinico 155, 00100 Rome, Italy</aff><aff id="I2"><sup>2</sup>Department of Neurology and Psychiatry, Neurosurgery, “Sapienza” University of Rome, Rome, Italy</aff><aff id="I3"><sup>3</sup>Department of Neurology and Psychiatry, Neuroradiology, “Sapienza” University of Rome, Italy</aff><aff id="I4"><sup>4</sup>Department of Neurology and Psychiatry, Interventional Neuroradiology, “Sapienza” University of Rome, Italy</aff><author-notes><corresp id="cor1">*Simone Peschillo: <email>simone.peschillo@gmail.com</email></corresp><fn fn-type="other"><p>Academic Editor: Robert M. Starke</p></fn></author-notes><pub-date pub-type="ppub"><year>2014</year></pub-date><pub-date pub-type="epub"><day>21</day><month>10</month><year>2014</year></pub-date><volume>2014</volume><elocation-id>834931</elocation-id><history><date date-type="received"><day>12</day><month>6</month><year>2014</year></date><date date-type="accepted"><day>1</day><month>8</month><year>2014</year></date></history><permissions><copyright-statement>Copyright © 2014 Simone Peschillo et al.</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><p>Brain arteriovenous malformations (bAVMs) are complex vascular lesions. Despite multiple studies, several classifications, and a great interest of the scientific community, case selection in AVM patients remains challenging. During the last few years, tremendous advancements widened therapeutic options and improved outcomes spreading indications for patients harboring lesions deemed inoperable in the past. Anatomical and biological case specific features, and natural history with a focus on presenting symptoms should be evaluated case by case and always kept in mind while planning a therapeutic management for a bAVMs. A multidisciplinary approach is strongly recommended when dealing with bAVMs and should involve physicians expertise in this kind of challenging lesions. The goal of this paper is to provide a focused review of the most recent acquisitions and therapeutic strategies regarding surgical, endovascular, and radiosurgical treatment.</p></abstract></article-meta></front><floats-group><table-wrap id="tab1" orientation="portrait" position="float"><label>Table 1</label><caption><p>Grading systems for AVMs.</p></caption><table frame="hsides" rules="groups"><thead><tr><th colspan="2" align="center" rowspan="1">Spetzler-Martin grading system for AVMs [<xref rid="B24" ref-type="bibr">9</xref>]</th><th colspan="3" align="center" rowspan="1">Spetzler-Ponce grading system for AVMs [<xref rid="B25" ref-type="bibr">10</xref>]</th><th colspan="2" align="center" rowspan="1">Grading score proposed by Lawton [<xref rid="B23" ref-type="bibr">11</xref>]</th></tr><tr><th align="left" rowspan="1" colspan="1"> </th><th align="center" rowspan="1" colspan="1">Points</th><th align="left" rowspan="1" colspan="1">Class</th><th align="center" rowspan="1" colspan="1">Spetzler-Martin grade</th><th align="left" rowspan="1" colspan="1"> </th><th align="left" rowspan="1" colspan="1"> </th><th align="center" rowspan="1" colspan="1">Points</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">Size of nidus</td><td align="center" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">Age (years)</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Small (<3 cm)</td><td align="center" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1"> A</td><td align="center" rowspan="1" colspan="1">I, II</td><td align="left" rowspan="1" colspan="1">Surgical resection</td><td align="left" rowspan="1" colspan="1"> <20</td><td align="center" rowspan="1" colspan="1">1</td></tr><tr><td align="left" rowspan="1" colspan="1"> Medium (3–6 cm)</td><td align="center" rowspan="1" colspan="1">2</td><td align="left" rowspan="1" colspan="1"> B</td><td align="center" rowspan="1" colspan="1">III</td><td align="left" rowspan="1" colspan="1">Multimodality treatment</td><td align="left" rowspan="1" colspan="1"> 20–40</td><td align="center" rowspan="1" colspan="1">2</td></tr><tr><td align="left" rowspan="1" colspan="1"> Large (>6 cm)</td><td align="center" rowspan="1" colspan="1">3</td><td align="left" rowspan="1" colspan="1"> C</td><td align="center" rowspan="1" colspan="1">IV, V</td><td align="left" rowspan="1" colspan="1">No treatment</td><td align="left" rowspan="1" colspan="1"> >40</td><td align="center" rowspan="1" colspan="1">3</td></tr><tr><td align="left" rowspan="1" colspan="1">Location</td><td align="center" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">Unruptured presentation</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Noneloquent site</td><td align="center" rowspan="1" colspan="1">0</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> No</td><td align="center" rowspan="1" colspan="1">0</td></tr><tr><td align="left" rowspan="1" colspan="1"> Eloquent site</td><td align="center" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> Yes</td><td align="center" rowspan="1" colspan="1">1</td></tr><tr><td align="left" rowspan="1" colspan="1">Pattern of venous drainage</td><td align="center" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1">Diffuse</td><td align="center" rowspan="1" colspan="1"> </td></tr><tr><td align="left" rowspan="1" colspan="1"> Superficial only</td><td align="center" rowspan="1" colspan="1">0</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> No</td><td align="center" rowspan="1" colspan="1">0</td></tr><tr><td align="left" rowspan="1" colspan="1"> Deep</td><td align="center" rowspan="1" colspan="1">1</td><td align="left" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> </td><td align="left" rowspan="1" colspan="1"> Yes</td><td align="center" rowspan="1" colspan="1">1</td></tr></tbody></table></table-wrap><table-wrap id="tab2" orientation="portrait" position="float"><label>Table 2</label><caption><p>Embolic materials.