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Diagnostic value of contrast-enhanced intraoperative Doppler sonography for cerebral arteriovenous malformations compared with angiography

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Chinese Medical Journal 2010年第20期123卷 2812-2815页

作者： XU Hong-zhi QIN Zhi-yong GU Yu-xiang ZHOU Ping CHEN Xian-cheng Department of Neurosurgery Huashan HospitalFudan University Shanghai Neurosurgical Center Shanghai 200040China

Background Intraoperative Doppler sonography has been used in the neurosurgical operating room for the localization and description of cerebral arteriovenous malformations （AVMs）. This study aimed to investigate the clinical value of contrast-enhanced intraoperative Doppler sonography, including its ability to assess the location and identify of feeding arteries in patients with AVMs and to compare this method with *** Twenty-three patients with cerebral AVMs who were diagnosed using angiography, were examined with contrast-enhanced intraoperative Doppler sonography. As an echo-enhancing agent, Sulphur Hexafluoride Microbubbles for Injection （＂SonoVue＂） was administered intravenously in all patients. Sonogram results were reviewed and correlated with angiographic findings. For statistical analysis, the Wilcoxon signed-rank test was *** Angiography identified 20 AVM lesions in the anterior or middle fossa and 3 in the posterior ***-enhanced intraoperative Doppler was somewhat less sensitive for only detecting 21/23 （91.3%） of the AVM lesions. Additionally, contrast-enhanced intraoperative Doppler slightly underestimated AVM size compared with angiographic findings but showed feeding arteries with sufficient acoustic properties. In 15 patients, angiography revealed a coincidental blood supply from another intracranial vessel, which was missed by contrast-enhanced intraoperative Doppler *** In a limited group of patients with AVMs, contrast-enhanced intraoperative Doppler sonography was a less sensitive but useful and simple method for the detection of AVMs in contrast to angiography. No specific untoward effects were attributed to the use of ＂SonoVue＂ as a contrast-enhancing substance.

关键词： arteriovenous malformations intraoperative ultrasonography ultrasound contrast agent

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Onyx in treatment of large and giant cerebral aneurysms and arteriovenous malformations

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Chinese Medical Journal 2004年第12期17卷 1869-1872页

作者：宋冬雷冷冰周良辅顾宇翔陈衔城 Department of Neurosurgery Huashan Hospital Fudan University Shanghai 200040 China

Onyx, a novel embolization material, is a mixture of ethylene-vinyl alcohol copolymer (EVOH), dimethyl sulfoxide (DMSO), and micronized tantalum. The polymer is dissolved in DMSO and is prepared in different concentration. Onyx HD-500 for aneurysm embolization contains 20% copolymer and 80% DMSO. Onyx-18 for arteriovenous malformations (AVMs) embolization contains 6.0% copolymer and 94.0% DMSO. When Onyx comes in contact with water or blood, the copolymer precipitates because of rapid diffusion of the DMSO solvent. It possesses stronger cohesiveness, but less likely to entrap the microcatheter. From September 2003, we have used Onyx to treat large and giant cerebral aneurysms and AVMs successfully in 10 patients. Here we report our preliminary experience with the Onyx technique.

关键词： intracranial aneurysm arteriovenous malformations therapy Onyx

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Relationships between hemorrhage, angioarchitectural factors and collagen of arteriovenous malformations

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Neuroscience Bulletin 2012年第5期28卷 595-605页

作者： Hongchuan Niu Yong Cao Xuejiang Wang Xiaowei Xue Lanbing Yu Ming Yang Rong Wang Department of Neurosurgery Beijing Tiantan Hospital affiliated to Capital Medical University Beijing 100050 China Department of Physiology and Pathophysiology School of Basic Medical Science Capital Medical University Beijing 100050 China

Objective While associations between the angioarchitecture of arteriovenous malformations （AVMs） in the brain and pathological features have been described, here we investigated the relationship between the angioarchitecture, the pathological features of the vessel wall, and hemorrhagic events. Methods The study was conducted on 43 patients： 16 with ruptured AVM （rAVM）, 15 with non-ruptured AVM （nrAVM）, 6 with craniocerebral trauma （control） and 6 with epilepsy （control）. The diagnosis of AVM was confirmed by preoperative digital subtraction angiography. Tissues were stained with hematoxylin and eosin and Masson＇s trichrome （for collagen fibers） to evaluate the vessel wall structure and endothelial integrity. The content and distribution of collagen types I and III in the vessel wall were assessed by immunohistochemical staining. Results In the nrAVM group, the nidus had more draining veins than the rAVM group （P 〈0.05）. Severely damaged endothelial cells, significantly fewer smooth muscle cells in the media, and hyperplasic type-I and -III collagen fibers were found in the rAVM group. The content of collagen types I and III in rAVMs was higher than that in the nrAVM （P 〈0.05） and control groups （P 〈0.01）. Conclusion There is an association between angioarchitectural features such as the number of draining veins and the pathological structure of the AVM wall. These abnormalities may contribute to AVM rupture.

