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Neurosurgical Review

Erschienen in:

13.11.2019 | Review

Targeted endovascular treatment for ruptured brain arteriovenous malformations

verfasst von: Kun Hou, Kan Xu, Xuan Chen, Tiefeng Ji, Yunbao Guo, Jinlu Yu

Erschienen in: Neurosurgical Review | Ausgabe 6/2020

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Abstract

Currently, endovascular treatment (EVT) is recommended for ruptured brain arteriovenous malformation (BAVM). When performing EVT for ruptured BAVM, curative complete embolization without complications is the ideal goal, but, more often than not, it is difficult, impossible, and dangerous. Therefore, EVT targeted toward ruptured focal weak structures plays a very important role. No previous study has comprehensively reviewed the use of targeted EVT for ruptured BAVMs. Therefore, the current paper reviews the available literature on this subject. In BAVM, the ruptured focal weak structures may include flow-related aneurysms, intranidal venous dilated structures, intranidal fistula, and venous varices or ectasia. These ruptured focal weak structures have direct and indirect imaging presentations. The indirect imaging presentations indicate various intracranial hemorrhages. In direct imaging presentations, digital subtraction angiography (DSA) has the highest degree resolution for showing ruptured focal weak structures. In addition, some magnetic resonance (MR) sequences can be useful to identify ruptured focal weak structures. Of all ruptured focal weak structures, flow-related aneurysms are considered the highest risk and require urgent occlusion. Other ruptured weak structures also need to undergo targeted EVT. After targeted EVT, a good prognosis can be obtained. Therefore, the use of targeted EVT for ruptured BAVM is promising.

Alexander MD, Cooke DL, Nelson J, Guo DE, Dowd CF, Higashida RT, Halbach VV, Lawton MT, Kim H, Hetts SW (2015) Association between venous angioarchitectural features of sporadic brain arteriovenous malformations and intracranial hemorrhage. AJNR Am J Neuroradiol 36:949–952. https://doi.org/10.3174/ajnr.A4224CrossRefPubMedPubMedCentral

Alexander MD, Cooke DL, Hallam DK, Kim H, Hetts SW, Ghodke BV (2016) Less can be more: targeted embolization of aneurysms associated with arteriovenous malformations unsuitable for surgical resection. Interv Neuroradiol 22:445–451. https://doi.org/10.1177/1591019916641316CrossRefPubMedPubMedCentral

Alexander MD, Hippe DS, Cooke DL, Hallam DK, Hetts SW, Kim H, Lawton MT, Sekhar LN, Kim LJ, Ghodke BV (2018) Targeted embolization of aneurysms associated with brain arteriovenous malformations at high risk for surgical resection: a case-control study. Neurosurgery 82:343–349. https://doi.org/10.1093/neuros/nyx167CrossRefPubMed

Aoun SG, Bendok BR, Batjer HH (2012) Acute management of ruptured arteriovenous malformations and dural arteriovenous fistulas. Neurosurg Clin N Am 23:87–103. https://doi.org/10.1016/j.nec.2011.09.013CrossRefPubMed

Asadi H, Kok HK, Looby S, Brennan P, O’Hare A, Thornton J (2016) Outcomes and complications after endovascular treatment of brain arteriovenous malformations: a prognostication attempt using artificial intelligence. World Neurosurg 96:562–569 e561. https://doi.org/10.1016/j.wneu.2016.09.086CrossRefPubMed

Baharvahdat H, Blanc R, Termechi R, Pistocchi S, Bartolini B, Redjem H, Piotin M (2014) Hemorrhagic complications after endovascular treatment of cerebral arteriovenous malformations. AJNR Am J Neuroradiol 35:978–983. https://doi.org/10.3174/ajnr.A3906CrossRefPubMed

Bhogal P, Lansley J, Wong K, Udani SD, Uff C, Wadley J, Kumar A, Matouk CC, Makalanda HL (2019) Vessel wall enhancement of a ruptured intra-nidal aneurysm in a brain arteriovenous malformation. Interv Neuroradiol 25:310–314. https://doi.org/10.1177/1591019918824796CrossRefPubMedPubMedCentral

