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F Turjman

Publications and source records attributed to F Turjman.

At least 37 records · Page 2Linked to original sources
PubMed1998

Predictors of aneurysmal occlusion in the period immediately after endovascular treatment with detachable coils: a multivariate analysis.

BACKGROUND AND PURPOSE: Complete intracranial aneurysmal occlusion by endovascular techniques is required for successful treatment and is presumably influenced by several parameters. The purpose of this study was to investigate whether operator experience and angiographic characteristics of intracranial aneurysms correspond to the degree of endovascular occlusion in the period immediately after treatment with Guglielmi detachable coils (GDCs). METHODS: Pre- and posttreatment angiograms of 72 patients undergoing GDC treatment were reviewed retrospectively. The following angiographic characteristics of the aneurysms were evaluated: largest diameter of the sac, volume, neck size, shape, type, cerebrovascular site, surroundings, and likely direction of aneurysmal inflow as judged by a score developed by measuring aneurysm/parent artery angulation. The chronological sequence in which the aneurysms were treated was used as a measure of operator experience. A chi2-test was used to identify parameters that correlated with outcomes of total (100%) or partial (<100%) occlusion. A multivariate analysis was used to determine the factors most predictive of aneurysmal occlusion at therapy. RESULTS: Parameters that correlated with the unsatisfactory result of partial occlusion were large aneurysmal diameter, volume, and neck size, more direct inflow (ie, increasingly obtuse aneurysm/parent artery angulation), and early chronological presentation in the series. The three factors most predictive of partial occlusion were large aneurysmal diameter, more direct inflow, and early chronological order of treatment. CONCLUSION: Several morphologic features of aneurysms were identified to help predict the immediate outcome of occlusion with GDCs. This study underscores the existence of a steep learning curve associated with GDC use in treating aneurysms and the importance of operator experience in achieving optimal therapeutic results.

Cerebral Angiography↗
PubMed1997

Depth separation in ten observers with a new stereoscopic X-ray acquisition system.

The aim of this work was to assess the depth separation of a new X-ray digital stereo angiographic system through visualization on a stereoscopic monitor. Before starting the clinical trial of this new stereo-digital angiographic system, it seemed to us mandatory to assess the inherent performance of the system to depict depth information, as well as the ability of the users to work with it. With this idea we designed a global test based on the observation of a physical test object by the potential users of the system, during a session long enough to simulate an angiographic study. The acquisition system consisted of a twin focal-spot X-ray tube and a standard DSA DG 300 (General Electric/CGR). The stereo display was controlled by a liquid crystal modulator placed in front of a black-and-white monitor. Special polarized glasses worn by the observers allowed right- and left-image separation. Depth separation was measured in ten observers by means of a stereoscopic test object. Six of the ten observers were able to locate accurately three-dimensional patterns separated by a 12- to 1.5-mm gap. No learning effect was noticed. This result suggested that stereo display through wireless polarized glasses coupled to up-to-date digital subtraction angiography technology may provide an accurate and ergonomic way to a dimensional enhancement of X-ray angiography.

Angiography, Digital Subtraction↗
PubMed1997

[An experimental study of the treatment of aneurysms using an intravascular prosthesis].

Intracranial aneurysms occur frequently with the risk of major damage. Neurosurgery or endovascular techniques can be used for treatment. Current techniques are not well adapted for aneurysms with a wide implantation (or neck). The aim of this experimental work was to study a technique for treating aneurysms which can be used for wide neck aneurysms. A metal stent is implanted facing the neck of the aneurysm to allow occlusion. In the first part of the study, the stent was inserted alone. Ten aneurysms were created surgically in five dogs. The stents were positioned facing seven of the ten aneurysms. The stent led to immediate occlusion of the aneurysm in six of the cases. One aneurysm remained patent despite the correct position of the stent. One dog developed secondary thrombosis of the carotid. Three dogs have been followed for sixty days after insertion of the stent. Two aneurysms thrombosed and one was patent. Since these results were less than satisfactory, a second part of the study was undertaken to cover the stent with a fragment of the autologous vein. Results in five aneurysms, evaluated three and eight weeks after treatment, showed partial or total repermeabilization of the aneurysms. In the third part of the study, we associated stents and detachable coils. Twelve aneurysms of the carotid artery in pigs were thrombosed and two aneurysms were completely occluded after stent implantation. In the nine other cases, the aneurysms were completely occluded after stent implantation. In the nine other cases, the aneurysms remained patent despite the stent and treatment was then completed with a coil. Six of the animals have been followed for thirteen weeks. One carotid artery thrombosed. In the five other cases, the carotid arteries were patent and the aneurysms were occluded at the control angiogram. Histology results showed the presence of a fibromuscular endothelialized neointima at the neck of the aneurysm in four of the five cases. The technique described here could be proposed for the treatment of wide-neck aneurysms implanted low on the carotid artery in man. Improvements should render the system more flexible.

