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Intracranial Arteriovenous Malformations - Philip E. Stieg

Intracranial Arteriovenous Malformations

By: Philip E. Stieg (Editor), H. Hunt Batjer (Editor), Duke Samson (Editor)

Hardcover Published: 25th October 2006
ISBN: 9780824709938
Number Of Pages: 496

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Offering expert recommendations and selected color illustrations, this guide furnishes readers with state-of-the-art information on the pathophysiology, diagnosis, evaluation, and treatment of AVMs. Offering a multidisciplinary approach, this book spans a wide array of therapeutic options and surgical approaches with step-by-step presentations of each procedure covered in the text.

Prefacep. iii
Contributorsp. xiii
Anatomy and Physiology
Surgical Anatomyp. 1
Introductionp. 1
Frontal Lobe AVMsp. 1
Parietal Lobe AVMsp. 2
Temporal Lobe AVMsp. 3
Occipital Lobe AVMsp. 5
Mediobasal Temporal Lobe AVMsp. 5
Interhemispheric Parafalcine and Callosal Region AVMsp. 9
Basal Ganglia Region AVMsp. 11
AVMs of the Posterior Fossap. 18
Referencesp. 19
Pathology and Genetic Factorsp. 21
Pathologyp. 21
Genetic Factorsp. 25
Referencesp. 27
Hemodynamic Propertiesp. 31
Introductionp. 31
Hemodynamic Effect within the Interstices of an AVMp. 32
Hemodynamic Effect on Cerebral Blood Vessels in the Presence of an AVMp. 33
Hemodynamic Effect on the Microcirculation of the Brain Associated with an AVMp. 37
Autoregulation and Reactivity to Changes in PaCO[subscript 2]p. 38
Hemodynamic Effect on Cerebral Blood Vessels at the Time of AVM Ablationp. 40
Hemodynamic Effect on the Brain at the Time of AVM Ablationp. 40
Arterio-Capillary-Venous Hypertensive Syndromesp. 41
Referencesp. 42
Use of Modeling for the Study of Cerebral Arteriovenous Malformationsp. 49
Introductionp. 49
Importance of Modeling for AVMsp. 49
Specific Modeling Attempts-Model Constructionp. 50
Model Applicationsp. 55
Long-Term Objectives of Computational Modelingp. 58
Animal Modelingp. 59
Summaryp. 61
Description of a Computational AVM Modelp. 61
Mathematical and Computational Approachp. 63
Vascular Stressp. 67
Referencesp. 68
Clinical Presentation and Diagnostic Evaluation
Natural Historyp. 73
Introductionp. 73
Presenting Symptomsp. 73
Morbidity and Mortality Related to Hemorrhagep. 75
AVMs in the Gravid Womanp. 77
Anatomical Factors Influencing the Natural History of AVMsp. 77
Spontaneous Regressionp. 78
Referencesp. 79
Classification and Grading Systemsp. 81
Introductionp. 81
Classification and Grading Parametersp. 81
Grading Scalesp. 84
Discussionp. 91
Referencesp. 92
Radiographic Diagnosisp. 95
Introductionp. 95
Epidemiology and Natural Historyp. 95
Therapeutic Options and Classificationp. 96
Computed Tomographyp. 97
Magnetic Resonance Imaging and Angiographyp. 98
Conventional Angiographyp. 105
Angiographically Occult AVMsp. 109
Conclusionp. 109
Referencesp. 120
Functional Evaluation and Diagnosisp. 115
Introductionp. 115
Parenchymal Functionp. 115
Relative Perfusionp. 118
Blood Pressure and Flow Analysisp. 119
Invasive Provocationp. 120
Conclusionp. 120
Referencesp. 120
Basic Considerations
Decision Analysis for Asymptomatic Lesionsp. 123
Introductionp. 123
Decision Analysis and Markov Modeling for the Treatment of Asymptomatic AVMsp. 124
Data Collectionp. 127
Sensitivity Analysisp. 130
Conclusionp. 132
Referencesp. 133
Multimodality Therapy: Treatment Algorithmsp. 135
Introductionp. 135
Pathology of the AVMp. 135
Location of the AVMp. 136
Natural Historyp. 136
Patient Characteristicsp. 137
Diagnostic Imagingp. 137
Management Optionsp. 138
Decision Analysis for the Management of Unruptured AVMsp. 140
Decision Analysis for the Management of Ruptured AVMsp. 140
Conclusionsp. 141
Referencesp. 141
Surgical Principlesp. 145
Introductionp. 145
Preoperative Imagingp. 145
