Congenital pelvic arteriovenous malformation

Our experience with congenital pelvic arteriovenous malformations is described. Presenting symptoms may be chronic and not always confined to the pelvis. Experience with arteriovenous malformations is limited. Preoperative angiography is essential to delineate the vascular supply to the lesion. Surgery has been successful in cases where complete tumor removal is performed. Careful long term follow-up is required for early detection of recurrence and follow-up angiography is recommended.     

Incidentally discovered giant renal arteriovenous malformation

A case is presented of giant renal arteriovenous malformation (AVM). A 61-year-old woman was admitted to the National Defense Medical College Hospital for further evaluation of a renal cyst. Doppler ultrasonography and magnetic resonance imaging revealed a giant renal AVM, although the patient had no history nor clinical sign suggesting an AVM. Under the diagnosis of a right renal AVM, the patient underwent AVM resection.     

Association of intracranial meningioma with arteriovenous malformation

Simultaneous occurrence of a cerebral arteriovenous malformation and a primary brain tumor is rare. A case of a left occipital meningioma and a right parietotemporal arteriovenous malformation is reported. Clinical, radiological, and postmortem findings are described. Thirty previous reports of arteriovenous malformations associated with primary brain tumors are reviewed. In 18 cases the two lesions were intermixed or in close proximity. This spatial relationship between the lesions suggests more than a coincidental association. Several hypotheses are proposed to explain common causal connections.     

Cerebral arteriovenous malformation with intracranial hypertension.

A parasagittal arterio-venous malformation with symptoms and signs of intracranial hypertension, is reported. The CT scan was considered normal, but following contrast enhancement the responsible lesion was demonstrated. The pertinent literature is briefly reviewed and possible pathogenetic mechanisms for the intracranial hypertension are discussed.     

Congenital arteriovenous malformation of the scalp--case report

A case of congenital arteriovenous malformation (AVM) of the scalp containing a complex vascular network is described. The AVM was totally removed, together with its feeding artery and draining veins. Congenital AVM of the scalp is rare; only 21 other cases have been reported since 1973. All involved complex vascular networks, and about one half of the patients had red or purple birthmarks. These clinical features clearly differ from those of traumatic arteriovenous fistulae of the scalp. Although many treatment approaches have been tried, total excision appears to be the most appropriate.     

Congenital arteriovenous malformation of kidney in pregnancy

Two cases of rupture of an arteriovenous malformation (AVM) of the kidney during pregnancy are reported. The surgical options are presented, and a new classification of arteriovenous malformation is proposed.     

Congenital arteriovenous malformation of the head and neck

A discussion of congenital arteriovenous malformation of the head and neck based on five patients followed from three to twenty years is presented. Definition of the lesion and its progression as followed by angiography is described. The poor response to surgery is ascribed to the ischemic nature of the area of involvement. The concept of supplying normal tissue with normal vascularity to the involved area is advocated.     

Multimodality treatment of giant intracranial arteriovenous malformations

OBJECTIVE: Giant arteriovenous malformations (AVMs) (i.e., those greater than 6 cm at maximum diameter) are difficult to treat and often carry higher treatment morbidity and mortality rates than do smaller AVMs. In this study, we reviewed the treatment, angiographic results, and clinical outcomes in 53 patients with giant AVMs who were treated at Stanford between 1987 and 2001. METHODS: The patients selected included 20 males (38%) and 33 females (62%). Their presenting symptoms were hemorrhage (n = 20; 38%), seizures (n = 18; 34%), headaches (n = 8; 15%), and progressive neurological deficits (n = 7; 13%). One patient was in Spetzler-Martin Grade III, 9 were in Spetzler-Martin Grade IV, and 43 were in Spetzler-Martin Grade V. The mean AVM size was 6.8 cm (range, 6-15 cm). AVM venous drainage was superficial (n = 7), deep (n = 20), or both (n = 26). At presentation, 31 patients (58%) were graded in excellent neurological condition, 17 were graded good (32%), and 5 were graded poor (9%). RESULTS: The patients were treated with surgery (n = 27; 51%), embolization (n = 52; 98%), and/or radiosurgery (n = 47; 89%). Most patients received multimodality treatment with embolization followed by surgery (n = 5), embolization followed by radiosurgery (n = 23), or embolization, radiosurgery, and surgery (n = 23). Nineteen patients (36%) were completely cured of their giant AVMs, 90% obliteration was achieved in 4 patients (8%), less than 90% obliteration was achieved in 29 patients (55%) who had residual AVMs even after multimodality therapy, and 1 patient was lost to follow-up. Of the 33 patients who either completed treatment or were alive more than 3 years after undergoing their most recent radiosurgery, 19 patients (58%) were cured of their AVMs. The long-term treatment-related morbidity rate was 15%. The clinical results after mean follow-up of 37 months were 27 excellent (51%), 15 good (28%), 3 poor (6%), and 8 dead (15%). CONCLUSION: The results in this series of patients with giant AVMs, which represents the largest series reported to date, suggest that selected symptomatic patients with giant AVMs can be treated successfully with good outcomes and acceptable risk. Multimodality treatment is usually necessary to achieve AVM obliteration.     

Association of intracranial aneurysm and arteriovenous malformation in childhood

The simultaneous occurrence in the same patient of an intracranial saccular aneurysm and an arteriovenous malformation (AVM) is a well-known phenomenon. Usually the aneurysms are related anatomically to the arteries supplying the AVM, and it is generally accepted that the aneurysms are caused by hemodynamic stresses resulting from the presence of an AVM. Because patients with both an AVM and an aneurysm are older than those presenting with an AVM alone, a time factor seems essential in the development of the aneurysm accompanying an AVM. In this article, the case reports of two children are presented. They both had a symptom-producing AVM and an attendant saccular aneurysm. The malformations were anatomically closely related and the significance of hemodynamic stresses in the development of the aneurysms cannot be neglected. However, in these two cases, the time factor obviously cannot be of vital importance. Therefore, another factor, possibly in the form of a vascular collagen defect, may be suspected as essential in the formation of aneurysms during childhood. The character of this defect is briefly discussed.     

Spontaneous angiographic disappearance of an intracranial arteriovenous malformation

A deep right hemisphere AVM was demonstrated by angiography in an 8-year-old girl soon after her presentation with a subarachnoid haemorrhage. Eight years later the AVM was no longer visible on angiography. During the interval she had been completely asymptomatic and had received no treatment. There was no residual neurological deficit or epilepsy. A similar case has previously been described and is discussed briefly along with other cases of complete AVM regression.     

Skin regeneration for giant pigmented nevus using autologous cultured dermal substitutes and epidermis separated from nevus skin

We have developed a modality of treatment of giant pigmented nevus of intradermal type. This method involves application of autologous cultured dermal substitute (CDS), followed by grafting of epidermis separated from the patient's nevus skin. To prepare the wound bed, autologous CDS was applied onto a full-thickness skin defect after complete excision of the nevus. The excised nevus skin was preserved for 1 week, after which the epidermis was separated from the nevus skin by enzymatic treatment with dispase. The epidermis thus obtained was grafted onto the resulting wound bed. This procedure was used to treat a giant pigmented nevus on a 7-year-old patient. The grafted region was soft with good tone 1 year after epidermis grafting. These results indicate that the present method can achieve complete excision of giant nevus, with esthetically acceptable results, although it requires careful monitoring for a long time.     

The management of giant arteriovenous malformation of the face

Summary A vascular malformation with arteriovenous shunts of the auricular area was treated with embolization followed by surgical excision in a young female. The value of combining embolization and surgery, and the timing of the latter, are discussed. The surgical treatment of AV malformations of the face is sometimes limited by the necessity to preserve important structures which are closely related to these lesions. A combined treatment including embolization and surgery offers an attractive solution in the management of such vascular malformations.     

Cerebral arteriovenous malformation causing benign intracranial hypertension--case report.

A 32-year-old male with a large arteriovenous malformation (AVM) in the right temporoparietal area presented with features of benign intracranial hypertension. This association is rare. The pathogenesis is believed to be due to cerebral venous hypertension. The excision of the AVM eliminated the intracranial hypertension.     

Anesthetic management of an intracranial arteriovenous malformation in infancy

The prevention and control of massive bleeding has always been a problem in neurosurgical procedures, particularly in patients with arteriovenous malformations, intracranial aneurysms, and large vascular tumors. During the past 25 years, new technics have reduced the risk of hemorrhage; however, these have been most suitable for adult patients. Vascular intracranial lesions during infancy present even more complex problems. This is a report of the anesthetic management of a 7-month-old infant with an aneurysm of the v cerebri magna (great vein of Galen). Anesthetic management consisted of (1) halothane-N2O-O2 general endotracheal anesthesia, (2) surface-induced profound hypothermia, and (3) low-flow extracorporeal circulation. Phenothiazine premedication was used with halothane anesthesia to antagonize reflex vasoconstriction during hypothermia, hypothermia and low cardiac output to lessen the possibility of hemorrhage, aneurysmal rupture, and neurologic damage, and surface-induced hypothermia because it provides better core perfusion than central cooling. This technic allowed a successful outcome in an otherwise high-risk procedure.