Name: comprehensive endovascular and open surgical management of cerebral arteriovenous malformations
Uploaded: 2017-10-20T12:30:00
Description: Watch this Scientific Journal Video about Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations at JoVE.com

著者は、ucsd の AVM の患者の世話をする毎日に貢献してすべての臨床チームをありがとうございます。

脳脳動静脈奇形症例に対する制度のガイドラインに従ってインフォームド・コンセントを得る後の標準治療として以下のすべての手順を実行しています。
 1 です。 最初の患者の評価およびイメージング 注: 未破裂脳動静脈奇形症例が生じる頭痛や発作精密検査撮像の奇形を発見した後。頭痛、吐き気、嘔吐、脱力感、しびれ、または視力の変化の急...

<ol>
	<li>Spetzler, R. F., Martin, N. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+proposed+grading+system+for+arteriovenous+malformations.">A proposed grading system for arteriovenous malformations.</a> J Neurosurg. 65 (4), 476-483 (1986).</li><li>Stapf, C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Predictors+of+hemorrhage+in+patients+with+untreated+brain+arteriovenous+malformation.">Predictors of hemorrhage in patients with untreated brain arteriovenous malformation.</a> Neurology. 66 (9), 1350-1355 (2006).</li><li>Kondziolka, D., McLaughlin, M. R., Kestle, J. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Simple+risk+predictions+for+arteriovenous+malformation+hemorrhage.">Simple risk predictions for arteriovenous malformation hemorrhage.</a> Neurosurgery. 37 (5), 851-855 (1995).</li><li>Fukuda, K., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multicenter+assessment+of+morbidity+associated+with+cerebral+arteriovenous+malformation+hemorrhages.">Multicenter assessment of morbidity associated with cerebral arteriovenous malformation hemorrhages.</a> J Neurointerv Surg. , (2016).</li><li>Conger, A., Kulwin, C., Lawton, M. T., Cohen-Gadol, A. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endovascular+and+microsurgical+treatment+of+cerebral+arteriovenous+malformations:+Current+recommendations.">Endovascular and microsurgical treatment of cerebral arteriovenous malformations: Current recommendations.</a> Surg Neurol Int. 6, (2015).</li><li>Mohr, J. P., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Medical+management+with+or+without+interventional+therapy+for+unruptured+brain+arteriovenous+malformations+(ARUBA):+a+multicentre,+non-blinded,+randomised+trial.">Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial.</a> Lancet. 383 (9917), 614-621 (2014).</li><li>Crawford, P. M., West, C. R., Chadwick, D. W., Shaw, M. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Arteriovenous+malformations+of+the+brain:+natural+history+in+unoperated+patients.">Arteriovenous malformations of the brain: natural history in unoperated patients.</a> J Neurol Neurosurg Psychiatry. 49 (1), 1-10 (1986).</li><li>Lawton, M. T., Kim, H., McCulloch, C. E., Mikhak, B., Young, W. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+supplementary+grading+scale+for+selecting+patients+with+brain+arteriovenous+malformations+for+surgery.">A supplementary grading scale for selecting patients with brain arteriovenous malformations for surgery.</a> Neurosurgery. 66 (4), 702-713 (2010).</li><li>Hemphill, J. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Guidelines+for+the+Management+of+Spontaneous+Intracerebral+Hemorrhage:+A+Guideline+for+Healthcare+Professionals+From+the+American+Heart+Association/American+Stroke+Association.">Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.</a> Stroke. 46 (7), 2032-2060 (2015).</li><li>Gross, B. A., Frerichs, K. U., Du, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sensitivity+of+CT+angiography,+T2-weighted+MRI,+and+magnetic+resonance+angiography+in+detecting+cerebral+arteriovenous+malformations+and+associated+aneurysms.">Sensitivity of CT angiography, T2-weighted MRI, and magnetic resonance angiography in detecting cerebral arteriovenous malformations and associated aneurysms.</a> J Clin Neurosci. 19 (8), 1093-1095 (2012).</li><li>Hashimoto, T., Young, W. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Anesthesia-related+considerations+for+cerebral+arteriovenous+malformations.">Anesthesia-related considerations for cerebral arteriovenous malformations.</a> Neurosurg Focus. 11 (5), 5 (2001).</li><li>Seldinger, S. I. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Catheter+replacement+of+the+needle+in+percutaneous+arteriography;+a+new+technique.">Catheter replacement of the needle in percutaneous arteriography; a new technique.</a> Acta. 39 (5), 368-376 (1953).</li><li>Abando, A., Hood, D., Weaver, F., Katz, S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+the+Angioseal+device+for+femoral+artery+closure.">The use of the Angioseal device for femoral artery closure.</a> J Vasc Surg. 40 (2), 287-290 (2004).</li><li>Deshaies, E. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Multimodality+intraoperative+neurophysiological+monitoring+during+Onyx+embolization+of+cerebrovascular+malformations.">Multimodality intraoperative neurophysiological monitoring during Onyx embolization of cerebrovascular malformations.</a> Neurodiagn J. 55 (1), 12-24 (2015).</li><li>Vi&#241;uela, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Combined+endovascular+embolization+and+surgery+in+the+management+of+cerebral+arteriovenous+malformations:+experience+with+101+cases.">Combined endovascular embolization and surgery in the management of cerebral arteriovenous malformations: experience with 101 cases.</a> J Neurosurg. 75 (6), 856-864 (1991).</li></ol>

