From 1/1991 to 5/1995, 43 arterio-venous malformations were operated on at the Dep of Neurosurgery of Viet Duc hospital- Ictus, neurological signs, disturbances of speech were the main presenting manifestations of this disease. CT Scanner angiogarphy and pathological examination were of paramount importance for the detection of this disease. Two procedures of treatment were utilised: surgical removal of the AVM and ventricular shunt. Post operative results were evaluted by repartition into 3 groups: - Good (clinical improvement): 95.3%. – Mean (with long lasting deficit): 2.35%.
Arteriovenous Malformations ; diagnosis ; surgery ; therapeutics

Adult ; Arteriovenous Malformations ; diagnosis ; surgery ; Female ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Young Adult

OBJECTIVE: Although three-dimensional time-of-flight magnetic resonance angiography (3D TOF-MRA) is used frequently as a follow-up tool to assess the response of arteriovenous malformations (AVMs) after radiosurgery, the diagnostic accuracy of 3D TOF-MRA is not well known. We evaluated the diagnostic accuracy of contrast-enhanced 3D TOF-MRA at 3.0 Tesla for the detection of residual AVMs. MATERIALS AND METHODS:This study included 32 AVMs from 32 patients who had been treated with radiosurgery (males/females: 21/11; average patient age, 33.1 years). The time interval between radiosurgery and MRA was an average of 35.3 months (range, 12-88 months). Three-dimensional TOF-MRA was obtained at a magnetic field strength of 3.0 Tesla after infusion of contrast media, with a measured voxel size of 0.40 x 0.80 x 1.4 (0.45) mm3 and a reconstructed voxel size of 0.27 x 0.27 x 0.70 (0.05) mm3 after zero-filling. X-ray angiography was performed as the reference of standard within six months after MRA (an average of two months). To determine the presence of a residual AVM, the source images of 3D TOF-MRA were independently reviewed, focusing on the presence of abnormally hyperintense fine tangled or tubular structures with continuity as seen on consecutive slices by two observers blinded to the X-ray angiography results. RESULTS: A residual AVM was identified in 10 patients (10 of 32, 31%) on X-ray angiography. The inter-observer agreement for MRA was excellent (kappa= 0.813). For the detection of a residual AVM after radiosurgery as determined by observer 1 and observer 2, the source images of MRA had an overall sensitivity of 100%/90% (10 of 10, 9 of 10), specificity of 68%/68% (15 of 22, 15 of 22), positive predictive value of 59%/56% (10 of 17, 9 of 16), negative predictive value of 100%/94% (15 of 15, 15 of 16) and diagnostic accuracy of 78%/75% (25 of 32, 24 of 32), respectively. CONCLUSION: The sensitivity of contrast-enhanced 3D TOF-MRA at 3.0 Tesla is high but the specificity is not sufficient for the detection of a residual AVM after radiosurgery.
Adult ; Contrast Media ; Female ; Humans ; Intracranial Arteriovenous Malformations/*diagnosis/*surgery ; Magnetic Resonance Angiography/methods/*standards ; Male ; *Radiosurgery ; Sensitivity and Specificity

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

INTRODUCTIONHaemangiomas in children usually involute spontaneously and surgical treatment is exceptional. Vascular malformations do not regress spontaneously and resection may become necessary. We present a series of surgically treated face and neck vascular anomalies during a 9-year period, assessing the epidemiology, presenting signs and symptoms, diagnostic modalities, indications for surgery, treatment methods and clinical outcome post-treatment.

MATERIALS AND METHODSThe medical and pathological records of all patients with cervicofacial vascular anomalies treated surgically at our department from 1997 to 2005 were retrospectively reviewed in relation to current evidence.

RESULTSForty-one patients were identified. Of these, 9 patients had haemangiomas and the remaining 32 had a variety of vascular malformations. Cervicofacial vascular anomalies were most commonly located at the lip. Atypical looking vascular anomalies like masseteric intramuscular haemangiomas and parotid malformations were diagnostic problems. All 41 had surgical excision of their vascular anomalies for troubling symptoms, cosmesis or diagnostic purpose. For cervicofacial arteriovenous malformations, 28% were classified as Schobinger stage I, 50% stage II, and the remainder stage III. Combined embolisation-resection was used to treat 6 arteriovenous malformations (stage II to III) and of these, 3 required flap reconstruction.