关键词： arteriovenous malformations angioarchitecture pathology

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Increased expression of osteopontin in brain arteriovenous malformations

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Chinese Medical Journal 2012年第23期125卷 4254-4258页

作者： XU Hong-zhi QIN Zhi-yong GU Yu-xiang ZHOU Ping XU Feng CHEN Xian-cheng Department of Neurosurgery Huashan HospitalFudan UniversityShanghai Neurosurgical CenterShanghai 200040China

Background The precise mechanisms responsible for the development and growth of intracranial arteriovenous malformations （AVMs） remain unclear. Osteopontin （OPN） is a phosphorylated glycoprotein with diverse functions. This study aimed to analyze the expression of OPN in human brain AVMs. Methods The AVM nidus was surgically obtained from patients with AVM, whereas control brain artery specimens were surgically obtained from patients with epilepsy. Reverse transcription-polymerase chain reaction （RT-PCR） was used to examine the expression of OPN mRNA in biopsy specimens. OPN protein expression was localized by immunohistochemistry. The statistical differences between different groups were assessed by two-way analysis of variance （ANOVA）. Results We analyzed 36 brain AVM specimens and 8 control brain artery specimens. Eleven patients with brain AVM received embolization treatment, and five underwent gamma knife radiotherapy before resection. Nineteen patients with brain AVM had a history of hemorrhage from AVMs. The expression of OPN mRNA was significantly higher in AVMs than that in the control specimens （25.76＋2.71 vs. 21.46＋2.01, P 〈0.01）. There was no statistically significant difference in the extent of OPN mRNA expression between the AVM group with and that without history of hemorrhage （26.13＋2.45 vs. 25.34＋2.99） or gamma knife radiotherapy （24.39：1：2.10 vs. 24.53＋1.85）, However, the difference between the AVM group with and that without embolization treatment history was statistically significant （24.39＋2.10 vs. 28.80＋1.13, P 〈0.01）. In the group with gamma knife radiotherapy history, OPN expression was found in arteries with early-stage radio-effect. Conclusions OPN may contribute to the vascular instability of brain AVMs. It may play an important role in the pathophysiological process related to embolization treatment.

关键词： osteopontin arteriovenous malformations embolization

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Systemic Hemodynamic Changes in Low-Dose Ethanol Embolotherapy for Soft-Tissue arteriovenous malformations

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Chinese Journal of Plastic and Reconstructive Surgery 2021年第1期3卷 32-40页

作者： Xi YANG Chen HUA Hui CHEN Lan LUO Gang MA Xiaojie HU YaJing QIU Wenxin YU Lei CHANG Yunbo JIN Xiaoxi LIN Department of Plastic Surgery Shanghai Ninth People’s HospitalShanghai Jiaotong University School of MedicineShanghai 200011China

Background Ethanol embolotherapy is considered an optimal choice for the treatment of arteriovenous malformations(AVMs);however,there are some complications associated with this *** study aimed to prospectively investigate systemic hemodynamic changes in high-flow AVMs using ethanol *** From September 2012 to September 2014,34 male patients and 26 female patients with AVMs who underwent embolotherapy(100 sessions in total)with absolute ethanol were included in this *** systolic blood pressure(SBP)and heart rate(HR)were recorded before and after each injection and throughout the *** between the initial and highest SBP(ΔmaxSP)and HR values(ΔmaxHR),as well as the initial and final SBP(ΔSP)and HR(ΔHR)values,were *** aimed to explore the potential association between these values and the amount of ethanol that was *** The total ethanol used was variable(0.01–0.40 mL/kg;mean,0.20 mL/kg).SBP and HR increased after ethanol injection in most sessions(91 in 100 sessions).SBP decreased in 9 sessions(9 in 100 sessions),while HR,oxygen saturation,and end-tidal CO2 decreased in one of the 9 sessions.ΔmaxSP andΔmaxHR averaged 38.4 mmHg and 27.8 bpm,respectively(both P<0.05),whileΔSP andΔHR averaged 3.4 mmHg and 4.0 bpm,respectively(both P<0.05).ΔmaxSP andΔmaxHR were positively correlated with the total dose of ethanol *** Elevations in SBP and HR during ethanol embolotherapy are common,temporary,and most likely pain-mediated;these increases tend to be positively correlated with ethanol *** may be regarded as an acute complication of ethanol *** combined with bradycardia,oxygen desaturation,and decreased end-tidal CO2 may be a potential predictor of cardiovascular collapse.