結合された血管内治療と手術の管理を開くを介して脳脳動静脈奇形に包括的なアプローチを示します。カテーテルを血管造影は脳動静脈奇形、イメージングのためのゴールド スタンダードです、手術の評価と計画する重要です。術前塞栓手術を簡略化できる最適な戦略的なアプローチを開発する手術、処置のチーム内のコミュニケーションが必要です。たとえば、最も簡単に塞栓 AVM の動脈?...

脳動静脈奇形 (少将)、動脈と静脈の間の通常毛管ベッドなし間の異常な接続は、ユニークな課題が脳神経外科。サイズに基づいて、深い流出静脈の存在感と説得力のある皮質、1 0.9 からの2 ~ 3% の年次平均破断リスクと、年間 8% まで以前未破裂脳動静脈奇形の出血のリスクが関与を分類しました。3脳動静脈奇形からの出血は死亡率率はほぼ 10%、中等度重度の障害からを有する患者の最大 34% と、重大な合併症に関連付けられています。4以前破裂脳動静脈奇形は、年間出血率、再破裂の比較的低即時の危険が2を増加しています。血腫から質量効果は、急性の介入を要求する場合を除き、その治療関連リスク対病変の予想される自然史を計量後治療はしばしば選択科目ごとに実行されます。5,6
外科的切除は、それはすぐに、決定的に将来の出血リスクを排除小さなアクセスできる脳動静脈奇形の治療の選択肢です。しかし、AVM による動脈瘤、4、7のリスクが高まるだけでなく、脳動静脈奇形、高流量すべて外科手術例の中で最も挑戦的な外科的切除になります。血流量が減少し、ハイリスクの AVM 機能を削除する脳動静脈奇形術前塞栓術は、切除術の技術的な課題を大きく削減できます。
総合的に訓練を受けた血管脳神経外科医は、両方の術前の血管造影および血管内塞栓術だけでなく、オープン切除行うによって決定的に脳動静脈奇形を治療するために一意に配置されます。本明細書で述べるアクセス手術脳脳動静脈奇形の管理用プロトコル (確立されたグレーディング スケール1,8と同様、外科医および学際的な会議評価によって定義) として当院で。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>ChloraPrep Sterilization Solution</td>
			<td>BD, Franklin Lakes, NJ</td>
			<td>260815</td>
			<td>For skin sterilization</td>
		</tr>
		<tr>
			<td>Lidocaine Hcl 1%&#160;</td>
			<td>ACE Surgical Supply, Inc, Brockton, MA</td>
			<td>001-1421</td>
			<td>For local anesthetic</td>
		</tr>
		<tr>
			<td>Micropuncture Groin Access Kit</td>
			<td>Cook Medical, Bloomington, IN</td>
			<td>G56202</td>
			<td>Used for femoral artery access</td>
		</tr>
		<tr>
			<td>0.035 Guidewire&#160;</td>
			<td>Terumo Medical, Somerset, NJ</td>
			<td>GR3506</td>
			<td>Used in conjunction with diagnostic catheters for cerebral angiography</td>
		</tr>
		<tr>
			<td>Cerebral Angiography Diagnostic Catheters&#160;</td>
			<td>Terumo Medical, Somerset, NJ</td>
			<td>CG416</td>
			<td>Used in conjunction with guidewire for cerebral angiography</td>
		</tr>
		<tr>
			<td>Omnipaque Contrast Agent</td>
			<td>GE Healthcare, Chicago, IL&#160;</td>
			<td>Q9965</td>
			<td>Contrast agent for cerebral vessel imaging</td>
		</tr>
		<tr>
			<td>Microcatheter and Microwire</td>
			<td>Covidian, Plymouth, MN</td>
			<td>105-5091-150, 103-0608</td>
			<td>Used for distal arterial catheterization</td>
		</tr>
		<tr>
			<td>Onyx Liquid Embolic</td>
			<td>Covidian, Plymouth, MN</td>
			<td>105-7100-060</td>
			<td>Used for AVM embolization</td>
		</tr>
		<tr>
			<td>Angio-Seal Vascular Closure Device</td>
			<td>St. Jude Medical, St Paul, MN</td>
			<td>610130</td>
			<td>Used for femoral artery closure following angiography/intra-arterial embolization</td>
		</tr>
		<tr>
			<td>Midas Rex High Power Drill System</td>
			<td>Medtronic, Minneapolis, MN</td>
			<td>PM700</td>
			<td>Used for craniotomy&#160;</td>
		</tr>
		<tr>
			<td>Matchstick Drill Bit</td>
			<td>Medtronic, Minneapolis, MN</td>
			<td>10MH30-MN</td>
			<td>Used to create burr hole for craniotomy&#160;</td>
		</tr>
		<tr>
			<td>Tapered Drill Bit</td>
			<td>Medtronic, Minneapolis, MN</td>
			<td>F1/8TA15</td>
			<td>Used to complete craniotomy&#160;</td>
		</tr>
		<tr>
			<td>#11 and 15 Blade Surgical Scalpels</td>
			<td>BD Bard-Parker, Franklin Lakes, NJ</td>
			<td>372615&#160;</td>
			<td>Used for groin incision for angiography and dural opening for external ventricular drain placement or AVM resection</td>
		</tr>
		<tr>
			<td>Metzenbaum Dissecting Scissors</td>
			<td>Stoelting Co, Wood Dale, IL</td>