CONCLUSIONSAccurate diagnosis distinguishing between cervicofacial haemangiomas and vascular malformations is key to best treatment. The diagnosis can usually be made by history and physical examination aided by early magnetic resonance imaging (MRI). Although cervicofacial haemangiomas can be managed conservatively or with medical therapy, surgery is indicated for preventing psychological distress and in cases of chronic aesthetic alteration resulting from partial regression. Aesthetic concerns and prevention of psychosocial distress point to early excision of venous malformation as the treatment of choice. Lymphatic malformations are best treated by excision. Outcome after excision of localised cervicofacial haemangiomas and low-flow vascular malformations is excellent. Large extensive low-flow malformations as well as those located at the lips may require multiple procedures including reconstruction; patients should be informed that the outcome is generally not as good. Combined embolisation-resection is definitive treatment for arteriovenous malformations and flap reconstruction may prevent their recurrence. Tissue expansion is a useful reconstructive tool after the excision of large vascular anomalies.

Adolescent ; Adult ; Arteriovenous Malformations ; diagnosis ; pathology ; surgery ; Child ; Child, Preschool ; Diagnosis, Differential ; Face ; blood supply ; Female ; Hemangioma ; diagnosis ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neck ; blood supply ; Vascular Malformations ; diagnosis ; pathology ; surgery

Pulmonary arteriovenous malformations (PAVMs) are thin-walled aneurysms caused by abnormal communication between the pulmonary arteries and veins. Migraine headaches are sometimes the presenting clinical manifestation of PAVMs. Although embolotherapy, using detachable balloons or stainless steel coils, is generally accepted as the best choice for the treatment of multiple PAVMs, the mode of intervention for solitary PAVMs remains a subject of debate. We present a 43-yr-old woman with a 10-yr history of chronic migraines and dyspnea on exertion. She was discovered to have a large solitary centrally located PAVM, placing her at high risk of complications if she were to undergo percutaneous transcatheter embolization. She underwent successful surgical resection of her right middle lobe without complications, resulting in subsequent symptomatic improvement.
Adult ; Arteriovenous Malformations/diagnosis/*surgery ; Female ; Humans ; Magnetic Resonance Angiography ; Migraine Disorders/diagnosis/*surgery ; Pulmonary Artery/*abnormalities ; Pulmonary Veins/*abnormalities ; Thoracotomy ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the effect of capsule endoscopic examination in the diagnosis of vascular malformation of small intestine and discuss the operative method of this disease.

METHODSThe clinical data of 11 cases of vascular malformation of small intestine by the capsule endoscopic diagnosis were analyzed retrospectively.

RESULTSAll of the 11 cases received operation with the assistance of intra-operative endoscopic examination, and 10 cases were confirmed to suffer from vascular malformation of small intestine postoperatively. The methods of operation included dot-resection, wedge-shaped resection and segmental resection.

CONCLUSIONSThe capsule endoscopic examination is optimal for the diagnosis of vascular malformation of small intestine. Dot-resection, wedge-shaped resection and segmental resection with the assistance of intra-operative endoscopic examination for the surgical intervention of this disease are recommendable.

Adult ; Aged ; Arteriovenous Malformations ; complications ; diagnosis ; surgery ; Endoscopy, Gastrointestinal ; methods ; Female ; Gastrointestinal Hemorrhage ; diagnosis ; etiology ; surgery ; Humans ; Intestine, Small ; blood supply ; Male ; Middle Aged ; Retrospective Studies

Colonic arteriovenous malformation (AVM) is one of the causes of lower gastrointestinal bleeding. Unlike small vascular ectasia or angiodysplasia, colonic AVM tends to be solitary, large in size, and identified endoscopically as flat or elevated bright red lesion. Herein, we report a case of non-solitary and small cecal AVMs which were removed by endoscopic biopsy. A 66-yr-old woman was referred for routine gastrointestinal cancer screening. She was suffering from diabetes, hypertension, end-stage renal disease, and anemia of chronic disease. On colonoscopic finding, three semi-pedunculated polyps, less than 5 mm in size, were noticed near to the appendiceal orifice. Since the lesions revealed normal-looking epithelium with converging folds on the cecal base, lesions were diagnosed as inflammatory polyps on gross finding. Three biopsies were taken from each lesion. Bleeding from the biopsied site ceased spontaneously. Histopathologic evaluation demonstrated intramucosal hemorrhage and dilated submucosal vessels which were consistent with polypoid colonic AVMs.
Aged ; Arteriovenous Malformations/*diagnosis/pathology/surgery ; Biopsy ; Cecum/blood supply/pathology ; Colon/*blood supply/pathology ; Colonic Polyps/pathology/*surgery ; Colonoscopy ; Female ; Humans