关键词： Systemic hemodynamic change Ethanol embolotherapy arteriovenous malformations Hypotension Blood pressure Heart rate

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Value of embolization of brain arteriovenous malformations with ethylene vinyl alcohol copolymer

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Chinese Medical Journal 2010年第11期123卷 1469-1469页

作者： Yang Xin-xin Song Lu Wu Na Liu Zhen-guo Shanghai Jiao Tong Univ Dept Neurol Xinhua Hosp Sch Med Shanghai 200092 Peoples R China

To the Editor： We are interested in a recent article Embolization of brain arteriovenous malformations with ethylene vinyl alcohol copolymer： technical aspects written by GAO et al. Ethylene vinyl alcohol copolymer （Onyx） is a novel liquid embolic material used to cure brain arteriovenous malformations. They performed the embolization on 115 patients and they found that the complications of the treatment are scarce.

关键词： arteriovenous malformations treatment aspects novel found

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Clinical values of intraoperative indocyanine green fluorescence video angiography with Flow 800 software in cerebrovascular surgery

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Chinese Medical Journal 2013年第22期126卷 4232-4237页

作者： YE Xun LIU Xing-ju MA Li LIU Ling-tong WANG Wen-lei WANG Shuo CAO Yong ZHANG Dong WANG Rong ZHAO Ji-zong ZHAO Yuan-li Department of Neurosurgery Beijing Tiantan Hospital Capilal Medical University Beijing 100050 China Department of Neurosurgery Meitan General Hospital Bei.jing100028 China

Background Microscope-integrated near-infrared indocyanine green video angiography （ICG-VA） has been used in neurosurgery for a decade. This study aimed to assess the value of intraoperative indocyanine green （ICG） video angiography with Flow 800 software in cerebrovascular surgery and to discover its hemodynamic features and changes of cerebrovascular diseases during surgery. Methods A total of 87 patients who received ICG-VA during various surgical procedures were enrolled in this study. Among them, 45 cases were cerebral aneurysms, 25 were cerebral arteriovenous malformations （AVMs）, and 17 were moyamoya disease （MMD）. A surgical microscope integrating an infrared fluorescence module was used to confirm the residual aneurysms and blocking of perforating arteries in aneurysms. Feeder arteries, draining veins, and normal cortical vessels were identified by the time delay color mode of Flow 800 software. Hemodynamic parameters were recorded. All data were analyzed by SPSS version 18.0 （SPSS Inc., USA）. T-test was used to analyze the hemodynamic features of AVMs and MMDs, the influence on peripheral cortex after resection in AVMs, and superficial temporal artery to middle cerebral artery （STA-MCA） bypass in MMDs. Results The visual delay map obtained by Flow 800 software had more advantages than the traditional playback mode in identifying the feeder arteries, draining veins, and their relations to normal cortex vessels. The maximum fluorescence intensity （MFI） and the slope of ICG fluorescence curve of feeder arteries and draining veins were higher than normal peripheral vessels （MFI： 584.24±85.86 vs. 382.94_±91.50, slope： 144.95±38.08 vs. 69.20±13.08, P 〈0.05）. The arteriovenous transit time in AVM was significantly shorter than in normal cortical vessels （（0.60±0.27） vs. （2.08±1.42） seconds, P 〈0.05）. After resection of AVM, the slope of artery in the cortex increased, which reflected the increased cerebral flow. In patients with MMD, after STA-MCA bypass, cortex

关键词： indocyanine green arteriovenous malformations moyamoya disease hemodynamic

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Hemodynamic changes in superficial arteriovenous malformation surgery measured by intraoperative ICG fluorescence videoangiography with FLOW 800 software

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中华神经外科杂志(英文) 2021年第1期6卷 19-27页

作者： Ye Xun Wang Liang Li Ming-tao Chen Xiao-lin Wang Hao Ma Li Wang Rong Zhang Yan Cao Yong Zhao Yuan-li Zhang Dong Wang Shuo Department of Neurosurgery Beijing Tian Tan Hospital Capital Medical University Beijing 100050 China Tianjin Fifth Center Hospital Tianjin 300450