Aneurysm↗
PubMed1997

[Postoperative arteriography in surgery for intracranial aneurysm. Prospective study in a consecutive series of 267 operated aneurysms].

OBJECTIVES: We present the results of a prospective study of post-operative angiographic data in a consecutive series of 267 intracranial aneurysms (in 217 patients) operated on by the same surgeon (M.S.). MATERIAL AND METHODS: All patients underwent a preoperative as well as a postoperative angiographic control. Besides, an analysis of the operative reports was done in order to correlate the surgical and angiographic data. RESULTS: Out of 267 operated aneurysms, 257 (96%) were located in the anterior circulation, and 10 (4%) in the posterior circulation. The surgical clipping was considered incomplete in 17 aneurysms (6.3%). Aneurysmal remnants were classified in 5 grades; grade I: remnant less than 50% of the neck size; grade II: remnant more than 50% of the neck size; grade III: remnant of a multilobed aneurysmal sac; grade IV: residual sac less than 75% of the aneurysmal size; and grade V: residual sac more than 75% of the aneurysmal size. The analysis of the operative reports helped in understanding the favoring factors of incomplete clipping: large neck and/or huge sized sac, insufficient exposure and dissection of the neck. The presence of a collateral artery with a large infundibulum in the vicinity of the neck-implantation zone on the parent artery. CONCLUSIONS: In most cases the surgeon can easily control peroperatively under the microscope, after puncture-evacuation of the sac, the watertightness of clipping and the absence of any residual neck or sac of the aneurysm. Therefore the remaining place for a postoperative arteriography can be limited to those cases when the surgeon has some doubt concerning the perfection of clipping, as well as for giant and/or "difficult" aneurysms. A re-operation or a complementary endovascular treatment can be discussed for remnants in graded III, IV or V. Knowledge concerning the percentages of aneurysm with neck remnant only and of aneurysms with sac remnant obtained by surgery is interesting at the present time when endovascular treatment is becoming popular. In our series they amounted at 4.1% and 2.2%, respectively. These percentages are those of a series comprising all types of aneurysms. Needless to say, that the percentage of incomplete occlusion will be less if only the aneurysms with small-sized neck were taken into account.

Adult↗
PubMed1996

Late MR follow-up of hypothalamic hamartomas.

The absence of changes over time in the diagnostic features of suspected hypothalamic hamartomas is of paramount importance. Since magnetic resonance (MR) imaging is very sensitive to modifications in the brain parenchyma, a late MR follow-up study was performed in five children. In all cases, the diagnosis of hypothalamic hamartoma has been suspected on the basis of the association of central precocious puberty and the presence of a mass in the inferior aspect of the hypothalamus, demonstrated on previous MR studies. Late MR evaluation (after a mean of 39 months) demonstrated stability of the lesions in shape, size, and signal intensity. In three cases the lesions demonstrated a rim of isointense signal with a hyperintense center on T2-weighted sequences. In two cases a Chiari I malformation was found in association with the hypothalamic malformation. In one case a pineal cyst was demonstrated. These unusual findings are discussed. Late MR follow-up showed the absence of changes in the lesions over time, allowing the diagnosis to be confirmed.

Arnold-Chiari Malformation↗
PubMed1996

Complications after multidisciplinary treatment of cerebral arteriovenous malformations.

