• Journal of Korean Neurosurgical Society
• /
• v.46 no.4
• /
• pp.378-384
• /
• 2009

Objective : In order to establish the role of Gamma Knife radiosurgery (GKS) in large intracranial arteriovenous malformations (AVMs), we analyzed clinical characteristics, radiological features, and radiosurgical outcomes. Methods : Between March 1992 and March 2005, 28 of 33 patients with large AVMs (> $10\;cm^3$ in nidus-volume) who were treated with GKS underwent single session radiosurgery (RS), and the other 5 patients underwent staged volumetric RS. Retrospectively collected data were available in 23 cases. We analyzed treatment outcomes in each subdivided groups and according to the AVM sizes. We compared the estimated volume, defined as primarily estimated nidus volume using MR images, with real target volume after excluding draining veins and feeding arteries embedded into the nidus. Results : Regarding those patients who underwent single session RS, 44.4% (8/18) had complete obliteration; regarding staged volumetric RS, the obliteration rate was 40% (2/5). The complete obliteration rate was 60% (6/10) in the smaller nidus group ($10-15\;cm^3$ size), and 25% (2/8) in the larger nidus group (over $15\;cm^3$ size). One case of cerebral edema and two cases (8.7%) of hemorrhage were seen during the latent period. The mean real target volume for 18 single sessions of RS was $17.1\;cm^3$ ($10.1-38.4\;cm^3$), in contrast with the mean estimated volume of $20.9\;cm^3$ ($12.0-45.0\;cm^3$). Conclusion : The radiosurgical treatment outcomes of large AVMs are generally poor. However, we presume that the recent development in planning software and imaging devices aid more accurate measurement of the nidus volume, therefore improving the treatment outcome.

• Journal of Cerebrovascular and Endovascular Neurosurgery
• /
• v.25 no.4
• /
• pp.373-379
• /
• 2023

To systematically review the reported outcomes and complications of different treatment options for choroid plexus arteriovenous malformations (AVMs), specifically focusing on surgical resection and endovascular embolization. A systematic literature review was performed using a PubMed query for studies published between January 1975 and July 2021. All studies describing the clinical presentation, management, and outcome of confirmed choroid plexus AVM cases were included. A total of 20 studies were included in the final analysis. Of these, 18 were single-patient case reports, one article contained two patients, and a single study was a cohort of 24 patients. Patient age ranged from one day to 61 years, with a mean of 31.8±20.4 years. Most choroid plexus AVMs were located in the lateral ventricles (14 patients, 70.0%), while there were four (20.0%) located in the third ventricle, and two in the fourth ventricle (10.0%). Almost all patients were treated with surgical resection (18 patients, 90%). In 14 patients (77.8%), complete resection of the AVM was achieved. A residual AVM was reported in one case (5.6%). Most patients were reported to have improved from their presentation status over time (14 patients, 70.0%). Presence or absence of long-term sequelae (e.g., neurologic deficits) were reported for 14 patients (70%). Eleven of these patients (78.6%) were reported to have no neurological sequelae. While data on choroid plexus AVMs remains limited, the available evidence suggests gross total resection of lesions in this location can be safely achieved with subsequent reduction in preoperative symptoms.

• Journal of Korean Neurosurgical Society
• /
• v.67 no.5
• /
• pp.541-549
• /
• 2024

Objective : Advancements in AVM surgical techniques for cerebral arteriovenous malformation (AVM) underscore its efficacy. Our research aims to showcase the positive outcomes of treating low-grade AVMs surgically, focusing on safety and effectiveness. Methods : We retrospectively reviewed 55 patients (36 males and 19 females; average age 37.4 years) with Spetzler-Martin (S-M) grade 1 and 2 AVMs who underwent surgical resection between January 2009 and December 2022. Results : In our study, 55 patients with S-M grade 1 and 2 AVMs underwent surgical resection, evenly divided between grades 1 (50.9%) and 2 (49.1%). Intracranial hemorrhage was the primary symptom in 74.5% of cases. Pre-operative Glasgow coma scale (GCS) scores revealed 69.1% of patients scored above 13, with 18% below 8. Successful resection was achieved in 87.3%. Postoperatively, 95.5% of ruptured and 90.9% of unruptured AVM patients showed lower or same modified Rankin scale scores. Poorer outcomes were significantly linked to lower GCS scores and intranidal/flow-related aneurysms through multivariate logistic regression. Postoperative seizures noted in nine patients, were exclusive to the ruptured AVM group. Conclusion : Our findings indicate surgical resection as a beneficial treatment for low-grade AVMs, yielding high cure rates and positive functional outcomes in both ruptured and unruptured cases. Preoperative GCS scores and the presence of associated aneurysms are predictive of postoperative functional status. Additionally, managing postoperative seizures effectively is key to enhancing prognosis.