Biswas S, Chandran A, Radon M, Puthuran M, Bhojak M, Nahser HC, Das K (2015) Accuracy of four-dimensional CT angiography in detection and characterisation of arteriovenous malformations and dural arteriovenous fistulas. Neuroradiol J 28:376–384. https://doi.org/10.1177/1971400915604526CrossRefPubMedPubMedCentral

Buell TJ, Ding D, Starke RM, Webster Crowley R, Liu KC (2014) Embolization-induced angiogenesis in cerebral arteriovenous malformations. J Clin Neurosci 21:1866–1871. https://doi.org/10.1016/j.jocn.2014.04.010CrossRefPubMed

10.

Cagnazzo F, Brinjikji W, Lanzino G (2016) Arterial aneurysms associated with arteriovenous malformations of the brain: classification, incidence, risk of hemorrhage, and treatment-a systematic review. Acta Neurochir (Wien) 158:2095–2104. https://doi.org/10.1007/s00701-016-2957-3CrossRef

11.

Chandran A, Radon M, Biswas S, Das K, Puthuran M, Nahser H (2016) Novel use of 4D-CTA in imaging of intranidal aneurysms in an acutely ruptured arteriovenous malformation: is this the way forward? J Neurointerv Surg 8:e36. https://doi.org/10.1136/neurintsurg-2015-011784.repCrossRefPubMed

12.

Chang W, Wu Y, Johnson K, Loecher M, Wieben O, Edjlali M, Oppenheim C, Roca P, Hald J, Aagaard-Kienitz B, Niemann D, Mistretta C, Turski P (2015) Fast contrast-enhanced 4D MRA and 4D flow MRI using constrained reconstruction (HYPRFlow): potential applications for brain arteriovenous malformations. AJNR Am J Neuroradiol 36:1049–1055. https://doi.org/10.3174/ajnr.A4245CrossRefPubMedPubMedCentral

13.

Consoli A, Scarpini G, Rosi A, Renieri L, Chiarotti I, Vignoli C, Ciampa I, Nappini S, Limbucci N, Mangiafico S (2014) Endovascular treatment of unruptured and ruptured brain arteriovenous malformations with Onyx18: a monocentric series of 84 patients. J Neurointerv Surg 6:600–606. https://doi.org/10.1136/neurintsurg-2013-010869CrossRefPubMed

14.

Cronqvist M, Wirestam R, Ramgren B, Brandt L, Romner B, Nilsson O, Saveland H, Holtas S, Larsson EM (2006) Endovascular treatment of intracerebral arteriovenous malformations: procedural safety, complications, and results evaluated by MR imaging, including diffusion and perfusion imaging. AJNR Am J Neuroradiol 27:162–176PubMed

15.

D’Aliberti G, Talamonti G, Cenzato M, La Camera A, Debernardi A, Valvassori L, Mariangela P, Nichelatti M (2015) Arterial and venous aneurysms associated with arteriovenous malformations. World Neurosurg 83:188–196. https://doi.org/10.1016/j.wneu.2014.05.037CrossRefPubMed

16.

de Castro-Afonso LH, Nakiri GS, Oliveira RS, Santos MV, Santos ACD, Machado HR, Abud DG (2016) Curative embolization of pediatric intracranial arteriovenous malformations using Onyx: the role of new embolization techniques on patient outcomes. Neuroradiology 58:585–594. https://doi.org/10.1007/s00234-016-1666-1CrossRefPubMed

17.

Derdeyn CP, Zipfel GJ, Albuquerque FC, Cooke DL, Feldmann E, Sheehan JP, Torner JC, American Heart Association Stroke C (2017) Management of brain arteriovenous malformations: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 48:e200–e224. https://doi.org/10.1161/STR.0000000000000134CrossRefPubMed

18.

Downer JJ, Cellerini M, Corkill RA, Lalloo S, Kuker W, Byrne JV (2011) Decision-making in the scheduling of endovascular treatment after brain arteriovenous malformation haemorrhage: a retrospective single centre study. Neuroradiol J 24:879–885. https://doi.org/10.1177/197140091102400609CrossRefPubMed

19.

