Cerebral arteriovenous malformations : usability of Spetzler-Martin and Spetzler-Ponce scales in qualification to endovascular embolisation and neurosurgical procedure

Purpose: Arteriovenous malformations (AVMs) are connected with cerebral haemorrhage, seizures, increased intracranial pressure, headaches, mass effect, and ischaemia symptoms. Selection of the best treatment method or even deciding if intervention is required can be difficult. Material and methods: The study included 50 patients who were diagnosed with cerebral AVMs and treated in our Centre between 2008 and 2014. A total of 111 procedures were performed, including 94 endovascular embolisations and 17 neurosurgical procedures. Medical records and imaging data were reviewed for all patients. All AVMs were measured and assessed, allowing classification in Spetzler-Martin and Spetzler-Ponce scales. Results: Complete or partial treatment was observed in 88.24% of neurosurgical procedures and in 84.00% of embolisations. Early complication rate was 21.28% for embolisation and 17.65% for neurosurgical procedures, while Glasgow Outcome Scale was 4.89 (σ = 0.38) and 5.0 (σ = 0.00), respectively. According to the Spetzler-Martin scale, cerebral haemorrhages occurred more frequently in grade 1, but no statistical significance was observed. In Spetzler- Ponce class B lower grades in Glasgow Coma Scale (GCS) were noticed (p = 0.02). Lower GCS scores were also correlated with deep location of AVM and with eloquence of adjacent brain. Patients with Spetzler-Martin grade 1 were more frequently qualified for neurosurgical procedures than other patients. Conclusions: Treating AVMs requires coordination of a multidisciplinary team. Both endovascular embolisation and neurosurgical procedure should be considered as a part of multimodal, frequently multistage treatment. Spetzler-Martin and Spetzler-Ponce scales have an influence on haemorrhage frequency and patients’ clinical condition and should be taken into consideration in selecting the treatment method

Preparation and characterization of gold nanoparticles prepared with aqueous extracts of Lamiaceae plants and the effect of follow-up treatment with atmospheric pressure glow microdischarge

AbstractThe unique properties of gold nanoparticles (AuNPs) make them attractive for use in a number of fields, ranging from cosmetology to medicine. If AuNPs are to be widely used in industrial and medical applications, it is necessary to develop environmentally friendly methods for their synthesis. This can be accomplished by replacing the traditional chemical compounds for the reduction of the Au(III) ions to Au0 during AuNPs synthesis with natural plant extracts or with atmospheric pressure plasmas. Here, the properties of three aqueous plant extracts (Mentha piperita, Melissa officinalis, and Salvia officinalis) in the synthesis of AuNPs were compared and optimized under standardized conditions. The effects of the type of plant extract, the reaction temperature, and the precursor concentration on the production and size of the obtained AuNPs were examined using UV–Vis absorption spectrophotometry, dynamic light scattering (DLS), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). It was observed that the size of the produced AuNPs was dependent on the aqueous plant extract used, and that under the optimized conditions, the aqueous leaf extract of M. piperita resulted in the production of AuNPs with the smallest volume-weighted diameter. Additionally, the bioactive compounds present in each extract were studied. Attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR) indicated that different chemical groups could be involved in the AuNPs synthesis, while a Folin–Ciocalteu (FC) assay revealed a clear role of phenolic compounds. Finally, it was shown that the treatment of the synthesized AuNPs, which were obtained after bioreduction using the plant extracts, with atmospheric pressure glow microdischarge (μAPGD) resulted in their agglomeration and enlargement

Progressive regression of intracranial arteriovenous malformations after Onyx embolization

Progressive regression of cerebral arteriovenous malformations (AVMs) is a rare phenomenon that may occur spontaneously or after previous surgical or endovascular incomplete obliteration. We present two cases of AVMs occluded partially with Onyx followed by the unexpected cure of the lesions with the angiographic evidences as well as multiannual follow-up

Stent-assisted embolization of wide-neck anterior communicating artery aneurysms: Review of consecutive 34 cases

Objective We report our experience with stent-assisted coiling of anterior communicating artery aneurysms with special consideration of angiographic and clinical outcomes, retreatment rate and periprocedural complications. Materials and methods The analysis included 34 consecutive ruptured and unruptured wide-neck aneurysms. The aneurysm size ranged from 2 to 18mm (mean 5.47). Clinical examinations with the use of modified Rankin Score and angiographic outcomes were evaluated initially post-embolization and at a minimum follow-up of 6 months. Results Initial post-treatment complete and near-complete aneurysm occlusion was achieved in 32 (94%) and 2 (6%) cases, respectively. Imaging follow-up, performed in 28 (82%) patients, showed no change in the degree of occlusion in 25 (89%) cases and coil compaction in 3 (11%) patients. Of these, one (3.6%) patient underwent a second coil embolization. The periprocedural severe complication rate was 2.9% (1/35) and was associated with prolonged attempt of retrieval of migrated coil resulting in anterior cerebral artery infarct with serious clinical consequences. In another 3 patients periprocedural adverse events without delayed clinical consequences were noticed. The clinical follow-up evaluation achieved in 33 (97%) patients showed no change in 30 (91%) cases, one patient (3%) with clinical improvement and two (6%) cases of neurological deterioration. Conclusions The use of stent is feasible and effective for coil embolization of wide-necked anterior communicating artery aneurysms. Although periprocedural complications resulting in severe morbidity are rare, they should be noted, since in terms of thromboembolic events some of them presumably have a potential to be avoidable

Safety and efficacy of treatment of very small intracranial aneurysms

Purpose: Very small intracranial aneurysms (VSIAs) may cause many neurological complications and even death. Thanks to technological progress and higher quality of non-invasive neuroimaging methods, these pathologies can be investigated sooner and treated earlier. Due to the controversy surrounding invasive treatment of these pathologies, the aim of the study was to analyse methods of treatment, their outcome, and complications in a group of patients with VSIAs. Material and methods: Out of 444 cases of intracranial aneurysms treated in our centre, 65 aneurysms met the radiological criteria of VSIAs. The parameters - width and length of the aneurysm's neck and width, length, and height of the aneurysm's dome - were measured. The analysed parameters were as follows: symptoms upon admission and after treatment, days in hospital, and intraoperative complications. Clinical and radiological intensity of subarachnoid haemorrhage (SAH) was evaluated by using the Hunt-Hess and Fisher scales. The degree of embolisation of the aneurysm after the procedure was assessed using the Montreal Scale. Clinical outcome was assessed by Glasgow Outcome Scale. Results: 50.77% of VSIAs were treated with endovascular procedures and 49.23% with neurosurgical clipping. SAH was presented in 38.46% of patients with VSIAs. Intraoperative complications were presented in 16.92% of patients with VSIAs, and the most common complication was ischaemic stroke. Stents were used in 51.52% of VSIAs. In 69.70% of embolisation procedures at VSIAs complete obliteration was achieved. The average result in the Montreal Scale was 1.31 (SD = 0.66). Conclusion: VSIAs can be treated as effectively and safely as larger aneurysms, by both endovascular and surgical methods

Endovascular treatment of small cerebral arteriovenous malformations as a primary therapy

Purpose: The patient population that would benefit most from endovascular curative treatment of intracranial arteriovenous malformations has not been clearly established. The aim of the study was to determine the effect of curative embolisation of cerebral arteriovenous malformations with special regard to radiographic and clinical outcomes and procedure-related complications. Material and methods: Between January 2009 and December 2014, 18 patients with intracranial arteriovenous malformations were embolised with Onyx with intent to cure. There were four women and 14 men, with a mean age of 40 years (range 10-62 years). Inclusion criteria were: maximal diameter of the lesions ≤ 3 cm and arterial supply consisting of no more than two major arteries. Five (27.8%) patients had ruptured lesions, and 13 (72.2%) patients had unruptured lesions. Mean arteriovenous malformation size was 2.3 cm (range 1.5-2.9 cm). Results: Thirty-three procedures were performed in 18 patients. Total obliteration was achieved in five patients (27.8%). The most common reason for initial incomplete angiographic occlusion was unfavourable angioarchitectural features of arteriovenous malformations, with the rate of 44.4%. The mean follow-up of patients with complete occlusion was 35.2 months (range 18-60 months). Complication rate was 12.1%. One patient had permanent neurological deficit with resulting morbidity of 5.6%. There were no deaths. Conclusions: Embolisation of intracranial arteriovenous malformations plays a limited role as a sole therapeutic modality even in terms of small lesions with two or fewer arterial feeders, although larger prospective series are necessary to confirm these findings. Associated complications are not trivial and should be considered when choosing this form of treatment

Endovascular treatment of complex intracranial aneurysms

Introduction: Complex intracranial aneurysms (CIA) are heterogenous group of intracranial vascular malformations. Due to its giant size, difficult location, broad neck, branches arising from the aneurysm, wall structure, calcification, presence of intraluminal thrombus or previous treatments it requires more careful approach. The aim of this study was to evaluate endovascular treatment results of CIA in our Department. Material and methods: In order to differentiate CIA from all the aneurysms, treated endovascularly in years 2008-2014, authors proposed their own qualification criteria. Additionally, subgroup of patients with CIA with simultaneous subarachnoid haemorrhage (SAH) was divided. Clinical outcomes of patients were assessed with Glasgow Outcome Scale (GOS), while radiological outcomes were assessed with Montreal Scale. Aneurysm localization, incidence of aborted procedures, intraoperative complications were also evaluated. Results: Internal carotid artery was the most common localization in both CIA and non-complex (nCIA) groups. Incidence of aborted procedures was significantly higher in CIA group than in nCIA (25% vs. 7%; p < 0.01). CIA group had worse Montreal scores then nCIA group (1.90 vs. 1.49; p < 0.01). Clinical outcome in GOS scale in patients with SAH and CIA was significantly worse than in SAH and nCIA (2.86 vs. 4.06; p = 0.04). Conclusions: To conclude, proposed criteria of CIA should be taken into consideration during diagnosis and qualification to invasive treatment. Classifying aneurysm as CIA is related to greater possibility of aborting endovascular procedure due to technical difficulties

Myśl i polityka: księga pamiątkowa dedykowana profesorowi Jackowi Marii Majchrowskiemu T. 2

Publikacja jubileuszowa z okazji 40-lecia pracy naukowej profesora Jacka Majchrowskieg