Arteriovenous malformation of the gut is well known to have been an important bleeding focus in past ages. We report a young Korean male patient, who had been known to have ventricular septal defect, presenting massive lower gastrointestinal bleeding from an arteriovenous malformation involving a long segment of the left colon. Angiographic, gross and histologic findings are presented and the literature is reviewed.
Adult ; Arteriovenous Malformations/pathology ; Arteriovenous Malformations/complications* ; Colon/blood supply* ; Gastrointestinal Hemorrhage/etiology* ; Heart Septal Defects, Ventricular/complications* ; Human ; Male

BACKGROUND: Advances in the field of interventional and diagnostic radiology have resulted in anesthesiologists becoming involved in angiographic suites. In the present study, we evaluated the characteristics of patients and the anesthetic management in an angiographic suite, to determine what factors influenced the patient outcome. METHODS: Data pertaining to patients that were anesthetized at an angiographic suite in a university hospital between 1 January 2007 and 31 December 2007 were evaluated retrospectively. Specifically, we evaluated the patient characteristics and the types of anesthesia administered, to determine which factors were related to patient outcome. RESULTS: Sixty-four percent of the patients enrolled in this study were women. Cases involving coiling for unruptured and ruptured aneurysm, embolization for intracranial arteriovenous malformation and fistula, pediatric diagnostic angiography, embolization for extracranial arteriovenous malformation, and implantable cardioverter-defibrillator (ICD) implantation all required the involvement of anesthesiologists. Major postoperatve complications included pneumonia, atelectasis, and hydrocephalus. In addition, GCS, net fluid balance, and anesthesia time had influence on patient outcome. CONCLUSIONS: We evaluated the characteristics of patient groups, procedures, and postoperative complications in an angiographic suite. The results of our analysis revealed that a through understanding of nervous and vascular pathology, as well as knowledge of current interventional radiology, neuroanesthesia and vascular anesthesia techniques is essential for development of safe and effective care.
Anesthesia ; Aneurysm ; Aneurysm, Ruptured ; Angiography ; Arteriovenous Malformations ; Defibrillators, Implantable ; Female ; Fistula ; Humans ; Hydrocephalus ; Intracranial Arteriovenous Malformations ; Pneumonia ; Postoperative Complications ; Pulmonary Atelectasis ; Radiology, Interventional ; Retrospective Studies ; Water-Electrolyte Balance

OBJECTS: The surgical management of large cerebral arteriovenous malformation(AVM) is still one of the most difficult fields in neurosurgery. To select the proper candiate for the surgery and improve the results of surgical management of large AVMs, the analysis of the author's cases and the review of the literstures are performed. METERIAL AND METHODS: During the past 17 years, 111 patients with cerebral AVMs were managed surgically. Among these cases, 23 patients had the large AVMs, more than 5 cm in the greatest diameter. The author analyzes these 23 cases clinically and discusses the natural history, surgical indication, surgical techniques, intraoperative and postoperative complications and their management on the basis of the author's experiences and a review of the literatures. RESULTS: Among 23 cases, 16 cases showed good outcome without any neurological morbidity. 6 cases showed mild neurological morbidity such as a memory disturbance, mild hemiparesis or unchanged patterns of seizure, and 1 case showed dense hemiplegia after surgery. There was no mortality. The surgical management of the large AVMs should be decided very carefully because their natural history is relatively benign. An early arterial phase of an angiogram is very useful in discriminating feeders from nidus. An intraoperative use of Doppler ultrasound miniature probe is useful for making a distinction between feeding arteries and drain veins. Wide opening of the fissures and sulci and follows the feeding arteries to the nidus, removing the nidus along the exact border to the brain, induced hypotension during operation and postoperative period with or without pentothal coma were the key points for the surgical management of large AVMs. CONCLUSION: The surgical management of large AVMs is so difficult that the candidates for surgery should be selected carefully bases on the characteristics of the AVMs and experiences of surgeons. However, with experience and meticulous attention, many of these lesions can be resected without development of any morbidity and mortality.
Arteries ; Arteriovenous Malformations ; Brain ; Coma ; Hemiplegia ; Humans ; Hypotension ; Intracranial Arteriovenous Malformations* ; Memory ; Mortality ; Natural History ; Neurosurgery ; Paresis ; Postoperative Care ; Postoperative Complications ; Postoperative Period ; Seizures ; Thiopental ; Ultrasonography ; Veins

Intracranial arteriovenous malformation is rarely presented in newborns or infants. We describe an unusual case of congenital arteriovenous malformation of the brain with multiple sequestered grape-like venous sacs presented with congenital hydrocephalus. This 4-month-old girl born with a large head, presented with progressive hydrocephalus over a period of 4 months. The brain CT showed multiloculated cysts with a high-density mural nodule and thin cerebral mantle. The right lateral ventricle was collapsed by the cystic lesion, and the contralateral ventricle was markedly dilated, which was thought to be due to aqueductal obstruction by the conglomerated nidus of the arteriovenous malformation. Surgical removal of both hemispheric masses, including the overlying thin mantle. The lesion was pathologically confirmed as the arteriovenous malformation which was composed of markedly dilated veins and multiple sequestered aneurysmal sacs. The overlying cerebral tissue was dysplastic and partly infarcted. This case shows that intracerebral arteriovenous malformation is indeed a congenital anomaly and suggests that intrauterine vascular compromise can result in focal or wide maldevelopment of the brain.
Female ; Humans ; Hydrocephalus/*etiology ; Infant ; Intracranial Arteriovenous Malformations/*complications/pathology/radiography ; Tomography, X-Ray Computed