			<td>52134-01P</td>
			<td>Used for dural opening</td>
		</tr>
		<tr>
			<td>Bone Elevator</td>
			<td>Stoelting Co, Wood Dale, IL</td>
			<td>52169</td>
			<td>Used for separating dura from the inner skull</td>
		</tr>
		<tr>
			<td>Gerald Forceps</td>
			<td>Stoelting Co, Wood Dale, IL</td>
			<td>52106-52</td>
			<td>Used for dural opening and manipulation</td>
		</tr>
		<tr>
			<td>Microsurgical Instruments&#160;</td>
			<td>Accurate Surgical &#38; Scientific Instruments Corporation, Westbury, NY</td>
			<td>ASSI.BML1</td>
			<td>Used for AVM microsurgical resection</td>
		</tr>
		<tr>
			<td>Bipolar Forceps&#160;</td>
			<td>Accurate Surgical &#38; Scientific Instruments Corporation, Westbury, NY</td>
			<td>ASSI.BPNS20423FP</td>
			<td>Used for AVM microsurgical resection</td>
		</tr>
		<tr>
			<td>Electrosurgery Generator</td>
			<td>Bovie Medical Products, Clearwater, FL&#160;</td>
			<td>IDS-200&#160;</td>
			<td>Used for electrosurgical cutting/coagulation</td>
		</tr>
		<tr>
			<td>Small Aneurysm Clips</td>
			<td>Codman Neuro, Raynham, MA</td>
			<td>20-1801</td>
			<td>Used for occlusion of arterial AVM feeders not amenable to coagulation</td>
		</tr>
		<tr>
			<td>Brain Retractors</td>
			<td>Medicon, Tuttlingen, Germany</td>
			<td>22.00.06</td>
			<td>For brain retraction for deep AVM dissection/resection</td>
		</tr>
		<tr>
			<td>Variable Action Suction tip</td>
			<td>Millennium Surgical, Narberth, PA</td>
			<td>6-8607</td>
			<td>For suction with AVM dissection/resection</td>
		</tr>
		<tr>
			<td>Fibrillar Absorbable Hemostatic Agent</td>
			<td>Ethicon, Somerville, NJ</td>
			<td>63713-0019-61</td>
			<td>For hemostatis within surgical cavity</td>
		</tr>
		<tr>
			<td>4-0 Suture</td>
			<td>Ethicon, Somerville, NJ</td>
			<td>C554D</td>
			<td>For dural closure</td>
		</tr>
		<tr>
			<td>2-0 Absorbable Suture</td>
			<td>Ethicon, Somerville, NJ</td>
			<td>J286G</td>
			<td>For deep tissue closure</td>
		</tr>
		<tr>
			<td>3-0 Nylon Suture</td>
			<td>Ethicon, Somerville, NJ</td>
			<td>ET-663G</td>
			<td>For skin closure</td>
		</tr>
		<tr>
			<td>Surgical Staples&#160;</td>
			<td>Medline, Mundelein, IL</td>
			<td>STAPLER35RB</td>
			<td>For skin closure</td>
		</tr>
		<tr>
			<td>Bone Plating System</td>
			<td>Biomet, Warsaw, IN</td>
			<td>15-7378-12</td>
			<td>For bone flap securement</td>
		</tr>
		<tr>
			<td>Operating Microscope</td>
			<td>Leica Microsystems, Buffalo Grove, IL</td>
			<td>M720 OH5</td>
			<td>Used for AVM microsurgical resection</td>
		</tr>
		<tr>
			<td>BrainLab Neuronavigation Imaging System</td>
			<td>Brainlab, Inc, Chicago, IL</td>
			<td>Brainlab Curve&#160;</td>
			<td>Used for AVM microsurgical resection</td>
		</tr>
		<tr>
			<td>Lumbar External Drainage System</td>
			<td>Codman Neuro, Raynham, MA</td>
			<td>K964923</td>
			<td>Used for placement of lumbar drain for CSF drainage</td>
		</tr>
		<tr>
			<td>External Ventricular Drainage Catheter</td>
			<td>Medtronic, Minneapolis, MN</td>
			<td></td>
			<td>Used for placement of ventricular catheter for CSF drainage</td>
		</tr>
		<tr>
			<td>Disposable Raney Scalp Clips</td>
			<td>A&#38;E Medical Corporation, Farmingdale, NJ</td>
			<td>070-001</td>
			<td>Used for scalp hemostasis</td>
		</tr>
	</tbody>
</table>