Eliava S, Dmitriev A, Shekhtman O, Yakovlev S, Kheireddin A, Pilipenko Y (2018) Treatment of brain arteriovenous malformations with hemodynamic aneurysms: a series of 131 consecutive cases. World Neurosurg 110:e917–e927. https://doi.org/10.1016/j.wneu.2017.11.114CrossRefPubMed

20.

Fukaya R, Mizutani K, Fukuchi M, Fujii K (2017) Thrombosis of the draining vein causes intracranial haemorrhage in the natural history of brain arteriovenous malformation: case report. Br J Neurosurg:1–2. https://doi.org/10.1080/02688697.2017.1318110

21.

Gabrieli J, Clarencon F, Di Maria F, Fahed R, Boch AL, Degos V, Chiras J, Sourour NA (2015) Fatal rupture of a brain arteriovenous malformation flow-related aneurysm during microcatheter removal: a rare complication. J Neurosurg 122:929–932. https://doi.org/10.3171/2014.11.JNS132515CrossRefPubMed

22.

Goldberg J, Raabe A, Bervini D (2018) Natural history of brain arteriovenous malformations: systematic review. J Neurosurg Sci 62:437–443. https://doi.org/10.23736/S0390-5616.18.04452-1CrossRefPubMed

23.

Gupta V, Chugh M, Walia BS, Vaishya S, Jha AN (2008) Use of CT angiography for anatomic localization of arteriovenous malformation nidal components. AJNR Am J Neuroradiol 29:1837–1840. https://doi.org/10.3174/ajnr.A1136CrossRefPubMed

24.

Hademenos GJ, Massoud TF (1996) Risk of intracranial arteriovenous malformation rupture due to venous drainage impairment. A theoretical analysis. Stroke 27:1072–1083CrossRef

25.

Haw CS, terBrugge K, Willinsky R, Tomlinson G (2006) Complications of embolization of arteriovenous malformations of the brain. J Neurosurg 104:226–232. https://doi.org/10.3171/jns.2006.104.2.226CrossRefPubMed

26.

Hodgson TJ, Kemeny AA, Gholkar A, Deasy N (2009) Embolization of residual fistula following stereotactic radiosurgery in cerebral arteriovenous malformations. AJNR Am J Neuroradiol 30:109–110. https://doi.org/10.3174/ajnr.A1240CrossRefPubMedPubMedCentral

27.

Hsu YH, Lee CW, Liu HM, Wang YH, Kuo MF (2015) Prioritized venous coiling facilitating endovascular treatment of brain arteriovenous malformations with a fistulous component. World Neurosurg 84:1857–1863. https://doi.org/10.1016/j.wneu.2015.08.014CrossRefPubMed

28.

Komatsu K, Takagi Y, Ishii A, Kikuchi T, Yamao Y, Fushimi Y, Grinstead J, Ahn S, Miyamoto S (2018) Ruptured intranidal aneurysm of an arteriovenous malformation diagnosed by delay alternating with nutation for tailored excitation (DANTE)-prepared contrast-enhanced magnetic resonance imaging. Acta Neurochir (Wien). 160:2435–2438. https://doi.org/10.1007/s00701-018-3713-7CrossRefPubMed

29.

Krings T, Hans FJ, Geibprasert S, Terbrugge K (2010) Partial “targeted” embolisation of brain arteriovenous malformations. Eur Radiol 20:2723–2731. https://doi.org/10.1007/s00330-010-1834-3CrossRefPubMedPubMedCentral

30.

Lang S, Golitz P, Struffert T, Rosch J, Rossler K, Kowarschik M, Strother C, Doerfler A (2017) 4D DSA for dynamic visualization of cerebral vasculature: a single-center experience in 26 cases. AJNR Am J Neuroradiol 38:1169–1176. https://doi.org/10.3174/ajnr.A5161CrossRefPubMed

31.

