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Visualization of angiographical arteriovenous shunting in perisylvian glioblastomas.
- Source :
-
Acta neurochirurgica [Acta Neurochir (Wien)] 2013 Apr; Vol. 155 (4), pp. 715-9. Date of Electronic Publication: 2013 Feb 23. - Publication Year :
- 2013
-
Abstract
- Background: Arteriovenous shunting visualized by angiography is one of the major features of glioblastomas, and the visualization is dependent on the presence of extensive shunting. Extensive arteriovenous shunting is associated with the risk of poorly controlled intraoperative bleeding. When a tumor with extensive arteriovenous shunting is located in close proximity to the eloquent regions of the brain, a meticulous surgical procedure is necessary. In the present study, the site-oriented visualization of angiographical arteriovenous shunting was evaluated from the perspective of surgical treatment, with a particular focus on the perisylvian region that is in close proximity to motor and language regions (dominant hemisphere), as well as large arteries and veins.<br />Methods: Twenty-six consecutive patients underwent a resection of glioblastoma between February 2007 and September 2012. All patients were presurgically examined using digital subtraction angiography. The patients were subdivided into the following two groups based on the location of the tumor: 1) perisylvian glioblastoma (18 patients) and 2) non-perisylvian glioblastoma (eight patients). Angiography to detect the arteriovenous shunting was performed. In addition, the number of intratumoral vessels, tumor proliferative activity (MIB-1 labeling index), and volume of intraoperative bleeding were evaluated and compared between the two groups.<br />Results: Angiographical arteriovenous shunting was definitively visualized in 13 of 18 (72 %) perisylvian glioblastomas, in contrast to only one of eight (13 %) non-perisylvian glioblastomas (p = 0.007). There were no significant differences between the two groups with respect to the number of intratumoral vessels, MIB-1 labeling index, and volume of intraoperative bleeding. However, massive intraoperative bleeding of > 2,000 mL occurred in one perisylvian glioblastoma patient.<br />Conclusions: Glioblastomas in the perisylvian region tend to be associated with extensive arteriovenous shunting that can be definitively visualized by performing an angiography. Because arteriovenous shunting carries the risk of intraoperative bleeding, perisylvian glioblastomas-particularly in the dominant hemisphere-should be resected with a meticulous surgical procedure and strategy.
- Subjects :
- Aged
Aged, 80 and over
Angiography, Digital Subtraction methods
Brain Neoplasms blood supply
Brain Neoplasms diagnosis
Brain Neoplasms surgery
Female
Glioblastoma blood supply
Glioblastoma diagnosis
Glioblastoma surgery
Humans
Intracranial Arteriovenous Malformations pathology
Male
Middle Aged
Arteriovenous Shunt, Surgical methods
Brain Neoplasms pathology
Cerebral Angiography
Glioblastoma pathology
Subjects
Details
- Language :
- English
- ISSN :
- 0942-0940
- Volume :
- 155
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Acta neurochirurgica
- Publication Type :
- Academic Journal
- Accession number :
- 23435867
- Full Text :
- https://doi.org/10.1007/s00701-013-1650-z