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Ultrasound localization of embolic material to guide resection of brain AVM: Report of two cases

BACKGROUND: The Spetzler–Martin Grade (SMG) is widely used to evaluate the risk of resection of cerebral arteriovenous malformation (AVM), and direct surgery is strongly recommended for low SMG lesions. Micro-AVMs are defined as AVMs with a nidus <1 cm in diameter, and sometimes, the challenge is...

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Autores principales: Yokoya, Shigeomi, Takezawa, Hidesato, Hidaka, Yukihiro, Fujiwara, Gaku, Oka, Hideki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Scientific Scholar 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10159302/
https://www.ncbi.nlm.nih.gov/pubmed/37151436
http://dx.doi.org/10.25259/SNI_242_2023
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author Yokoya, Shigeomi
Takezawa, Hidesato
Hidaka, Yukihiro
Fujiwara, Gaku
Oka, Hideki
author_facet Yokoya, Shigeomi
Takezawa, Hidesato
Hidaka, Yukihiro
Fujiwara, Gaku
Oka, Hideki
author_sort Yokoya, Shigeomi
collection PubMed
description BACKGROUND: The Spetzler–Martin Grade (SMG) is widely used to evaluate the risk of resection of cerebral arteriovenous malformation (AVM), and direct surgery is strongly recommended for low SMG lesions. Micro-AVMs are defined as AVMs with a nidus <1 cm in diameter, and sometimes, the challenge is identifying the exact lesion site during AVM resection, although identification of the site is very important in the procedure. Here, we present two cases in which the sites of micro-AVM were marked using presurgical embolization and easily confirmed by intraoperative ultrasonography (IUS) and discuss the benefits of IUS in combination with presurgical embolization for low-grade micro-AVM. CASE DESCRIPTION: (Patient 1) A 30-year-old man was brought to our hospital and diagnosed with a micro-AVM, which was classified as SMG II AVM. He underwent evacuation of the intracerebral hematoma and subsequently underwent AVM resection. However, the lesion was not identified because it was not exposed in the cerebral cortex although we searched for the lesion. Therefore, endovascular embolization was performed before subsequent surgical resection. During AVM resection following embolization with Onyx, the IUS clearly demonstrated the Onyx-embolized lesion, and it was resected uneventfully. (Patient 2) A 46-year-old man with a ruptured SMG II AVM underwent AVM resection using a microsurgical technique with IUS after embolization for AVM preoperatively. IUS clearly showed abnormal vessels embolized with Onyx and indicated the correct location of the nidus, although the lesion was not observed directly from the brain surface. After identifying some embolized AVM constructions, we excised the entire AVM with ease and safety. CONCLUSION: The combined use of presurgical embolization, which focuses on marking the lesions and IUS, may contribute to improving surgical outcomes of low SMG micro-AVMs, which are not exposed on the brain surface.
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spelling pubmed-101593022023-05-05 Ultrasound localization of embolic material to guide resection of brain AVM: Report of two cases Yokoya, Shigeomi Takezawa, Hidesato Hidaka, Yukihiro Fujiwara, Gaku Oka, Hideki Surg Neurol Int Case Report BACKGROUND: The Spetzler–Martin Grade (SMG) is widely used to evaluate the risk of resection of cerebral arteriovenous malformation (AVM), and direct surgery is strongly recommended for low SMG lesions. Micro-AVMs are defined as AVMs with a nidus <1 cm in diameter, and sometimes, the challenge is identifying the exact lesion site during AVM resection, although identification of the site is very important in the procedure. Here, we present two cases in which the sites of micro-AVM were marked using presurgical embolization and easily confirmed by intraoperative ultrasonography (IUS) and discuss the benefits of IUS in combination with presurgical embolization for low-grade micro-AVM. CASE DESCRIPTION: (Patient 1) A 30-year-old man was brought to our hospital and diagnosed with a micro-AVM, which was classified as SMG II AVM. He underwent evacuation of the intracerebral hematoma and subsequently underwent AVM resection. However, the lesion was not identified because it was not exposed in the cerebral cortex although we searched for the lesion. Therefore, endovascular embolization was performed before subsequent surgical resection. During AVM resection following embolization with Onyx, the IUS clearly demonstrated the Onyx-embolized lesion, and it was resected uneventfully. (Patient 2) A 46-year-old man with a ruptured SMG II AVM underwent AVM resection using a microsurgical technique with IUS after embolization for AVM preoperatively. IUS clearly showed abnormal vessels embolized with Onyx and indicated the correct location of the nidus, although the lesion was not observed directly from the brain surface. After identifying some embolized AVM constructions, we excised the entire AVM with ease and safety. CONCLUSION: The combined use of presurgical embolization, which focuses on marking the lesions and IUS, may contribute to improving surgical outcomes of low SMG micro-AVMs, which are not exposed on the brain surface. Scientific Scholar 2023-04-21 /pmc/articles/PMC10159302/ /pubmed/37151436 http://dx.doi.org/10.25259/SNI_242_2023 Text en Copyright: © 2023 Surgical Neurology International https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Case Report
Yokoya, Shigeomi
Takezawa, Hidesato
Hidaka, Yukihiro
Fujiwara, Gaku
Oka, Hideki
Ultrasound localization of embolic material to guide resection of brain AVM: Report of two cases
title Ultrasound localization of embolic material to guide resection of brain AVM: Report of two cases
title_full Ultrasound localization of embolic material to guide resection of brain AVM: Report of two cases
title_fullStr Ultrasound localization of embolic material to guide resection of brain AVM: Report of two cases
title_full_unstemmed Ultrasound localization of embolic material to guide resection of brain AVM: Report of two cases
title_short Ultrasound localization of embolic material to guide resection of brain AVM: Report of two cases
title_sort ultrasound localization of embolic material to guide resection of brain avm: report of two cases
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10159302/
https://www.ncbi.nlm.nih.gov/pubmed/37151436
http://dx.doi.org/10.25259/SNI_242_2023
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