Le Feuvre D, Taylor A (2007) Target embolization of AVMs: identification of sites and results of treatment. Interv Neuroradiol 13:389–394. https://doi.org/10.1177/159101990701300411CrossRefPubMed

32.

Luo CB, Guo WY, Teng MM, Chang FC, Lin CJ, Wu HM, Chang CY, Chung WY (2013) Fistula components of brain arteriovenous malformations: angioarchitecture analysis and embolization prior to gamma-knife surgery. J Chin Med Assoc 76:277–281. https://doi.org/10.1016/j.jcma.2013.01.011CrossRefPubMed

33.

Martinez JL, Macdonald RL (2015) Surgical strategies for acutely ruptured arteriovenous malformations. Front Neurol Neurosci 37:166–181. https://doi.org/10.1159/000437121CrossRefPubMed

34.

Matsushige T, Shimonaga K, Mizoue T, Hosogai M, Hashimoto Y, Kaneko M, Ono C, Ishii D, Sakamoto S, Kurisu K (2019) Focal aneurysm wall enhancement on magnetic resonance imaging indicates intraluminal thrombus and the rupture point. World Neurosurg 127:e578–e584. https://doi.org/10.1016/j.wneu.2019.03.209CrossRefPubMed

35.

Meisel HJ, Mansmann U, Alvarez H, Rodesch G, Brock M, Lasjaunias P (2002) Effect of partial targeted N-butyl-cyano-acrylate embolization in brain AVM. Acta Neurochir (Wien) 144:879–887; discussion 888. https://doi.org/10.1007/s00701-002-0978-6CrossRef

36.

Mendoza-Elias N, Shakur SF, Charbel FT, Alaraj A (2018) Cerebral arteriovenous malformation draining vein stenosis is associated with atherosclerotic risk factors. J Neurointerv Surg 10:788–790. https://doi.org/10.1136/neurintsurg-2017-013580CrossRefPubMed

37.

Mjoli N, Le Feuvre D, Taylor A (2011) Bleeding source identification and treatment in brain arteriovenous malformations. Interv Neuroradiol 17:323–330. https://doi.org/10.1177/159101991101700307CrossRefPubMedPubMedCentral

38.

Mohr JP, Parides MK, Stapf C, Moquete E, Moy CS, Overbey JR, Al-Shahi Salman R, Vicaut E, Young WL, Houdart E, Cordonnier C, Stefani MA, Hartmann A, von Kummer R, Biondi A, Berkefeld J, Klijn CJ, Harkness K, Libman R, Barreau X, Moskowitz AJ, international Ai (2014) Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet 383:614–621. https://doi.org/10.1016/S0140-6736(13)62302-8CrossRefPubMed

39.

Morgan MK, Guilfoyle M, Kirollos R, Heller GZ (2018) Remodeling of the feeding arterial system after surgery for resection of brain arteriovenous malformations: an observational study. Neurosurgery. https://doi.org/10.1093/neuros/nyy007

40.

Omodaka S, Endo H, Fujimura M, Niizuma K, Sato K, Matsumoto Y, Tominaga T (2015) High-grade cerebral arteriovenous malformation treated with targeted embolization of a ruptured site: wall enhancement of an intranidal aneurysm as a sign of ruptured site. Neurol Med Chir (Tokyo) 55:813–817. https://doi.org/10.2176/nmc.cr.2015-0052CrossRef

41.

Peres CMA, Souza EC, Teixeira MJ, Figueiredo EG, Caldas J (2017) Impact of associated nidal lesions in outcome of brain arteriovenous malformations after radiosurgery with or without embolization. World Neurosurg 105:643–650. https://doi.org/10.1016/j.wneu.2017.06.044CrossRefPubMed

42.

Platz J, Berkefeld J, Singer OC, Wolff R, Seifert V, Konczalla J, Guresir E (2014) Frequency, risk of hemorrhage and treatment considerations for cerebral arteriovenous malformations with associated aneurysms. Acta Neurochir (Wien) 156:2025–2034. https://doi.org/10.1007/s00701-014-2225-3CrossRef

43.

