Intracranial subarachnoid hemorrhage resulting from non-cervical spinal arteriovenous lesions: Analysis of possible cause of bleeding and literature review
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Keywords:
Arteriovenous malformation
Digital subtraction angiography
Foramen magnum
Objective
To estimate the cognitive function of subarachnoid hemorrhage patients with negative digital subtraction angiography (DSA), and analyse its relevant factors and clinical characteristics.
Methods
96 subarachnoid hemorrhage patients were selected, and the disease condition were classfied into different grades by Fisher scale, Hunt-Hess scale and the cognitive function were estimated by mini-mental state examination(MMSE), then calculated its incidence, analysed the relationship between the classification and cognitive impairments.
Results
The incidences of cognitive impairment in subarachnoid hemorrhage patients with negative DSA were 51.04%. Cognitive impairment was closely related to Hunt-Hess and Fisher grade (P<0.01).
Conclusion
Subarachnoid hemorrhage patients with negative DSA exist different extent of cognitive impairment.The higher Hunt-Hess or Fisher grade, the more serious cognitive impairment.
Key words:
Subarachnoid hemorrhage; Cognitive impairment; Digital subtraction angiography
Digital subtraction angiography
Subtraction
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Head and neck arteriovenous malformation (AVM) and fistulae treatment without reflux and with nidal penetration are challenging. We describe a case series including adult and pediatric patients utilizing a specific two-microcatheter technique using Onyx with strategic embolization of small feeding branches prior to dominant branch embolization. We aim to demonstrate the safety and efficacy of this technique.Head and neck vascular malformation cases were reviewed from 2010 to 2017. 11 patients between 2010 and 2017 were treated with serial embolization along with Onyx embolization utilizing a two-microcatheter technique. Five patients had cerebral AVMs, three had dural arteriovenous fistulae, two had mandibular AVMs, and one had a posterior neck AVM. Vascular anatomy, location, and procedural details were recorded.During procedures 1-4, smaller arterial feeders were embolized first to maximally decrease the intranidal pressure at the time of the embolization of the major residual feeder. The dominant residual feeder was then embolized using two catheters. Coils followed by Onyx were initially deployed through the proximal catheter to form a dense plug. The plug was allowed to solidify for 30 min. Aggressive embolization of the nidus was then performed through the distal catheter.All 11 patients had excellent treatment results with complete (6) or near-complete (5) obliteration of the vascular malformation nidus. No procedural complications were noted, specifically no strokes, hemorrhages, or unintentionally retained catheter fragments occurred.AVMs and fistulae are challenging to treat. A two-microcatheter technique for Onyx embolization with prior embolization of smaller arterial feeders is a safe and efficacious treatment option. This technique allows for maximal nidus penetration while minimizing the risk of nontarget embolization/reflux. In all cases, we achieved excellent results with complete or near-complete obliteration of the vascular malformation nidus.
Arteriovenous malformation
Intracranial Arteriovenous Malformations
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Arteriovenous malformation
Vascular surgery
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Objective To study clinical therapeutic effect of endovascular embolization on cerebral arteriovenous malformation(cAVM). Methods In digital subtraction angiography (DSA), 23 patients suffering from cAVM were treated by endovascular embolization with NBCA through microduct technique. 6 cases were embolizated only one time, and 17 cases more than one time. 11 patients were treated with gamma knife after embolization. Results Among 23 patients, 6 cases of cAVM were embolizated completely, 4 cases more than 95%, 9 cases 75% to 95%, and 4 cases less than 70%. 3 patients occurred dizziness and headache after embolization. All patients were followed up after treatment, 4 cases had seizure, and the others' symptoms were obviously improved. Conclusion Endovascular embolization was a safe and effective method for treating cAVM, and combination of embolization and gamma knife could improve the clinical efficiency.
Digital subtraction angiography
Arteriovenous malformation
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Objective To verify the effectiveness and safety of the endovascular embolization in the treatment cerebral arte-riovenous malformation. Methods 87 patients underwent embolization with the microcatheter technique under digital subtraction angiography(DSA) monitoring. Results 87 patients underwent 105 times of embolization therapy, and single case underwent 1 -7 times, averagely, 1.2 times. Complete obliteration of the nidus was achieved in 19 patients, 90% in 19, 80% in 10, 70% in 12, 60% in 10 and below 60% in 17 reskectively. 42 patients received surgery after the embolization. 15 patients received γ-knife treatment. Among the 87 patients, 82 patients fully recovered, while 5 patients suffered from moderate persistent neurologic deficits. Conclusions Endovascular embolization of the cerebral arteriovenous malformations is effective and relatively safe.
Digital subtraction angiography
Arteriovenous malformation
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Summary A case of gastric arteriovenous malformation, successfully treated by selective arterial embolization, is described. The advantages of embolization in comparison with surgery are considered.
Arteriovenous malformation
Arterial Embolization
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Arteriovenous malformation
Intracranial Arteriovenous Malformations
Cerebral hemisphere
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[Objective]To explore the clinical value of three dimesional digital subtraction angiography(3D-DSA) in endovascular treatment of cerebral arteriovenous malformation(CAVM) .[Methods]26 patients with cerebral arteriovenous malformation were treated with endovascular treatment,the characteristics of their supplying arteries,draining veins and internal structure of the arteriovenous malformation were analyzed by 3D-DSA.[Results]3D-DSA could be helpful in selecting appropriate work angle,confirming the direction of microcatheter and evaluating accurately the degree of embolization of the arteriovenous malformation.[Conclusion]3D-DSA has great application value in endovascular treatment of cerebral arteriovenous malformation,and could provide more valuable information than normal DSA.
Digital subtraction angiography
Arteriovenous malformation
Subtraction
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Digital subtraction angiography
Arteriovenous malformation
Magnetic resonance angiography
Subtraction
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Objective To investigate the effect of digital subtraction angiographic embolization for treatment of uncontrollable epistaxis. Methods 17 patients with uncontrollable epistaxis were treated with embolization aided by digital subtraction angiography(DSA) of carotid, meanwhile the facial artery were also embolized in 3 cases. Results It was comfirmed that hypogenesis and malformation in the ends of internal maxillary artery were existed in all cases during DSA, and facial artery with abnormal shape was found in 3 cases. Nose bleeding was stopped in all cases after embolized. There no recurrent nose-bleeding was observed in all cases after a follow-up of 0.8 to 5 years and no severe complications occurred to these cases. Conclusion Angiographic embolization is a safe and effective method for stopping uncontrollable epistaxis and it is the best method in the senile patients with other diseases.
Digital subtraction angiography
Facial artery
External carotid artery
Subtraction
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