Effective Surgical Management of Competitive Venous Outflow Restriction After Radiosurgery for Cerebral AVMs: Report of 2 Cases

Authors

Vernard S. Fennell, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Nikolay L. Martirosyan, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA; Division of Neurosurgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA.Follow
Gursant S. Atwal, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
M Yashar Kalani, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.Follow
Robert F. Spetzler, Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA. Electronic address: Neuropub@dignityhealth.org.
G Michael Lemole, Division of Neurosurgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA.
Travis Dumont, Division of Neurosurgery, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA.

Document Type

Article

Abstract

BACKGROUND: Intracranial arteriovenous malformations (AVMs) are complex pathologies. For patients who do not present with hemorrhage, treatment strategies are often predicated on reducing the risk of hemorrhage and minimizing morbidity. Outcomes vary according to the efficacy of treatment selected. Radiosurgical treatment of certain AVMs can result in incomplete obliteration and may also have only a minimal effect on the presenting nonhemorrhagic symptoms. CASE DESCRIPTIONS: We present 2 cases of patients with AVMs who were initially treated with radiosurgery. Both patients' primary clinical symptoms were headaches, which persisted after radiosurgical treatment but abated after subsequent microsurgical resection with or without endovascular embolization. CONCLUSION: Venous outflow obstruction is likely a sizable contributive factor in occipital AVMs among patients who present with headaches and symptoms of intracranial hypertension. Because these high-flow lesions may be suboptimally responsive to stereotactic radiosurgery, microsurgical resection, with or without adjunctive endovascular embolization, should be considered as an initial and definitive treatment strategy. Optimal outcomes may be achieved in patients with a visual deficit that is anatomically correlated to their AVMs.

Medical Subject Headings

Cerebral Angiography; Embolization, Therapeutic (adverse effects); Female; Humans; Intracranial Arteriovenous Malformations (surgery); Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Microsurgery (methods); Middle Aged; Postoperative Complications (diagnostic imaging, etiology, surgery); Radiosurgery (adverse effects); Ventricular Outflow Obstruction (diagnostic imaging, etiology, surgery)

Publication Date

2-1-2017

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

98

First Page

882.e1

Last Page

882.e7

PubMed ID

27838427

Digital Object Identifier (DOI)

10.1016/j.wneu.2016.11.007

Recommended Citation

Fennell, Vernard S.; Martirosyan, Nikolay L.; Atwal, Gursant S.; Kalani, M Yashar; Spetzler, Robert F.; Lemole, G Michael; and Dumont, Travis, "Effective Surgical Management of Competitive Venous Outflow Restriction After Radiosurgery for Cerebral AVMs: Report of 2 Cases" (2017). Neurosurgery. 1681.
https://scholar.barrowneuro.org/neurosurgery/1681