PATIENTS AND TECHNIQUES: A series of 67 patients treated for cerebral AVMs with a multidisciplinary approach is reported, with special attention for the complications due to treatment. The malformations were classified after the Spetzler Grading Scale, with 67% low-grade and 33% high-grade AVMs. Three modes of treatment were used: surgical resection, endovascular embolization, and radiosurgery (linear accelerator technique). The actual treatment was: resection alone (25% of cases), embolization plus resection (24%), embolization alone (21%), and radiosurgery (30%), either alone or after embolization or surgery. The following eradication rates were obtained: overall 80%, after resection (with or without embolization) 91%, after embolization alone 13%, after radiosurgery 87%. CLINICAL OUTCOME: The outcome was evaluated in terms of deterioration due to treatment. A deterioration after treatment occurred in 19 patients (28%), and was a minor deterioration (19%), a neurological deficit (4%), or death (4%). As far as the mode of treatment is concerned, surgical resection was responsible for deterioration (minor) in 17% of all cases operated upon. Radiosurgery was followed by a minor deterioration in 10% of irradiated cases. Embolization gave a complication in 25% of all embolized cases (minor or neurological deficit, or death). The mechanism of the complications was: resection or manipulation of an eloquent area during surgery, radionecrosis after radiosurgery, ischaemia and haemorrhage (50% each) following embolization. In most cases of haemorrhage due to embolization, occlusion of the main venous drainage could be demonstrated. DISCUSSION: The haemodynamic disturbances to AVMs and to their treatment are reviewed in the literature. The main haemodynamic mechanisms admitted at the beginning of a complication after treatment of cerebral AVMs are the normal perfusion pressure breakthrough syndrome, the disturbances of the venous drainage (venous overload or occlusive hyperaemia), and the retrograde thrombosis of the feeding arteries. CONCLUSIONS: According the authors' experience, the emphasis of treatment for cerebral AVMs has now shifted from surgical resection to endovascular embolization. One of the explanations is that endovascular techniques are now employed in the most difficult cases (high grade AVMs). As severe complications of endovascular embolization may also occur for low-grade malformations, the question arises whether surgery or radiosurgery should not be used first for this low-grade group even if embolization is feasible.

Adult↗
PubMed1996

A phase II trial of fotemustine and cisplatin in central nervous system metastases from non-small cell lung cancer.

A phase II study was conducted in order to determine the feasibility and toxicity of cisplatin combined with the nitrosourea fotemustine in central nervous system metastases from non-small cell lung cancer. 31 chemotherapy-naïve patients were included between November 1990 and April 1993. Computed tomography scan-documented tumour regression in brain metastases was observed in 7 of the 25 evaluable patients, but only 4 of these (16%) lasted more than 4 weeks. In 2 of these 4 patients, the response on central nervous system metastases was considered as complete. The median duration of response was 20.5 weeks and the median survival was 16 weeks overall and 28.5 weeks for responding patients. The limiting toxicity of this regimen was haematological. 2 patients died from infectious pneumonitis while in neutropenia. Treatment delays due to haematological toxicity occurred in 57% of patients. Despite the rather encouraging response rate, such toxicity appears too high when compared to the overall bad prognosis of this population of patients. Cranial radiotherapy remains the standard treatment in this setting and should only be compared in the future to less aggressive schedules.

Adult↗
PubMed1996

Diagnostic utility of somatosensory evoked potentials (SEPs) in presurgical assessment of cervical spondylotic myelopathy.

Median and tibial nerve SEPs were recorded in 27 patients with spondylotic myelopathy. SEP data were compared with clinical and MRI data. SEPs were abnormal in all but five patients. Segmental dysfuction of the cervical cord was observed in 12 patients (45%), whereas abnormality of dorsal column conduction was observed in 10 (37%) and 16 (59.3%) patients after median and tibial nerve stimulation, respectively. No clear correlation was found between the severity of MRI abnormalities and that of clinical presentation or SEP abnormalities. However, there was no patient with normal SEPs and severe MRI abnormalities, including narrowing of cervical cord diameter or impingement of the cervical cord or intramedullary T2 signal hyper intensity. Conversely, 8 of the 13 patients with no evidence of cord narrowing or T2 signal abnormality showed abnormal SEPs. This divergence between SEP and MRI data suggests that SEP recording should be included in presurgical assessment of these patients, especially those without clear MRI evidence of cervical cord compression.

Evaluation Studies as Topic↗
PubMed1996

Open trial of intravenous tissue plasminogen activator in acute carotid territory stroke. Correlations of outcome with clinical and radiological data.