Background: arteriovenous malformation(AVM) have long-term "blood stealing" characteristics, which result in complicated hemodynamic features. To analyze the application of intraoperative indocyanine green angiography with FLOW 800 software in AVM ***: Data on 17 patients undergoing surgery with ICG fluorescence were collected in Beijing Tiantan Hospital. To analyze the hemodynamic features of AVM and the influence on the peripheral cortex of AVM resection, we assessed the following hemodynamic parameters: maximum intensity, slope of rise, time to half-maximal fluorescence, and transit time from arteries to ***: In the 17 superficial AVMs studied, the time-delay color mode of the FLOW 800 software was superior to the traditional playback mode for identifying feeding arteries, draining veins, and their relation to normal cortical vessels. The maximum fluorescence intensity and slope of the ICG fluorescence curve of feeder arteries and draining veins were higher than those of normal peripheral vessels (P 0.05).Conclusions: Hemodynamic parameter analysis provided quality guidance for the resection of AVMs and could also be used in estimating changes in blood flow in the local cortex to identify abnormal hyperperfusion and residual nidus.

关键词： arteriovenous malformations FLOW 800 software Hemodynamics Indocyanine green

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Spontaneous Subdural Hemorrhage due to Ruptured arteriovenous Malformation in a Child

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Journal of Forensic Science and Medicine 2018年第3期4卷 174-178页

作者： Nor Fadhilah Madon Ahmad Hafizam Hasmi Khairul Anuar Zainun Hapizah Mohd Nawawi Department of Forensic Medicine National Institute of Forensic MedicineHospital Kuala LumpurMinistry of Health MalaysiaKuala Lumpur department of Forensic MedicineHospital Sungai BulohJalan Hospital institute of Pathology Laboratory and Forensic MedicineUniversiti Teknologi MARASungai Buloh CampusJalan HospitalSelangorMalaysia

Spontaneous subdural hemorrhage(SDH)is an uncommon nontraumatic bleed of the brain,involving the dura and arachnoid *** commonly occurs due to tearing of bridging veins;however,SDH from the rupture of arteriovenous malformation(AVM)is an uncommon phenomenon,particularly in *** report a case of atypical SDH in a 1-year-old child with AVM and a history of alleged *** revealed SDH in the right parietal and middle cranial fossa without any external or internal injuries to the head,brain,or other parts of the *** examination and immunohistochemical staining of the brain tissue revealed an abnormal distribution of arteries and veins of various sizes and *** a detailed histopathological examination of the brain and meticulous investigation of vascular abnormalities,we conclude the cause of acute SDH to be due to a ruptured AVM.

关键词： arteriovenous malformations child abuse spontaneous subdural hemorrhage

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Predictors of double balloon endoscopy outcomes in the evaluation of gastrointestinal bleeding

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World Journal of Gastrointestinal Endoscopy 2014年第6期6卷 248-253页

作者： Hisham Hussan Nicholas R Crews Caroline M Geremakis Soubhi Bahna Jennifer L LaBundy Christine Hachem Section of Intestinal Neoplasia and Hereditary Polyposis(INHP) Department of GastroenterologyHepatology and NutritionThe Ohio State University Medical Center Division of Gastroenterology and Hepatology Saint Louis University School of Medicine School of Medicine Saint Louis University School of Medicine Center for Outcomes Research Saint Louis University Department of Internal Medicine Saint Louis University School of Medicine

AIM:To identify patients' characteristics associated with double balloon endoscopy(DBE)outcomes in investigation of obscure gastrointestinal bleeding(OGIB).METHODS:Retrospective study performed at an academic tertiary referral *** endpoints were clinical factors associated with no diagnostic yield or non-therapeutic intervention of DBE performed for OGIB ***:We included fifty-five DBE between August 2010 and April *** mean age of the sample was 67 with 32 males(58.2%).Twenty-four DBE had no diagnostic yield and 30 DBE did not require ***-diagnostic yield was associated with performing two or more DBE studies in one day [odds ratio(OR):13.72,P=0.008],absence of blood transfusions within a year of the DBE(OR:7.16,P=0.03)and absence of ulcers or arteriovenous malformations(AVMs)on prior esophagogastroduodenoscopy(EGD)or colonoscopy(OR:19.30,P=0.033).Non-therapeutic DBE was associated with performing two or more DBE per day(OR:18.579,P=0.007),gastrointestinal bleeding episode within a week of the DBE(OR:11.48,P=0.003),fewer blood transfusion requirements prior to DBE(OR:4.55,P=0.036)and absence of ulcers or AVMs on prior EGD or colonoscopy(OR:8.47,P=0.027).CONCLUSION:Predictors of DBE yield and therapeutic intervention on DBE include blood transfusion requirements,previous endoscopic findings and possibly endoscopist fatigue.

关键词： Double balloon endoscopy Enteroscopy Obscure gastrointestinal bleeding Small bowel Anemia arteriovenous malformations arteriovenous malformations

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