Pollock GA, Shaibani A, Awad I, Batjer HH, Bendok BR (2011) Intraventricular hemorrhage secondary to intranidal aneurysm rupture-successful management by arteriovenous malformation embolization followed by intraventricular tissue plasminogen activator: case report. Neurosurgery 68:E581–E586; discussion E586. https://doi.org/10.1227/NEU.0b013e31820208a6CrossRefPubMedPubMedCentral

44.

Pritz MB (1994) Ruptured supratentorial arteriovenous malformations associated with venous aneurysms. Acta Neurochir (Wien) 128:150–162CrossRef

45.

Rahme R, Farley CW, Zuccarello M, Ringer AJ, Khan U, Abruzzo TA (2011) Transarterial embolization of cerebral arteriovenous malformations: a durable treatment for venous side hemorrhage? Med Hypotheses 76:827–830. https://doi.org/10.1016/j.mehy.2011.02.029CrossRefPubMed

46.

Rammos SK, Gardenghi B, Bortolotti C, Cloft HJ, Lanzino G (2016) Aneurysms associated with brain arteriovenous malformations. AJNR Am J Neuroradiol 37:1966–1971. https://doi.org/10.3174/ajnr.A4869CrossRefPubMed

47.

Reynolds MR, Arias EJ, Chatterjee AR, Chicoine MR, Cross DT 3rd (2015) Acute rupture of a feeding artery aneurysm after embolization of a brain arteriovenous malformation. Interv Neuroradiol 21:613–619. https://doi.org/10.1177/1591019915591740CrossRefPubMedPubMedCentral

48.

Shakur SF, Hussein AE, Amin-Hanjani S, Valyi-Nagy T, Charbel FT, Alaraj A (2017) Cerebral arteriovenous malformation flow is associated with venous intimal hyperplasia. Stroke 48:1088–1091. https://doi.org/10.1161/STROKEAHA.116.015666CrossRefPubMed

49.

Shakur SF, Brunozzi D, Ismail R, Pandey D, Charbel FT, Alaraj A (2018) Effect of age on cerebral arteriovenous malformation draining vein stenosis. World Neurosurg 113:e654–e658. https://doi.org/10.1016/j.wneu.2018.02.116CrossRefPubMed

50.

Shotar E, Al Raaisi A, Lenck S, Premat K, Degos V, Mathon B, Clarencon F, Sourour NA (2019) Injection of N-butyl cyanoacrylate through a dual-lumen balloon for embolization of high-flow intranidal fistulas in brain arteriovenous malformations: technical note. Clin Neuroradiol.:1–7. https://doi.org/10.1007/s00062-019-00780-6

51.

Signorelli F, Gory B, Pelissou-Guyotat I, Guyotat J, Riva R, Dailler F, Turjman F (2014) Ruptured brain arteriovenous malformations associated with aneurysms: safety and efficacy of selective embolization in the acute phase of hemorrhage. Neuroradiology 56:763–769. https://doi.org/10.1007/s00234-014-1395-2CrossRefPubMed

52.

Singh R, Gupta V, Ahuja C, Kumar A, Mukherjee KK, Khandelwal N (2018) Role of time-resolved-CTA in intracranial arteriovenous malformation evaluation at 128-slice CT in comparison with digital subtraction angiography. Neuroradiol J 31:235–243. https://doi.org/10.1177/1971400917744403CrossRefPubMedPubMedCentral

53.

Soize S, Bouquigny F, Kadziolka K, Portefaix C, Pierot L (2014) Value of 4D MR angiography at 3T compared with DSA for the follow-up of treated brain arteriovenous malformation. AJNR Am J Neuroradiol 35:1903–1909. https://doi.org/10.3174/ajnr.A3982CrossRefPubMed

54.

Stapf C, Mohr JP, Pile-Spellman J, Sciacca RR, Hartmann A, Schumacher HC, Mast H (2002) Concurrent arterial aneurysms in brain arteriovenous malformations with haemorrhagic presentation. J Neurol Neurosurg Psychiatry 73:294–298CrossRef

55.