Embolizationp. 149
Anesthesiap. 149
Neurosurgical Emergency: Intracranial Hemorrhage Related to AVM Rupturep. 151
Surgical Resectionp. 152
Conclusionp. 157
Referencesp. 157
Endovascular Principlesp. 159
Introductionp. 159
Historical Perspectivep. 159
Role of Endovascular Therapyp. 160
Hemodynamic Considerations and Staging of Embolizationp. 165
Anesthetic Considerations and Monitoringp. 166
Functional Testingp. 167
Equipmentp. 168
Strategy and Techniquep. 171
Outcomesp. 172
Complications and Complication Avoidancep. 172
Future Directionsp. 174
Referencesp. 174
Radiosurgical Principlesp. 177
Introductionp. 177
History of Radiosurgery for AVMsp. 177
Radiobiology of AVM Radiosurgeryp. 177
Pathologic Changes of AVMs After Radiosurgeryp. 178
Radiosurgery Platformsp. 178
Stereotactic Radiosurgery Techniquep. 178
Evaluation of Treatment Responsep. 182
Complicationsp. 183
Combined Modality Management of AVMsp. 183
Single Fraction Versus Fractionated Therapyp. 183
Future Directions for AVM Radiosurgeryp. 184
Referencesp. 184
Combined Therapy: The Team Approachp. 189
Introductionp. 189
Goals of Therapyp. 189
Therapeutic Strategiesp. 190
Remedies for Palliationp. 196
Conclusionp. 198
Referencesp. 198
Therapeutic Management
Anesthetic Considerationsp. 201
General Considerationsp. 201
Cerebral Circulatory Changes in Patients with AVMsp. 202
Anesthetic Management During Surgeryp. 203
Anesthetic Management During Interventional Neuroradiologic Proceduresp. 206
Referencesp. 211
Supratentorial Lobar Arteriovenous Malformationsp. 215
Introductionp. 215
General Considerationsp. 215
Frontal Lobe AVMsp. 228
Temporal Lobe AVMsp. 231
Parietal Lobe AVMsp. 233
Occipital Lobe AVMsp. 235
Referencesp. 237
Perisylvian Arteriovenous Malformationsp. 243
Introductionp. 243
Presentationp. 244
Diagnostic Studiesp. 244
Managementp. 246
Resultsp. 254
Referencesp. 254
Supratentorial Periventricular Arteriovenous Malformationsp. 259
Introductionp. 259
Epidemiology, Presentation, and Natural Historyp. 259
Anatomical Considerationsp. 260
Evaluation of Patients with Periventricular AVMsp. 262
Therapeutic Optionsp. 263
Surgical Approachesp. 264
Conclusionsp. 269
Referencesp. 270
Corpus Callosum Arteriovenous Malformationsp. 273
Introductionp. 273
Epidemiologyp. 273
Anatomy of the Corpus Callosump. 274
Functions of the Corpus Callosum and Callosal Syndromesp. 275
Clinical Presentationp. 275
Classification/Grading Systems for AVMs of the Corpus Callosump. 277
Treatmentp. 278
Summaryp. 282
Referencesp. 283
Arteriovenous Malformations of the Cerebellar Vermis and Hemispheresp. 285
Introductionp. 285
Cerebellar Surface Anatomy and Vascular Supplyp. 285
Cerebellar Functional Anatomyp. 288
Clinical Presentationp. 289
Classification and Risk Stratificationp. 289
Treatmentp. 290
Summaryp. 295
Referencesp. 296
Infratentorial Cerebellopontine Angle Arteriovenous Malformationsp. 299
Introductionp. 299
Regional Anatomyp. 299
Clinical Presentationp. 302
Diagnosisp. 303
Therapyp. 304
Surgical Techniquep. 305
Complicationsp. 310
Summaryp. 311
Referencesp. 312
Brainstem Arteriovenous Malformationsp. 315
Introductionp. 315
Natural Historyp. 315
Classification of Brainstem AVMsp. 315
Arterial Supply and Venous Drainagep. 316
Clinical Presentationp. 316
Indications and Contraindications for Surgeryp. 316
Potential Risksp. 317
Preoperative Preparationp. 317
Anesthetic Techniquep. 317
Surgical Approaches and Positioningp. 319
Closure Techniques and Postoperative Managementp. 323
Special Perioperative Equipment/Techniquesp. 323
Stereotactic Radiosurgeryp. 324
Embolizationp. 324
Clinical Outcomep. 326
Complications and Complication Avoidancep. 327
Summaryp. 327
Referencesp. 327
Intraoperative and Postoperative Angiographyp. 329
Introductionp. 329
Intraoperative Angiographyp. 329
Intraoperative Embolizationp. 336
Postoperative Angiographyp. 337