</p></caption><table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Embolic material </th><th align="left" rowspan="1" colspan="1">Advantages</th><th align="left" rowspan="1" colspan="1">Limitations</th></tr></thead><tbody><tr><td align="left" rowspan="1" colspan="1">N-butyl cyanoacrylate (n-BCA)</td><td align="left" rowspan="1" colspan="1">(i) Great penetration potential into bAVMs nidus.<break></break>(ii) Permanent embolization with durable occlusion of the embolized vessel or pedicle.<break></break>(iii) Deliverable through small, flexible, and flow-directed catheters causing minimal trauma even in distal vessels of the cerebrovascular system.<break></break>(iv) Easy and quick delivery, infusion generally takes less than 1 minute.<break></break>(v) Radiolucent, must be mixed with a radiopaque agent (i.e. ethiodized oil: lipiodol, ethiodol). Usual ratios for the mixture are 1.5 : 1 to 3 : 1 (oil-to-NBCA) with nonnegligible margin of error.<break></break> (vi) Radiolucent. Follow-up angiograms and eventual indications for further endovascular surgery are not hampered by radiological artifacts from the first intervention.</td><td align="left" rowspan="1" colspan="1">(i) Experience is required to judge the best fitted ratio for NBCA/Ethiodol for each different scenario.<break></break>(ii) Adhesive-tendency to adhere to the catheter, making withdrawal traumatic or impossible.<break></break>(iii) High level of expertise is required to control the injection to achieve adequate nidal obliteration preventing venous dissemination.<break></break>(iv) Far higher consistency than ONYX. In case of packed AVM it cannot be removed piecemeal with scissors.</td></tr><tr><td align="center" colspan="3" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Onyx<break></break></td><td align="left" rowspan="1" colspan="1">(i) Nonadhesive,<break></break>(ii) Great radiopacity—enhanced angiographic control during injection.<break></break>(iii) Lesser consistency than NBCA. In a packed AVM can be removed piecemeal with scissors.</td><td align="left" rowspan="1" colspan="1">(i) DMSO component of the mixture may induce vasospasm and angionecrosis.<break></break>(ii) Tantalum powder must be mixed with the agent to provide radiopacity.<break></break>(iii) Great radiopacity—follow-up angiograms and eventual subsequent endovascular procedures are hampered by radiological artifacts.</td></tr><tr><td align="center" colspan="3" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Ethanol (ETOH)</td><td align="left" rowspan="1" colspan="1">(i) Sclerosant-dehydration and disruption of endothelium surface with fractures of the vessel walls to the level of the internal elastic lamina resulting in acute thrombosis.<break></break>(ii) Great penetration potential.</td><td align="left" rowspan="1" colspan="1">(i) Risk of significant brain edema.<break></break>(ii) It may induce pulmonary precapillary vasospasm possibly leading to cardiopulmonary collapse.<break></break>(iii) Great penetration potential-high level of experience is required to perform ETOH embolization safely.</td></tr><tr><td align="center" colspan="3" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Polyvinyl alcohol (PVA)/Embospheres</td><td align="left" rowspan="1" colspan="1">(i) Penetration potential depends on particle size allowing the adoption of different strategies in function of case specific angiographical features.<break></break>(ii) Once injected particles expand obstructing vessels with higher diameters than the catheters.<break></break>(iii) Particles are far more controllable than embolic liquid agents during injection.</td><td align="left" rowspan="1" colspan="1">(i) Particulate embolization requires a microcatheter with an internal diameter larger than the particle itself. <break></break>(ii) During mixing process, PVA particles may fragment contaminating the mixture with smaller “dangerous” emboli.<break></break>(iii) Risk of particles to clump up and/or catheters to be clogged due to particles high friction coefficient. Potential risk of vascular perforation.<break></break>(iv) The choice of the particles' size depends on operator's interpretation of the superselective angiogram.<break></break>(v) Nonpermanent embolization effects—particles may be absorbed or degraded by endogenous lytic agents. Risk of recanalization. Best fitted for presurgical embolization purposes rather than stand-alone endovascular curative procedures.</td></tr><tr><td align="center" colspan="3" rowspan="1"><hr></hr></td></tr><tr><td align="left" rowspan="1" colspan="1">Coils</td><td align="left" rowspan="1" colspan="1">(i) Detachable coils are most useful for the initial embolization of large fistulae.<break></break>(ii) Poor penetration potential if compared to particulates or liquid embolic agents-risk of distal dissemination is relatively contained.</td><td align="left" rowspan="1" colspan="1">(i) Potential for vascular perforation.<break></break>(ii) Poor penetration potential.</td></tr></tbody></table></table-wrap></floats-group></pmc><affiliations><list><country><li>Italie</li></country><region><li>Latium</li></region><settlement><li>Rome</li></settlement></list><tree><country name="Italie"><region name="Latium"><name sortKey="Peschillo, Simone" sort="Peschillo, Simone" uniqKey="Peschillo S" first="Simone" last="Peschillo">Simone Peschillo</name></region><name sortKey="Caporlingua, Alessandro" sort="Caporlingua, Alessandro" uniqKey="Caporlingua A" first="Alessandro" last="Caporlingua">Alessandro Caporlingua</name><name sortKey="Colonnese, Claudio" sort="Colonnese, Claudio" uniqKey="Colonnese C" first="Claudio" last="Colonnese">Claudio Colonnese</name><name sortKey="Guidetti, Giulio" sort="Guidetti, Giulio" uniqKey="Guidetti G" first="Giulio" last="Guidetti">Giulio Guidetti</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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