• Korean Journal of Radiology
• /
• 제20권8호
• /
• pp.1285-1292
• /
• 2019

Objective: To evaluate the safety and efficacy of the coil-protected technique for liquid embolization in neurovascular malformations. Materials and Methods: Twenty-two patients who underwent coil-protected liquid embolization for symptomatic cranial (n = 13) and spinal (n = 9) arteriovenous fistula (AVF) or arteriovenous malformations (AVMs) were identified. A total of 36 target feeder vessels were embolized with N-butyl cyanoacrylate and/or Onyx (Medtronic). This technique was used to promote delivery of a sufficient amount of liquid embolic agent into the target shunt or nidus in cases where tortuous feeding arteries preclude a microcatheter wedging techniqu and/or to prevent reflux of the liquid embolic agent in cases with a short safety margin. The procedure was considered technically successful if the target lesion was sufficiently filled with liquid embolic agent without unintentional reflux. Angiographic and clinical outcomes were retrospectively evaluated. Results: Technical success was achieved for all 36 target feeders. Post-embolization angiographies revealed complete occlusion in 16 patients and near-complete and partial occlusion in three patients each. There were no treatment-related complications. Of the six patients who showed near-complete or partial occlusion, five received additional treatments: two received stereotactic radiosurgery for cerebral AVM, two underwent surgical removal of cerebral AVM, and one underwent additional embolization by direct puncture for a mandibular AVM. Finally, all patients showed complete (n = 19) or near-complete (n = 3) occlusion of the target AVF or AVM on follow-up angiographies. The presenting neurological symptoms improved completely in 15 patients (68.2%) and partially in seven patients (31.8%). Conclusion: The coil-protected technique is a safe and effective method for liquid embolization, especially in patients with various neurovascular shunts or malformations who could not be successfully treated with conventional techniques.

• 대한영상의학회지
• /
• 제84권2호
• /
• pp.489-497
• /
• 2023

두개내 경막 동정맥루는 모든 두개내 혈관 기형의 약 10%-15%를 차지하는 비정상적인 동정맥 단락이다. 대부분의 두개내 경막동정맥루는 단독형이며, 다른 부위에 여러 경막동정맥루가 있는 경우는 드물다. 여러 경막동정맥루에 대한 대부분의 증례 보고에서는 동기형 동정맥루를 기술하였고, 이시성 경막동정맥루에 대한 보고는 상대적으로 적다. 이에 저자들은 경막 동정맥루의 색전술 후 추적 영상에서 이시성 경막 동정맥루가 발견된 75세 여성의 증례를 보고 하고자 한다.

• Journal of Korean Neurosurgical Society
• /
• 제45권6호
• /
• pp.401-404
• /
• 2009

Arteriovenous malformations (AVM) are generally considered to be cured following angiographically proven complete resection. However, rare instances of AVM recurrence have been reported in both children and adults with negative findings on postoperative angiography. The authors present the case of a 12-year-old boy with recurrent AVM. The AVM was originally fed by the pericallosal arteries on both sides, and it showed changing patterns of supply at recurrence. The authors concluded that a negative postoperative angiogram is not necessarily indicative of a cure. Repeat angiography and regular follow-up examinations should be performed to exclude the possibility of recurrence, especially in children.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
• /
• 제29권6호
• /
• pp.450-454
• /
• 2003

Mandibular arteriovenous malformations(AVM) are relatively rare and potentially life threatening lesions. Surgical treatment consists of wide resection of the mandible, which is difficult and potentially hazardous due to significant blood loss during surgery. Therefore, some authors advocate that transvenous embolization may be a safer and more effective method in the treatment of mandibular AVM. We report a treatment case of mandibular AVM in a 9-year-old-girl for episodes of spontaneous bleeding for 6 days using by selective transarterial embolization, direct puncture embolization and microcoil embolization.

• Journal of Korean Neurosurgical Society
• /
• 제38권6호
• /
• pp.471-474
• /
• 2005

Pure sylvian fissure arteriovenous malformations[AVMs] are vascular malformations confined to the sylvian fissure without parenchymal involvement. Surgical removal is regarded as difficult because the nidus is located just lateral to important structures such as the basal ganglia and the internal capsule. Because most feeding arteries to the nidus are branches of the middle cerebral artery[MCA], differentiation between these feeders from en passant and normal vessels is of great importance in order to reduce morbidity and mortality from surgical intervention. We report a case of pure sylvian fissure AVM who presented with an intra-temporal lobe hematoma that was located around venous aneurysms distant from the nidus. The clinical characteristics of this AVM and the surgical methods employed to avoid complications are discussed.

• Journal of Korean Neurosurgical Society
• /
• 제67권3호
• /
• pp.308-314
• /
• 2024

Vein of Galen aneurysmal malformation is one of important pediatric arteriovenous shunt diseases, especially among neonates and infants. Here, early history of the disease identification, basic pathoanatomy with a focus on the embryonic median prosencephalic vein, classification and differential diagnoses, and recent genetic studies are reviewed.

• Radiation Oncology Journal
• /
• 제10권1호
• /
• pp.21-26
• /
• 1992

가톨릭의대 강남성모병원 치료방사선과에서는 1988년 7월부터 1991년 11월 사이 40개월 동안에 26명의 수술 불가능한 뇌동정맥기형 환자에 대하여 6 MV선형가속기를 이용하여 뇌정위다방향 단일 방사선치료를 실시하였다. 환자연령은 6세부터 63세였고(중앙값 29세), 남녀의 비는 21:5였다. 치료 종료 후 추적기간은 4개월$\~$40개월 간이었다(중앙값 15개월). 뇌동정맥기형의 크기는 직경 1 cm부터 $43cm^3$까지였으며 환자 연영, 병소의 크기 및 뇌내 위치에 따라 4$\~$7회의 부분회전 조사를 실시하여 15$\~$30 Gy를 단일 조사하였다. 모든 환자는 임상적 그리고 CT또는 MRI나 뇌혈관조영술을 병행하여 방사선치료 전 및 후 6개월간격으로 뇌동정맥기형의 크기변화를 추적 분석하였다. 2년 이상된 예의 추적 검사를 분석한 결과 완전 관해 6($23\%$), 부분관해 8($31\%$), 무변화 1($4\%$)명 씩으로 분석되었다. 11($42\%$)명은 방사선치료한지 1년 미만의 무반응군으로 간주되었다. 이상으로 치료후 2년째 반응율은 $54\%$(14예)였다. 치료에 따른 부작용은 아직 관찰되지 않았다.

• Journal of Korean Neurosurgical Society
• /
• 제51권6호
• /
• pp.374-376
• /
• 2012

Endovascular embolization is being increasingly used to treat intracranial arteriovenous malformations (AVMs). However, we experienced two patients with retained microcatheters after AVM embolization using Onyx.

• Journal of Korean Neurosurgical Society
• /
• 제67권4호
• /
• pp.431-441
• /
• 2024

Objective : Gamma Knife radiosurgery (GKRS) is an effective and noninvasive treatment for high-risk arteriovenous malformations (AVMs). Since differences in GKRS outcomes by nidus type are unknown, this study evaluated GKRS feasibility and safety in patients with brain AVMs. Methods : This single-center retrospective study included patients with AVM who underwent GKRS between 2008 and 2021. Patients were divided into compact- and diffuse-type groups according to nidus characteristics. We excluded patients who performed GKRS and did not follow-up evaluation with magnetic resonance imaging or digital subtraction angiography within 36 months from the study. We used univariate and multivariate analyses to characterize associations of nidus type with obliteration rate and GKRS-related complications. Results : We enrolled 154 patients (mean age, 32.14±17.17 years; mean post-GKRS follow-up, 52.10±33.67 months) of whom 131 (85.1%) had compact- and 23 (14.9%) diffuse-type nidus AVMs. Of all AVMs, 89 (57.8%) were unruptured, and 65 (42.2%) had ruptured. The mean Spetzler-Martin AVM grades were 2.03±0.95 and 3.39±1.23 for the compact- and diffuse-type groups, respectively (p<0.001). During the follow-up period, AVM-related hemorrhages occurred in four individuals (2.6%), three of whom had compact nidi. Substantial radiation-induced changes and cyst formation were observed in 21 (13.6%) and one patient (0.6%), respectively. The AVM complete obliteration rate was 46.1% across both groups. Post-GKRS complication and complete obliteration rates were not significantly different between nidus types. For diffuse-type nidus AVMs, larger AVM size and volume (p<0.001), lower radiation dose (p<0.001), eloquent area location (p=0.015), and higher Spetzler-Martin grade (p<0.001) were observed. Conclusion : GKRS is a safe and feasible treatment for brain AVMs characterized by both diffuse- and compact-type nidi.

• Journal of Korean Neurosurgical Society
• /
• 제39권1호
• /
• pp.1-10
• /
• 2006