• Radiation Oncology Journal
• /
• v.21 no.1
• /
• pp.1-9
• /
• 2003

Purpose : The purpose of this study was to analyze the effect of a Linear accelerator based Photon Knife Radiosurgery System developed by the staff of Keimyung University Dongsan Medical Center for the treatment of cerebral arterlovenous malformation Material and Methods : Between December 1993 and October 2000, 30 patients with cerebral arteriovenous malformation (AVM) were treated with the Linac based Photon knife Radlosurgery System In the Department of Therapeutlc Radiology at Keimyung University Dongsan Medical Center. The median age was 34, ranging from 7 to 63 years, with a 2 : 1 male to female ratio. The locations of the AVM nidi were the frontal lobe (motor cortex), parletal lobe, and the thalamus, In that order. The diameters of the AVM nidi ranged 1.2 to 5.5 cm with a mean on 2.9 cm, and target volumes of between 0.5 and 20.5 cc, with a mean of 5.8 cc. The majority of patients received radiation doses of between 1,500 and 2,500 cGy, w14h a mean of 2,000 cGy, at 80% the isodose line. Twenty-five patients were treated with one isocenter, 4 with two, and 1 with four. The follow-up radiological evaluations were peformed with cranial computed tomogram (CT) or MRI between 6 month and one year interval, and if the AVM nidus had completely disappeared in the CT or MRI, we confirmed thls was a complete obliteration, with a cerebral or magnetic resonance angiogram (MRA). The median iollow-up period was 39 months with a range of 10 to 103 months. Results : Twenty patients were radloiogicaiiy followed up ior over 20 months, with complete obliteration observed in 14 (70%). According to the maximal diameter, all four of the small AVM (<2 cm) completely obliterated, 8 of the 10 patients with a medium AVW (2~3 cm) showed a complete obliteration, and two showed partial obliteration. Among the patients with a large AVM (>3 cm), only one showed complete obliteration, and S showed partial obliteration, but 3 oT these underwent further radiosurgery 3 years later. One who followed up for 20 months fellowing further radiosurgery eventually showed complete obliteration. Ten patients with seizure symptoms had no recurrent seizure due to radiosurgery and medication. One of the eleven patients who suffered intracranlal bleeding developed further bleeding at 9 and 51 months fellowing the radiosurgery although complete obliteration was eventually observed and the patient was managed in hospital then recovered. No patient suffered severe complications fellowing the radiosurgery. Conclusion : The radiosurgery with Linac-based Photon knife radiosurgery system, developed by the staff at our hospital, is a safe and effective treatment for AVM patients having diameters or volumes of less than 3 cm or 10 cm$^{3}$, respectively, located In Inoperable areas or who refused neurosurgery. We suggest that staged AVM radiosurgery may initially be considered, if the AVM target volume is above 10 cm$^{3}$

• Annals of Clinical Neurophysiology
• /
• v.1 no.1
• /
• pp.60-63
• /
• 1999

Transcranial Doppler(TCD) is an important diagnostic tool for evaluating the patients with stroke. It has some advantages and unique role when compared with other neuroimaging modalities. Recent development of transcranial color-coded Doppler(TCD) improves the limitation and pitfalls of TCD. The current indications of TCD are as follows: 1. Screening and evaluation of the intracranial major vessels 2. early detection and follow-up of vasospasm due to SAH 3. emboli detection (high-imtensity transient signals, HITs) 4. dignosis and follow-up of subclavian steal 5. evaluation of intracranial collaterals when the extracranial ICA has severe stenosis or occlusion 6. evaluation of cerebral perfusion pressure (intracranial pressure) 7. evaluation of arteriovenous malformation 8. diagnosis and follow-up of arterial dissenction 9. diagnosis and follow-up of venous sinus thrombosis (experimental).