BACKGROUND AND PURPOSE: Pilot studies using early thrombolytic therapy in stroke have suggested that recombinant tissue plasminogen activator (rTPA) might be effective. While large, double-blind, randomized studies are needed, open trials could generate hypotheses concerning (1) the clinical correlations of outcome, (2) the significance of CT scan data during the first week, and (3) the use of adjunctive therapies. METHODS: We performed an open trial of intravenous rTPA on patients referred to our emergency service with all types of ischemic stroke in the carotid territory. All patients between 20 and 81 years hospitalized during 1994 with completed stroke in the internal carotid artery territory and a baseline Scandinavian Stroke Scale score lower than 48, even with severe disturbances of consciousness, were included. The inclusion time was within 7 hours after stroke onset. A 0.8-mg/kg dose of rTPA was infused for 90 minutes. Intravenous heparin was given either immediately at efficient dosage or after 24 hours. Mannitol was used in patients with severe presentation. The Scandinavian Stroke Scale evaluation was done at baseline, 3 hours, and 1, 7, 30, and 90 days. The CT scan was performed before the treatment and at days 1 (24 +/- 6 hours) and 7. RESULTS: Forty-three consecutive patients met the criteria of the protocol. The mean age at inclusion was 65 +/- 10.4 years, and the mean interval to treatment was 232 +/- 79 minutes. At day 90, 25 patients (58.1%) exhibited a complete regression of symptoms, and 3 had moderate neurological sequelae. Thirteen patients had severe neurological sequelae, 11 with infarcts and 2 with secondary parenchymal hematomas. Two patients died (4.6%), 1 with hematoma. The overall hematoma rate was 6.9%. Excellent outcome at day 90 was significantly correlated with major neurological improvement at day 1. Intravenous immediate heparin versus delayed heparin after 24 hours improved the ischemic outcome but not the overall outcome. Reinfarction syndromes after major neurological improvement, likely to be rethrombosis syndromes, were observed in 3 patients (6.9%). For the day 1 CT scan, poor outcome was associated with the presence of structured and homogeneous hypodensities likely to represent classic infarcts, as confirmed by day 7 CT scan. Conversely, total recovery was significantly associated with the absence of any image or with unstructured hypodensities, a particular type of image characterized by its heterogeneous darkness and often polylobar shape. This type of image disappeared at day 7 in 17.6% of the cases and is likely to represent reperfusion images and/or incomplete ischemic damage. CONCLUSIONS: The results obtained in this open, small study suggest safety and effectiveness of rTPA thrombolysis at the dose of 0.8 mg/kg within 7 hours in acute strokes of the carotid territory, including highly serious baseline neurological presentations, until age 81 years and under special therapeutic conditions. Complete recovery is significantly associated with major neurological improvement during the first 24 hours and the presence of a particular type of image at day 1 CT scan characterized by an unstructured hypodensity, often polylobar and heterogeneous, which is likely to correspond to reperfusion images.

Adult↗
PubMed1996

[Therapeutic risk in multidisciplinary approach of cerebral arteriovenous malformations].

PATIENTS AND TECHNIQUES: A series of 67 patients treated for cerebral AVMs using a multidisciplinary approach is reported, paying special attention to the complications due to treatment. The malformations were classified according to the Spetzler Grading Scale, with 67% low-grade and 33% high-grade AVMs. Three modes of treatment were used: surgical resection, endovascular embolization, and radiosurgery (linear accelerator technique). The actual treatment was: resection alone (25% of cases), embolization plus resection (24%), embolization alone (21%), and radiosurgery, (30%) either alone or after embolization or surgery. The following eradication rates were obtained: 80% overall, 91% after resection (with or without embolization), 13% after embolization alone, 87% after radiosurgery. CLINICAL OUTCOME: The outcome was evaluated in terms of deterioration due to treatment. Treatment-related deterioration occurred in 28% of cases and consisted of a minor deterioration (19%), a neurological deficit (4%), or death (4%). As far as the mode of treatment is concerned, surgical resection was followed by deterioration in 20% of all operated cases (minor 17%, deficit 3%). Radiosurgery was followed by a minor deterioration in 10% of irradiated cases. Embolization resulted in complication in 25% of all embolized cases (minor 12.5%, neurological deficit 5%, or death 7.5%). The mechanism of the complication was: resection on manipulation of a functional area and the haemorrhage for cases treated by surgery, radionecrosis for radiosurgery, ischemia and haemorrhage (50% each) for embolization. In 4 out of the 5 cases of haemorrhage due to embolization, an occlusion of the main venous drainage could be demonstrated. DISCUSSION: The haemodynamic disturbances relating to AVMs and to their treatment are reviewed in the literature. The main haemodynamic mechanisms at the origin of a complication after treatment of cerebral AVMs are the normal perfusion pressure breakthrough syndrome, venous drainage defects (venous overload or occlusive hyperemia), and retrograde thrombosis of the feeding arteries. CONCLUSIONS: Improved treatment of cerebral AVMs has been achieved through the multidisciplinary approach, and especially through the endovascular embolization technique. Such an improvement is especially visible in the field of high-grade malformations, which are the most difficult and the most dangerous to treat. As a consequence, the risk of the treatment has naturally shifted from surgical resection towards endovascular embolization which is the first procedure to be performed in difficult cases. Careful consultation between the various specialists is necessary in this pathology, particularly as some of these AVMs are a good indication for each of the three available methods of treatment.