Referencesp. 341
Associated Aneurysmsp. 343
Introductionp. 343
Classificationp. 343
Incidencep. 343
Pathophysiologyp. 344
Natural Historyp. 344
Managementp. 344
Conclusionsp. 348
Referencesp. 349
Arteriovenous Malformations in Pregnancyp. 351
Introductionp. 351
Epidemiologyp. 351
Physiologic Changes Associated with Pregnancyp. 351
Radiologic Diagnosis of AVM in Pregnancyp. 352
Medical Managementp. 353
Surgical Managementp. 354
Embolization and Radiosurgical Proceduresp. 355
Ethical Considerationsp. 355
Conclusionsp. 355
Referencesp. 356
Diagnosis and Management of Pediatric Arteriovenous Malformationsp. 359
Introductionp. 359
Epidemiologyp. 359
Developmental Biology of AVMs in Childrenp. 359
Natural Historyp. 360
Presentation and Evaluation of AVMs in Childrenp. 361
Considerations for Interventionp. 363
Timing of Interventionp. 363
Preoperative Embolizationp. 364
Stereotactic Radiosurgeryp. 365
Surgical Techniquep. 366
Complications Avoidancep. 366
Outcomesp. 367
Referencesp. 368
Management of Residual Arteriovenous Malformationsp. 371
Introductionp. 371
Residual Malformations after Endovascular Embolizationp. 372
Residual Malformations after Radiosurgeryp. 375
Residual Malformations after Microsurgical Resectionp. 378
Conclusionp. 380
Referencesp. 380
Special Problems
Critical Care Managementp. 383
Introductionp. 383
Neurological Monitoring and Imagingp. 383
Perioperative Cerebral Edemap. 384
Cardiovascular Managementp. 386
Pulmonary Managementp. 387
Fluids and Electrolytesp. 387
Nutrition and Diabetic Managementp. 388
Infectious Diseasep. 389
Sedation and Analgesiap. 389
Glucocorticoidsp. 390
Thrombotic Complicationsp. 390
Seizure Prophylaxis and Treatmentp. 390
Referencesp. 390
Surgical Complicationsp. 393
Introductionp. 393
Preoperative Considerationsp. 393
Intraoperative Considerationsp. 395
Postoperative Considerationsp. 400
Summaryp. 403
Referencesp. 403
Endovascular Therapy: Indications, Complications, and Outcomep. 407
Introductionp. 407
Cerebrovascular Malformationsp. 407
Natural History of AVMsp. 408
Indications for Treatmentp. 408
Management Principles for Endovascular Treatmentp. 417
Complications: Avoidance and Managementp. 422
The Jefferson Hospital for Neuroscience Experiencep. 424
Summaryp. 424
Referencesp. 424
Radiosurgical Complicationsp. 429
Historical Backgroundp. 429
Risk of Hemorrhagep. 430
Transient Effects on Normal Brain Tissuep. 434
Radionecrosis and Other Long-Term Effectsp. 440
Conclusionsp. 446
Referencesp. 447
Future Considerations
Endovascular Techniquesp. 451
Introductionp. 451
Microcathetersp. 452
Embolic Materialsp. 452
Reduction of Complicationsp. 454
Conclusionp. 455
Referencesp. 455
Radiosurgeryp. 457
Introductionp. 457
Radiobiology of Vascular Malformation Radiosurgeryp. 457
Indications for AVM Radiosurgeryp. 458
Clinical Experiencep. 458
Stereotactic Radiosurgery Techniquep. 458
AVM Obliterationp. 461
Postradiosurgery Effectsp. 461
Repeat Radiosurgeryp. 463
Staged Volume Radiosurgeryp. 463
Future Roles for AVM Radiosurgeryp. 463
Summaryp. 465
Referencesp. 465
Molecular Biology of Arteriovenous Malformationsp. 469
Introductionp. 469
Angiogenesis and Vasculogenesisp. 469
Mendelian Forms of AVMsp. 471
Molecular Information on Sporadic AVMsp. 475
Future Researchp. 479
Referencesp. 479
Surgical Approachesp. 483
Introductionp. 483
Drug Delivery Systemsp. 483
Surgical Instrumentationp. 484
Anatomical, Physiological, and Operatively Integrated Imagingp. 486
Advanced Operating Suitep. 488
Conclusionp. 489
Referencesp. 489
Indexp. 491
Table of Contents provided by Ingram. All Rights Reserved.

ISBN: 9780824709938
ISBN-10: 0824709934
Audience: Professional
Format: Hardcover
Language: English
Number Of Pages: 496
Published: 25th October 2006
Country of Publication: US
Dimensions (cm): 26.21 x 18.14  x 3.0
Weight (kg): 1.46
Edition Number: 1