comprehensive endovascular and open surgical management of cerebral arteriovenous malformations

Arteriovenious 奇形 (少将) は重要な罹患率と死亡率と関連付けられ、年間 ~ 3% の破裂のリスクがあります。小さな、アクセス可能な病変のゴールド スタンダードをされている外科的切除で病変、具体的に脳動静脈奇形の治療していかなければなりません。脳動静脈奇形術前塞栓術はニダル血流を減らすし、挑戦的な脳神経外科の手順を簡略化、intranidal または静脈の動脈瘤などハイリスクの AVM 機能を削除できます。ここで、段階的な血管内塞栓術、脳動静脈奇形、オープン切除のための我々 のアプローチと臨床チームは学際的総合的に訓練を受けた神経血管外科医を持つことの利点を強調.開頭術と切除術により積極的な塞栓術と迅速な切除の麻酔の 1 つのセッションを使用して、最終的な塞栓術ステージの直後に計画が含まれます。最後に、正常に段階的塞栓オープン切除による治療を受けた発作精密検査中に診断された未破裂右前頭部 AVM と 22 歳の女性の代表的なケースを提供します。

新しいてんかん発作を呈した 22 歳以前に健康な女性。非造影頭部 CT 急性出血に対する否定的だったが、不完全に特徴付けられた右前頭葉病変を明らかにしました。MRI を示した、約 2.9 x 2.4 cm Spetzler マーティン グレード 3 AVM 優れた上矢状静脈洞と動脈供給しようとして右の大きい枝を介して大規模な流出皮質静脈と右前頭 (図 1)、内中大脳動脈。(?...

