Occipital Lobe Arteriovenous Malformations

Malformações Arteriovenosas Occipitais

• Isabela Fernandes de Melo Pereira    
• Giulia Bassalo Canals Silva    
• Larissa Lacorte Moreno Luiggi Sammour    
• Paulo Henrique Pires de Aguiar    

• https://doi.org/10.22290/jbnc.2025.360209
• J Bras Neurocirur 36 (2):179-188, 2025

Resumo

Introdução: Malformações arteriovenosas (MAVs) do lobo occipital desafiam os neurocirurgiões com sua anatomia e eloquência únicas. Preservar essa função neurológica requer um conhecimento profundo da anatomia microcirúrgica e vascularização do lobo occipital, técnica cirúrgica, avaliação clínica e opções de tratamento. Objetivo: revisar esses tópicos relevantes sobre MAVs occipitais. Métodos e resultados: Uma busca foi conduzida nas bases de dados Pubmed, Embase e Web of Science. Os critérios de exclusão foram fuga temática e relatos de caso. Os artigos foram selecionados de acordo com a qualidade metodológica, experiência dos autores em neurocirurgia vascular e relevância. Vinte e três estudos foram selecionados. Discussão: Ao contrário da maioria dos lobos cerebrais, a anatomia microcirúrgica do lobo occipital revela convoluções irregulares. Sua eloquência aumenta a necessidade de identificar o tratamento adequado para atingir não apenas o controle hemorrágico, mas também a preservação do campo visual. Particularmente, quando localizados na superfície medial e recebem suprimento direto da artéria calcarina, um desfecho pior é esperado, pois alguns estudos mostraram que a maioria das perdas de campo visual ocorrem no tratamento cirúrgico desses casos. Conclusões: MAVs occipitais devem sempre ser meticulosamente avaliadas por um neurocirurgião vascular experiente, considerando não apenas o sistema de classificação Spetzler-Martin suplementado, mas também um exame neurológico completo e estudo anatômico funcional para cada caso.

Palavras-chave

Malformação arteriovenosa intracraniana; Lobo occipital; Distúrbios da visão;

Abstract

Introduction: Occipital lobe Arteriovenous Malformations (AVMs) challenge neurosurgeons with their unique lobe anatomy and eloquence. Preserving this neurological function requires a profound knowledge of microsurgical anatomy and vascularization of the occipital lobe, surgical technique, clinical evaluation, and treatment options. Objective: to review these relevant topics regarding occipital AVMs. Methods and results: A search was conducted through Pubmed, Embase, and Web of Science databases. The exclusion criteria were fugue theme and case reports. Papers were selected according to the methodological quality, experience of the authors in vascular neurosurgery, and relevance. Twenty-three studies were selected. Discussion: Unlike most cerebral lobes, the microsurgical anatomy of the occipital lobe reveals irregular convolutions. Its eloquence adds to the need to identify the proper treatment to achieve not only hemorrhagic control but also visual field preservation. Particularly, when located on the medial surface and receiving direct supply from the calcarine artery, a worse outcome is expected, as some studies showed a majority of visual field loss in the surgical treatment of those cases. Conclusions: Occipital AVMs must always be meticulously evaluated by an experienced vascular neurosurgeon, considering not only the supplemented Spetzler-Martin grading system but also a thorough neurological examination and functional anatomy study for each case.

Keywords

Intracranial arteriovenous malformation; Occipital lobe; Vision disorders; Headache disorders

References

1. Lawton MT, Rutledge WC, Kim H, et al. Brain arteriovenous malformations. Nat Rev Dis Primers. 2015;1(1):15008. http://doi. org/10.1038/nrdp.2015.8. PMid:27188382.

2. Stieg PE, Batjer HH, Samson D. Intracranial arteriovenous malformations. Boca Raton: CRC Press; 2007. p. 215-37.

3. Spetzler RF, Martin NA. A proposed grading system for arteriovenous malformations. J Neurosurg. 1986;65(4):476-83. http://doi.org/10.3171/ jns.1986.65.4.0476. PMid:3760956.

4. Lawton MT, Kim H, McCulloch CE, Mikhak B, Young WL. A supplementary grading scale for selecting patients with brain arteriovenous malformations for surgery. Neurosurgery. 2010;66(4):702-13. http:// doi.org/10.1227/01.NEU.0000367555.16733.E1. PMid:20190666.

5. Kim H, Abla AA, Nelson J, et al. Validation of the supplemented Spetzler-Martin grading system for brain arteriovenous malformations in a multicenter cohort of 1009 surgical patients. Neurosurgery. 2015;76(1):25-33. http://doi.org/10.1227/NEU.0000000000000556. PMid:25251197.

6. Ramina R, Aguiar PHP, Tatagiba M, editors. Samii’s essentials in neurosurgery. Stuttgart: Springer; 2008. http://doi.org/10.1007/978-3540-49250-4.

7. Yasargil MG. Special surgical considerations. In: Yasargil MG, editor. Microneurosurgery: AVM of the brain, clinical considerations, general and special operative techniques, surgical results, nonoperated cases, cavernous and venous angiomas, neuroanesthesia. Stuttgart: Georg Thieme Verlag; 1988. p. 56-8, 83-111, 133-51, 164-7. (vol. IIIB).