Adult ; Dura Mater ; blood supply ; Humans ; Intracranial Arteriovenous Malformations ; complications ; diagnosis ; Male ; Tinnitus ; etiology

Most patients with strabismus are in good health. However, the incidence of strabismus is high in patients with central nervous system dysfunction and musculoskeletal abnormalities. Authors report one case of intracerebral hematoma due to bleeding from an intracranial arteriovenous malformation after a surgical correction of strabismus under general endotracheal anesthesia. The initial operation and postoperative course of this case were uneventful except for several episodes of nausea and vomiting, continuing hours after the operation. Twenty-four hours after the operation, the patient showed a stuporous mental state and right-sided hemiplegia. A brain C-T scan and carotid angiography revealed an intracerebral hematoma with small-sized vascular abnormalities in the frontoparietal region on the left side. Following an emergency evacuation of the hematoma and removal of the malformed vessels, the patient showed progressive improvement.
Cerebral Hemorrhage/etiology* ; Child ; Female ; Hematoma/etiology* ; Human ; Intracranial Arteriovenous Malformations/complications ; Postoperative Complications* ; Rupture, Spontaneous ; Strabismus/surgery*

A 36-year-old man was diagnosed with a right temporal lobe grade II cerebral arteriovenous malformation (cAVM) and was treated with radiosurgery. At nine months after the cAVM radiosurgery, the patient began to develop bilateral focal narrowing at the M1 segments of the bilateral middle cerebral arteries. The narrowing progressively deteriorated as was demonstrated on longitudinal serial follow-up MR imaging. X-ray angiography performed at 51 months after radiosurgery confirmed that the cAVM was cured and a diagnosis of moyamoya disease. To the best of our knowledge, this is the first case of cAVM-associated moyamoya disease that developed after radiosurgery. Given the chronological sequence of disease development and radiation dose distribution of radiosurgery, it is proposed that humoral or unknown predisposing factors, rather than direct radiation effects, are the cause of moyamoya disease associated with cAVM.
Adult ; Humans ; Intracranial Arteriovenous Malformations/diagnosis/*surgery ; Magnetic Resonance Imaging ; Male ; Moyamoya Disease/*etiology ; Postoperative Complications ; Radiosurgery

In this report, we descrbed a case of multiple brain abscesses associated with diffuse congenital pulmonary arteriovenous malformations (PAVM). Although the cases of brain abscesses associated with congenital PAVM are very rare, the brain abscess could be an initial clinical manifestation in asymptomatic PAVM as in the case presented in this report. PAVM may contribute to the development of a brain abscess by allowing easy bacterial access to systemic circulation through the right-to-left pulmonary vascular shunt, bypassing the filtering effect of the pulmonary capillaries. Hence, this association should be considered in cases with brain abscesses of undetermined etiologic factors.
Arteriovenous Malformations/*complications/radiography ; Brain Abscess/*etiology/radiography ; Capillaries ; Child ; Humans ; Male ; *Pulmonary Circulation ; Tomography, X-Ray Computed

We present a series of 42 patients with the lateral ventricular mass lesions who underwent operative removal between 1979 and 1992 at the Seoul National University Hospital. These lesions included 29 tumors, 10 benign cysts and 3 arteriovenous malformations. There were 20 lesions in the trigone, 14 in the frontal horn, 6 in the body, and 2 in the temporal horn. Together with the age of the patient, the location in the lateral ventricle and the CT or MR patterns, the range of the differential diagnosis of the lesions can be narrowed. The mass were removed by various surgical approaches;11 by the middle frontal gyrus, 10 by the superior parieto-occipital, 13 by the middle temporal gyrus, 4 by the anterior transcallosal, 2 by the posterior transcallosal and 3 by the combined approaches. The superior parieto-occipital approach left postoperative morbidities in 64% and other approaches in 20 to 25% of the cases. These morbidities included hemiparesis, hemianopsia, aphasia, memory distubance and seizure. Most hydrocephalus disappeared without the shunting procedure after removal of the lateral ventricular mass. The high frequency of postoperative complications in the superior parieto-occpital approach require meticulous consideration in the selection of this approach.
Animals ; Aphasia ; Arteriovenous Malformations ; Diagnosis, Differential* ; Hemianopsia ; Horns ; Humans ; Hydrocephalus ; Lateral Ventricles ; Memory ; Paresis ; Postoperative Complications ; Seizures ; Seoul

Animals ; Arteriovenous Malformations ; complications ; Child, Preschool ; Diaphragm ; blood supply ; Hemothorax ; etiology ; Humans ; Male ; Nematode Infections ; pathology ; Pleural Effusion ; etiology