Adult↗
PubMed1996

Laboratory simulations and training in endovascular embolotherapy with a swine arteriovenous malformation model.

We assessed the suitability of a swine experimental arteriovenous malformation model for laboratory simulations and training in endovascular embolotherapy. Embolizations with liquid glue or particles were performed in 10 animals. The parameters of injection (microcatheter position, concentration and volume of embolic agent, injection rate) were deliberately varied to simulate results that may be observed in clinical practice. A range of successful and less desirable therapeutic outcomes or complications was simulated. In one model, intravascular mean blood pressure in the "terminal feeder" rose after "nidus" embolization, consistent with observations in feeders of cerebral arteriovenous malformations. Experience in the technical aspects of embolotherapy was gained by repeated performances using this model. Simplicity of creation, clear angiographic visibility of feeders, a nidus and a draining vein, and hemodynamic similarities with cerebral arteriovenous malformations make this an attractive in vivo experimental model for learning the principles of embolotherapy, testing new embolic agents, and training/gaining experience in embolization techniques.

Animals↗
PubMed1996

[Diagnosis of a post-thrombophlebitic dural fistula using MR angiography].

We report a case in which MRA made it possible to diagnose a dural arteriovenous fistula and thrombophlebitis in a 23-year old woman. 2D TOF MRA is the usual technique in the diagnosis of thrombophlebitis. Our experience shows the limits of 2D TOF since the increased signal intensity in the sinus could simulate a normal flow, and we describe the advantages of MR subtraction angiography. In our study, 3D TOF MRA showed the dural arteriovenous fistula, its location near the right transverse sinus and some of the feeding vessels: tentorial branch of the internal carotid artery and meningeal branch of the right occipital artery. 3D TOF MRA provides the diagnosis of dural arteriovenous fistula, but it cannot replace the plain angiography performed before endovascular or surgical treatment.

Adult↗
PubMed1995

CT-guided needle biopsy of intracranial tumours: results in 118 consecutive patients.

The purpose of this paper is to evaluate the efficacy and safety of CT-guided needle biopsies and to determine the optimal indications for this technique. The case histories of 118 patients who underwent a CT-guided biopsy for brain lesions during a six-year period, from November 1986 to September 1992, were reviewed. During a preliminary CT-scan, the entry site was determined and localized using a radio opaque marker and the safest route to the lesion was chosen. One hundred and thirty four procedures were performed in 118 patients. A positive diagnosis of tumour was obtained in 106 patients (89.8%). Repeat procedures were required in 18 patients. High-grade gliomas were the more common lesions (55.1%). Morbidity and mortality was assessed over the 30-day period after the procedure. Nine patients died during this time. Eight patients from day 3 to day 30 in the expected course of their disease and one within 48 first hours from neurological deterioration following the procedure. We found that CT-scan guided biopsies are a safe and accurate way to obtain brain tissue specimens for pathological diagnosis in selected cases. For superficial and large tumours it is a simple, fast and effective procedure.

Adolescent↗
PubMed1995

Endovascular treatment of an infantile nongalenic cerebral arteriovenous fistula with cyanoacrylate.

We report the radiological features, including Doppler sonography and magnetic resonance angiography (MRA) findings, of a nongalenic arteriovenous fistula diagnosed in the neonatal period. Hypertensive hydrocephalus developed in infancy. Emergent percutaneous transarterial embolization with n-butyl-2-cyanoacrylate was successfully performed and lead to clinical improvement. MRA allowed a noninvasive follow-up.