8. Friedlander RM. Arteriovenous malformations of the brain. N Engl J Med. 2007;356(26):2704-12. http://doi.org/10.1056/NEJMcp067192.

PMid:17596605.

9. Kato Y, Dong V, Chaddad F, et al. Expert consensus on the management of brain arteriovenous malformations. Asian J Neurosurg. 2019;14(4):1074-81. http://doi.org/10.4103/ajns.AJNS_234_19. PMid:31903343.

10. Starke RM, Kano H, Ding D, et al. Stereotactic radiosurgery for cerebral arteriovenous malformations: evaluation of long-term outcomes in a multicenter cohort. J Neurosurg. 2017;126(1):36-44. http://doi. org/10.3171/2015.9.JNS151311. PMid:26943847.

11. Potts MB, Zumofen DW, Raz E, Nelson PK, Riina HA. Curing arteriovenous malformations using embolization. Neurosurg Focus. 2014;37(3):E19. http://doi.org/10.3171/2014.6.FOCUS14228. PMid:25175438.

12. Rhoton AL Jr. The cerebrum. Neurosurgery. 2007;61(1, Suppl):37. http://doi.org/10.1227/01.NEU.0000255490.88321.CE. PMid:18813175.

13. Tzu WH, Kadri PAS, Mussi ACM, Oliveira E, Rhoton AL Jr. Surgical anatomy of the brain. In: Winn HR, editor. Youmans & Winn neurological surgery. 8th ed. Philadelphia: Elsevier; 2023. p. 3695-716.

14. Frigeri T, Paglioli E, de Oliveira E, Rhoton AL Jr. Microsurgical anatomy of the central lobe. J Neurosurg. 2015;122(3):483-98. http:// doi.org/10.3171/2014.11.JNS14315. PMid:25555079.

15. Kucukyuruk B, Richardson RM, Wen HT, Fernandez-Miranda JC, Rhoton AL Jr. Microsurgical anatomy of the temporal lobe and its implications on temporal lobe epilepsy surgery. Epilepsy Res Treat. 2012;2012:769825. http://doi.org/10.1155/2012/769825. PMid:22957242.

16. Abdulrauf SI. Awake craniotomies for aneurysms, arteriovenous malformations, skull base tumors, high flow bypass, and brain stem lesions. J Craniovertebr Junction Spine. 2015;6(1):8-9. http://doi. org/10.4103/0974-8237.151580. PMid:25788813.

17. Chaddad-Neto F, Joaquim AF, Santos MJD, Linhares PW, Oliveira ED. The microsurgical approach of arteriovenous malformations in the central lobule. Arq Neuropsiquiatr. 2008;66(4):872-5. http://doi.

org/10.1590/S0004-282X2008000600018. PMid:19099128.

18. Tedeschi H, Oliveira E, Hung Tzu W, Rhoton AL Jr. Surgical anatomy. In: Stieg PE, Batjer HH, Samson D, editors. Intracranial arteriovenous malformations. 1st ed. Boca Raton: CRC Press; 2007. p. 1-19.

19. Elhammady MS, Roser F, Heros RC. Microsurgery of arteriovenous malformations. In: Winn HR, editor. Youmans & Winn neurological surgery. 8th ed. Philadelphia: Elsevier; 2023. p. 3695-716.

20. Dehdashti AR, Thines L, Willinsky RA, et al. Multidisciplinary care of occipital arteriovenous malformations: effect on non-hemorrhagic headache, vision, and outcome in a series of 135 patients. J Neurosurg. 2010;113(4):742-8. http://doi.org/10.3171/2009.11.JNS09884. PMid:20059323.

21. Yang W, Porras JL, Philadelphia E, et al. Treatment decision for occipital arteriovenous malformations (AVMs) to achieve hemorrhagic control while maximizing visual preservation: our experience and review of literature. J Clin Neurosci. 2018;48:50-7. http://doi.org/10.1016/j. jocn.2017.10.058. PMid:29113859.

22. Martin NA, Wilson CB. Medial occipital arteriovenous malformations: surgical treatment. J Neurosurg. 1982;56(6):798-802.

http://doi.org/10.3171/jns.1982.56.6.0798. PMid:7077379.

23. Troost BT, Newton TH. Occipital lobe arteriovenous malformations: clinical and radiologic features in 26 cases with comments on differentiation from migraine. Arch Ophthalmol. 1975;93(4):250-6. http://doi.org/10.1001/archopht.1975.01010020260002. PMid:1119966.

---

1Afya Faculdade de Ciências Médicas da Paraíba, João Pessoa, PB, Brasil.

2Pontifícia Universidade Católica de São Paulo, São Paulo, SP, Brasil.

3Faculdade de Medicina do ABC, Santo André, SP, Brasil.

4Department of Neurology, Pontifícia Universidade Católica de São Paulo, São Paulo, SP, Brasil.

5Department of Neurosurgery, Universidade de São Paulo, Sorocaba, SP, Brasil.

6Hospital Santa Paula, DASA, São Paulo, SP, Brasil.

7Sociedade Brasileira de Neurocirurgia (SBN), São Paulo, SP, Brasil.

 

Received Jan 25, 2025

Corrected Mar 15, 2025

Accepted Mar 17, 2025