Watch this Scientific Journal Video about Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations at JoVE.com

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

手術は、アクセス可能な arteriovenious 奇形 (少将) のゴールド スタンダードと術前塞栓術は、この手順を簡略化できます。段階的な血管内塞栓術、脳動静脈奇形、オープン切除のための我々 のアプローチを記述する臨床チームは学際的総合的に訓練を受けた神経血管外科医の長所を強調する代表的な臨床例を提供しています.

包括的な血管内治療、脳動静脈奇形のオープン手術の管理

Arteriovenious malformations (AVMs) are associated with significant morbidity and mortality, and have a rupture risk of ~3% per year. Treatment of AVMs ...

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Neuroscience

Focal Cerebral Ischemia Model by Endovascular Suture Occlusion of the Middle Cerebral Artery in the Rat

ラット中大脳動脈の血管縫合閉塞による局所脳虚血モデル

Stroke is the leading cause of disability and the third leading cause of death in adults worldwide1. In human stroke, there exists a highly variable ...

Dual Electrophysiological Recordings of Synaptically-evoked Astroglial and Neuronal Responses in Acute Hippocampal Slices

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Astrocytes form together with neurons tripartite synapses, where they integrate and modulate neuronal activity. Indeed, astrocytes sense neuronal inputs ...

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単離および脳実質細動脈のカニューレ挿入

Intracerebral parenchymal arterioles (PAs), which include parenchymal arterioles, penetrating arterioles and pre-capillary arterioles, are high resistance ...

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This manuscript describes a streamlined protocol for the management of patients with acute ischemic stroke, which aims at the minimization of time from ...

A Rat Model of Mild Intrauterine Hypoperfusion with Microcoil Stenosis

栓塞狭窄軽度子宮内血流の低下のモデルラット

Intrauterine hypoperfusion/ischemia is one of the major causes of intrauterine/fetal growth restriction, preterm birth, and low birth weight. Most studies ...

Simulator Training for Endovascular Neurosurgery

血管内脳神経外科シミュレータトレーニング

Simulation-based training has become common practice across medical specialties, especially for learning complex skills performed in high-risk ...

Endovascular Perforation Model for Subarachnoid Hemorrhage Combined with Magnetic Resonance Imaging (MRI)

Endovascular Perforation Model for Subarachnoid Hemorrhage Combined with Magnetic Resonance Imaging MRI

くも膜下出血の血管内穿孔モデルと磁気共鳴画像法(MRI)の組み合わせ

The endovascular filament perforation model to mimic subarachnoid hemorrhage (SAH) is a commonly used model - however, the technique can cause a high ...

Comprehensive Understanding of Inactivity-Induced Gait Alteration in Rodents

げっ歯類における不活動誘発歩行変化の包括的理解

It is well known that disuse affects neural systems and that joint motions become altered; however, which outcomes properly exhibit these characteristics ...

Mapping Cerebral Blood Flow and Electrical Fields: Electrode Placement in Mice

Placement of Extracranial Stimulating Electrodes and Measurement of Cerebral Blood Flow and Intracranial Electrical Fields in Anesthetized Mice

Stimulation-Based Approach to Improve Cerebral Blood Flow in Alzheimer's Model (Video) | JoVE

麻酔マウスにおける頭蓋外刺激電極の配置と脳血流および頭蓋内電界の測定

The detection of cerebral blood flow (CBF) responses to various forms of neuronal activation is critical for understanding dynamic brain function and ...

Unveiling Mitochondrial Ultrastructure in Neurons Using STED Microscopy

Using Live Cell STED Imaging to Visualize Mitochondrial Inner Membrane Ultrastructure in Neuronal Cell Models

Decoding Mitochondrial Aging (Video) | JoVE

生細胞STEDイメージングを用いた神経細胞モデルにおけるミトコンドリア内膜の微細構造の可視化

Mitochondria play many essential roles in the cell, including energy production, regulation of Ca2+ homeostasis, lipid biosynthesis, and production of ...