• The Korean Journal of Pain
• /
• v.9 no.2
• /
• pp.395-398
• /
• 1996

A retrospective analysis of 175 patients who were suffering from trigeminal neuralgia was done. We found 21 cases (12.0%) of abnormal findings including brain tumors and cerebrovascular disease on brain MRI. All patients were transferred to department of neurosurgery for operation. Among them, 7 patients refused or gave up operation and received nerve blocks with pure alcohol. Their MRI findings were meningioma, arachnoid cyst, arteriovenous malformation, venous angioma, and frontal sinus cancer This study demonstrates that peripheral nerve block or trigeminal nerve block with pure alcohol would be possible in case of elderly patients, patients who have poor general condition, patients who refuse operation, and brain tumor or cerebrovascular disease which located in dangerous area to be operated.

• Journal of Chest Surgery
• /
• v.15 no.1
• /
• pp.112-117
• /
• 1982

Communications of coronary arteries with the cardiac cavities have first time been described by Krause in 1865 in a case of an accessory artery draining into the pulmonary artery and later Cayla in a case of a right coronary artery entering the right ventricle. The initial cases have been found accidentally at autopsies, however In recent years after the Introduction of angiography and coronary arteriography, the malformation Is diagnosed during life and is corrected surgically. These conditions are unusual entitles since the advent of angiography they are being diagnosed with increasing frequency. Three patients who had surgical correction of coronary-cardiac chamber fistula at our hospital are presented. In the first case and second case, coronary arteriovenous fistula was corrected horizontal mattress suture ligation with pladget under the cardiopulmonary bypass and third case was corrected double ligation with cardiopulmonary bypass standby. The postoperative courses were uneventful. They discharged without any fistula related complica-tions.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.18 no.4
• /
• pp.741-745
• /
• 1996

AVMs is not a neoplasm, but a congenital developmental anomalies.$^{5)}$ In oral and maxillofacial area, the high recurrence rate and more facial disfigurement give a difficult problem to surgen and patient.$^{8)}$ Conventional treatment modality nowadays is presurgical embolization and surgical resection. In treatment planning, we consider the possibility of complete surgical resection and the esthetics of soft tissue reconstruction. But, two things are very difficult to achieve. We present a patient with AVMs in left upper lip, he had presurgical embolization with Ivalon and Bucrylate, and conservative surgical procedure. So we present this possible treatment modality.

• Journal of Chest Surgery
• /
• v.19 no.4
• /
• pp.683-687
• /
• 1986

A direct communication between the left ventricle and right atrium is a relatively uncommon defect. Familiarity with this anomaly has become increasingly important, however, since the preoperative findings may be identical with those of an atrial septal defect. The left ventricle is directly related to the right atrium over. an area of the membranous ventricular septum which extends superior to the septal attachment of the right atrioventricular valve in the LV-RA communication. The clinical triad of a ventricular septal defect murmur, cardiac enlargement, and an arteriovenous shunt at atrial level is characteristic of the malformation. A 2-year-old boy with left ventriculo-right atrial communication has operated at the Maryknoll Hospital. Under the cardiopulmonary bypass, the atrium was opened, there was a jet-blood stream just above the atria-ventricular portion adjacent to the septal leaflet of the tricuspid valve.

• Korean Journal of Bronchoesophagology
• /
• v.8 no.1
• /
• pp.57-60
• /
• 2002

Tracheoinnominate artery fistula is a rare but a catastrophic complication after tracheostomy or tracheal reconstruction. We experienced two cases of tracheoinnominate artery fistula after tracheal reconstruction and tracheostomy. The first patient was a 11 year old girl with cerebral arteriovenous malformation who maintained tracheostomy for 6 months before undergoing tracheal reconstruction. Three days after tracheal reconstruction, massive bleeding occurred through the intubation tube. She underwent emergency reoperation of repair the innominate artery with 5-0 Prolene and reconstruction of trachea. She died of bleeding 3 days after the reoperation. The second patient was a 68 year old man who underwent right upper lobectomy due to lung cancer. After operarion MRSA Pneumonia was developed and tracheostomy was performed 10 days after intubation. Twelve days after tracheostomy, massive bleeding occurred and emergency operation of ligation of innominate artery was performed. He died of sepsis 7 days after reoperation.