Angiography, Digital Subtraction↗
PubMed1995

MRI of intramedullary cavernous haemangiomas.

We reviewed 11 cases of intramedullary cavernous haemangiomas (IMCH) studied by MRI, to assess its diagnostic value in these lesions. Follow-up MRI was obtained in five patients 7 days-2 years following the initial study. In one case a postoperative examination was obtained. The diagnosis was pathologically proven in ten cases, and supported in the last by a family and personal history of cavernous haemangiomas. A reticulate appearance with areas of mixed signal intensity in both T1- and T2-weighted images was the most common finding. Homogeneous high, low or intermediate signal intensity was each found in one case. Two small lesions gave low signal. A rim of low signal was less common than in cerebral cavernous haemangiomas. In one case, the brain showed more than 20 lesions with the MRI appearances of cavernous haemangiomas. In two of five patients, serial preoperative MRI showed progressive disappearance of high-signal areas on both T1- and T2-weighted images. To find a haemorrhagic intramedullary lesion on MRI is not rare. Although the appearances are not pathognomonic, an IMCH can be suggested. We suggest that the following characteristics may help: (1) a personal and/or family history of cavernous haemangiomas; (2) typical MRI appearances of mixed acute, subacute and chronic haemorrhage; (3) a tendency for signal intensity to decrease on follow-up; (4) normal spinal angiography; and (5) associated brain lesions.

Adult↗
PubMed1995

Auditory evoked potentials in a patient with a unilateral lesion of the inferior colliculus and medial geniculate body.

Brain-stem, middle latency and late auditory evoked potentials (BAEPs, MLAEPs and LAEPs, respectively) were recorded in a patient 2 months after removal of affecting the quadrigeminal plate. Simultaneously, MRI showed a left unilateral lesion involving the inferior colliculus, brachium colliculi and the medial geniculate body (MGB). On dichotic listening, there was complete extinction of the right ear input, without subjective auditory disturbance. BAEPs were abnormal after stimulation of the right ear alone. Wave V was delayed and reduced in amplitude, and the I-V interval was augmented. Above all, MLAEPs of both ears were very abnormal. The Pa and Na components over the left hemisphere were abolished (Pa) or very reduced in amplitude or abolished (Na) whereas both Pa and Na components over the right hemisphere were normal. LAEPs were asymmetrical, with reduced P1N1P2 complex over the left hemisphere and absence of polarity reversal over the mastoid. It has been demonstrated that a lesion affecting only the inferior colliculus and MGB unilaterally and not extending beyond the MGB can abolish Na and Pa ipsilaterally. Any discussion of Na and Pa sources should take into account the output of the MGB to the auditory radiations, the MGB, the brachium colliculi and the inferior colliculus.

Acoustic Stimulation↗
PubMed1995

Multidisciplinary treatment of cerebral arteriovenous malformations.

A series of 67 patients treated for cerebral AVM with a multidisciplinary approach is reported. The malformations were classified after the Spetzler Grading Scale, with 67% low-grade and 33% high-grade AVMs. Three modes of treatment were used: surgical resection, endovascular embolization, and radiosurgery (linear accelerator technique). The actual treatment was: surgical resection alone (25% of cases), embolization plus resection (25% of cases), embolization alone (21%) and radiosurgery (30%) either alone (12%), or after incomplete embolization (15%) or after incomplete resection (3%). The clinical outcome was evaluated in terms of deterioration due to treatment. The treatment was responsible for a deterioration in 28% of all patients, either minor deterioration (19%) neurological deficit (4%), or death (4%). All complications of surgical resection (17% of all operated cases) and of radiosurgery (10% of irradiated cases) remained minor. None was haemodynamic-related. After endovascular embolization, a deterioration occurred in 25% of all embolized cases (minor 13%, neurological deficit 5% and death 8%). These complications occurring after embolization were haemodynamic related: ischaemia and haemorrhage (50% for each mechanism). Haemorrhage occurred either during or some days after the embolization procedure. The angiographic eradication rate was: 80% overall, 91% after resection (with or without previous embolization), 87% after radiosurgery (alone or after other techniques), and 10% after embolization alone. The discussion reviews in the literature the general evolution of the management of cerebral AVMs, with successive application of first surgical resection, the embolization and lastly radiosurgery.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