Starke RM, Komotar RJ, Connolly ES (2013) A randomized trial of unruptured brain arteriovenous malformations. Neurosurgery 73:N13–N15. https://doi.org/10.1227/01.neu.0000435114.33768.e3CrossRefPubMed

56.

Stemer AB, Bank WO, Armonda RA, Liu AH, Herzig DW, Bell RS (2013) Acute embolization of ruptured brain arteriovenous malformations. J Neurointerv Surg 5:196–200. https://doi.org/10.1136/neurintsurg-2011-010214CrossRefPubMed

57.

Sun Y, Jin H, Li Y, Tian Z (2017) Target embolization of associated aneurysms in ruptured arteriovenous malformations. World Neurosurg 101:26–32. https://doi.org/10.1016/j.wneu.2017.01.081CrossRefPubMed

58.

Todnem N, Ward A, Nahhas M, Vender J, Alleyne CH, Rahimi S (2018) A Retrospective cohort analysis of hemorrhagic AVMs treated with combination endovascular embolization and gamma-knife stereotactic radiosurgery. World Neurosurg. https://doi.org/10.1016/j.wneu.2018.10.125

59.

Tranvinh E, Heit JJ, Hacein-Bey L, Provenzale J, Wintermark M (2017) Contemporary imaging of cerebral arteriovenous malformations. AJR Am J Roentgenol 208:1320–1330. https://doi.org/10.2214/AJR.16.17306CrossRefPubMed

60.

Tu J, Stoodley MA, Morgan MK, Storer KP (2006) Ultrastructure of perinidal capillaries in cerebral arteriovenous malformations. Neurosurgery 58:961–970; discussion 961-970. https://doi.org/10.1227/01.NEU.0000210248.39504.B5CrossRefPubMed

61.

van Rooij WJ, Jacobs S, Sluzewski M, van der Pol B, Beute GN, Sprengers ME (2012) Curative embolization of brain arteriovenous malformations with onyx: patient selection, embolization technique, and results. AJNR Am J Neuroradiol 33:1299–1304. https://doi.org/10.3174/ajnr.A2947CrossRefPubMed

62.

Wolf RL, Wang J, Detre JA, Zager EL, Hurst RW (2008) Arteriovenous shunt visualization in arteriovenous malformations with arterial spin-labeling MR imaging. AJNR Am J Neuroradiol 29:681–687. https://doi.org/10.3174/ajnr.A0901CrossRefPubMed

63.

Yang W, Porras JL, Xu R, Braileanu M, Khalid S, Hung AL, Caplan JM, Garzon-Muvdi T, Rong X, Colby GP, Coon AL, Tamargo RJ, Huang J (2018) Comparison of hemorrhagic risk in intracranial arteriovenous malformations between conservative management and embolization as the single treatment modality. Neurosurgery 82:481–490. https://doi.org/10.1093/neuros/nyx230CrossRefPubMed

64.

Yu JL, Yang S, Luo Q, Wang HL, Wang B, Qu YY, Xu K (2011) Endovascular treatment of intracranial ruptured aneurysms associated with arteriovenous malformations: a clinical analysis of 14 hemorrhagic cases. Interv Neuroradiol 17:78–86. https://doi.org/10.1177/159101991101700113CrossRefPubMedPubMedCentral

65.

Yuki I, Kim RH, Duckwiler G, Jahan R, Tateshima S, Gonzalez N, Gorgulho A, Diaz JL, De Salles AA, Vinuela F (2010) Treatment of brain arteriovenous malformations with high-flow arteriovenous fistulas: risk and complications associated with endovascular embolization in multimodality treatment. Clinical article. J Neurosurg 113:715–722. https://doi.org/10.3171/2009.9.JNS081588CrossRefPubMed

66.

Zacharia BE, Vaughan KA, Jacoby A, Hickman ZL, Bodmer D, Connolly ES Jr (2012) Management of ruptured brain arteriovenous malformations. Curr Atheroscler Rep 14:335–342. https://doi.org/10.1007/s11883-012-0257-9CrossRefPubMed

67.

Zuurbier SM, Al-Shahi Salman R (2019) Interventions for treating brain arteriovenous malformations in adults. