Since the early s, the application of RS in the treatment of cAVMs has become increasingly widespread, with thousands patients treated worldwide, including patients in pediatric and adolescent ages 1. Histopathologic, immunohistochemical, and electromicroscopic examination of cAVM specimens obtained postoperatively 10—60 months after Gamma Knife GK RS demonstrated that the endothelial damage caused by irradiation induces the proliferation of smooth muscle cells and the production of extracellular collagen by these cells, which leads to progressive stenosis and obliteration of the cAVM nidus 6. Moreover, cAVMs are more frequently deep-seated in the basal ganglia, thalamus, corpus callosum or brain stem or located in critical areas of the brain i. At the same time, this aggressive approach does not entail an increasd risk of RS-related permanent complications. View in gallery Gradual deflation of an occluding balloon after treatment. RN: radiation necrosis. Statistical analysis of our study showed that the probability of complete obliteration highly increases, and the risks of symptomatic permanent complications due to ARE and bleeding during the latency period highly decrease, when the nidus volume is less than 10 ml and a PD higher than 16 Gy can be delivered. Variuos explanations have been offered for the greater frequency of bleeding in deep-seated cAVMs conpared with cAVMs in other locations: higher perfusion pressures in cAVMs with a high flow rate, the higher incidence of associated arterial and venous aneurysms, and a smaller number of venous drains. Therefore, taking into account the complicated and challenging management of pediatric and adolescent patients with cAVMs, the use of a noninvasive treatment tool such as radiosurgery RS has become more and more prevalent worldwide. RN: radiation necrosis.
A. Beltramello. Servizio di Neuroradiologia, Ospedale Maggiore, Verona Frisoni G, Beltramello A: Linear measures of atrophy in mild Alzheimer's disease. E.
Piovan, F. Pizzini, A.
Grazioli, L. Rosta, A. Beltramello. Servizio di Neuroradiologia, Ospedale Maggiore, Verona. Corresponding Author: Dr E.
Piovan, Servizio. Beltramello A(1), Casartelli Liviero M, Bernardi B, Causin F, Di Paola F, Muto (1 )Dipartimento di Neuroradiologia, AOUI Verona, Verona, Italia.
Importance of the study. Most relevant papers dealing with predictors of unfavorable outcome identified separately several factors for the different treatment modalities.
The neurological surgeon, radiation oncologist, and medical physicist created highly conformal dose planning using multiple collimators and performed the dose selection. Objectives : The goal of this study was to evaluate advantages, risks, and failures of Gamma Knife radiosurgery GKRS in a large series of pediatric and adolescent patients with cerebral arteriovenous malformations cAVMs who were followed up for at least 36 months.
Results : Obliteration rate OR was angiographically documented in 75 of 84 cases Thus, EE alone is often unsatisfactory as a single therapeutic strategy for the majority of inoperable cAVMs.
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|More recently, Hashimoto et al.
Computed tomography angiography a double step methodology in brain death confirmation.
J Neurosurg 38 : 99 — Parkinson D: Carotid cavernous fistula: direct repair with preservation of the carotid artery. They showed that the mean Ki index was higher for cAVM vessels than for control brain cortical vessels 0. Debrun G Lacour P Caron JP et al : Detachable balloon and calibrated-leak balloon techniques in the treatment of cerebral vascular lesions.
Postcontrast 2-mm-thick coronal and axial images and, more recently, 1-mm-isovoxel volumetric images with gadolinium enhancement, 2-mm-thick T2-weighted MR images, and MR angiography sequences were acquired. The fistula disappeared after the intravascular introduction of an inflated balloon, which was then detached into the cavernous sinus with preservation of the internal carotid blood flow c and d.
J Neurosurg 50 : — Mullan S: Treatment of carotid-cavernous fistulas by cavernous sinus occlusion.
Azienda Ospedaliera Universitaria Integrata, University of Verona, Lungadige Porta Vittoria 17, Verona, Italy; USO. Franco Alessandrini of Azienda Ospedaliera Universitaria Integrata Verona, Verona with expertise in Neuroradiology. Read 97 Alberto Beltramello. Alberto Beltramello's research works with citations and reads, with Azienda Ospedaliera Universitaria Integrata Verona and other places.
Statistical analysis revealed that S-M grade and preplanned treatment single versus staged treatment significantly influenced ORs.
This phenomenon might be related to greater radiation sensitivity in younger patients, although no biologic evidence emerged to support this theory until recently. Nevertheless, EE still carries the risks of an invasive technique and it is uncommon that complete obliteration is achieved when used as a single treatment modality 1.
The fistula is occluded by the detachable balloon, and the internal carotid blood flow is preserved c and d. Volume Issue 6 Dec in Journal of Neurosurgery.
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|Among the other 8 patients, hemorrhage resulted in a permanent neurological worsening in just 1 case.
Nevertheless, EE still carries the risks of an invasive technique and it is uncommon that complete obliteration is achieved when used as a single treatment modality 1. The fistula is occluded by the detachable balloon, and the internal carotid blood flow is preserved c and d.
J Neurosurg 38 : 99 —Parkinson D: Carotid cavernous fistula: direct repair with preservation of the carotid artery.
Associazione Italiana di Neuroradiologia
Summary of clinical and neurological results. Rhoton Anatomy Links.
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The inflated balloon was introduced into the cavernous sinus, occluding the fistula c and d.