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Douglas Chyatte

V ascular malformations of the brain stem are unusual lesions and often present with catastrophic neurological dysfunction. 1, 4–7, 9–11, 16, 19, 23, 24, 26, 28 Because of their treacherous location, surgical removal of these anomalies has been considered hazardous or impossible. 13, 16, 24, 25 Reports of resection of these lesions are rare and few authors recommend surgical treatment of brain-stem malformations. 1–3, 5, 6, 8, 11, 12, 14, 15, 17, 18, 21–23, 27 Seven patients with vascular malformations involving the brain stem were referred to us for

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M. Neil Woodall, Melissa McGettigan, Ramon Figueroa, James R. Gossage and Cargill H. Alleyne Jr.

patients with possible or definite HHT for cerebral vascular malformations (CVMs) using MRI with and without contrast enhancement, including sequences to detect blood products to increase sensitivity. 13 , 35 Debate exists in the literature regarding this recommendation, as some authors argue that cerebral AVMs in HHT have a different natural history and lower spontaneous rupture rate (as low as 0.36%–0.56% per year) than AVMs in the general population. 21 , 24 , 41 In the present study, we set out to further characterize the types and frequency, as well as the

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Dudley H. Davis and Patrick J. Kelly

autopsy verification. With these imaging techniques, diagnosis of an occult vascular malformation can be made with a high degree of accuracy. 2, 9, 13, 15, 16, 21 On CT, the lesions can appear as small, hyperdense masses that may show mottled calcification. They show mild to moderate contrast enhancement and little mass effect in the absence of hemorrhage. On MR imaging, the lesions appear as heterogeneous, circumscribed masses that will have signal-void areas secondary to the paramagnetic effect of hemosiderin. Low-grade neoplasms are frequently in the differential

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Christopher S. Eddleman, Hyun Jeong, Ty A. Cashen, Matthew Walker, Bernard R. Bendok, H. Hunt Batjer and Timothy J. Carroll

S pinal vascular malformations are an uncommon, heterogeneous group of vascular anomalies that can render devastating neurological consequences if they are not diagnosed and treated in a timely fashion. The most common classification system separates SVMs into the following 4 types: spinal DAVFs (Type I), intramedullary glomus malformations (Type II), extensive juvenile or metameric malformations (Type III), and perimedullary spinal cord AVFs (Type IV). 2 , 4–6 , 14 However, Kim and Spetzler 9 recently proposed a new classification system based on the

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Charles B. Wilson, Hoi Sang U and James Domingue

B etween July, 1968, and August, 1978, 83 patients with intracranial vascular malformations (AVM's) were operated on by C.B.W. The operative procedure employed was either total excision or clipping of feeding arteries. This experience is the subject of the present report, which gives particular attention to 1) large arteriovenous shunts associated with chronic ischemia of the surrounding brain, and 2) deeply situated occult malformations that bleed despite the absence of pathological vessels discernible by angiography. Clinical Material Location and

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Martin Pham, Bradley A. Gross, Bernard R. Bendok, Issam A. Awad and H. Hunt Batjer

A ngiographically occult vascular malformations are a heterogeneous group of lesions that include CMs, cryptic or thrombosed AVMs, capillary telangiectasias, venous malformations, and mixed lesions. 15 , 43 Recent reports have indicated that the majority (up to 96%) of AOVMs are CMs, 60 with prospective natural history data showing symptomatic, radiographically verified, extralesional annual hemorrhage rates ranging from 0.7 to 3.1%. 32 , 45 Several authors have described the potential for highly aggressive lesion behavior with accumulating resultant

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Hideo Terao, Tomokatsu Hori, Masao Matsutani and Riki Okeda

C ryptic vascular malformations are not a frequent cause of intracerebral or subarachnoid hemorrhage (SAH), and are rarely demonstrated by angiography. Computerized tomography (CT), however, holds great promise as an effective, noninvasive means of diagnosing this entity. Since April, 1977, two cases of cryptic angioma with intracerebral hematoma or SAH were detected by CT in our hospital. The vascular malformations were surgically removed and studied histologically. During the same period, six cases of spontaneous intracerebral hematomas and seven cases of

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Mark E. Linskey, Peter J. Jannetta and A. Julio Martinez

I n most clinical series, 7% to 17% of intracranial vascular malformations arise in the posterior fossa. 9, 24, 31 A prospective autopsy series of vascular malformations placed the figure at 13% 25 while a retrospective autopsy series arrived at a figure of 32%. 26 Vascular malformations of the posterior fossa can be divided into those in the cerebellum, in the brain stem, and in the cerebellopontine angle (CPA). 10, 22, 35 Of the three types, those in the cerebellum are the most common. 22, 26 Vascular malformations constitute less than 1% of all

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Aaron A. Cohen-Gadol and Dennis D. Spencer

, and then died. …” (II Kings 4:18–20) The exact cause of the child's apoplexy is not clear. Considering his youth, we suspect the cause of the apoplexy may be more likely related to the rupture of an intracranial AVM than an aneurysm. 5 Gaupp reported one of the earlier published cases of cerebral AVM in 1888; the lesion was described as a “hemorrhoid of the pia mater.” 6 Before Cushing came on the scene, a handful of surgeons unexpectedly exposed vascular malformations during exploratory craniotomies; however, their attempts at resection led to disastrous results

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Ricky Medel, R. Webster Crowley and Aaron S. Dumont

S pinal vascular malformations represent a rare and complex group of heterogeneous pathological entities whose optimal management remains in continuous evolution. Given the ever-increasing role of endovascular therapy, we endeavored to review the current literature regarding this therapeutic approach and to provide recommendations guiding management. Endovascular Treatment of Spinal Vascular Malformations Although variable in pathophysiology and clinical presentation, these lesions have been recognized for their considerable attendant morbidity since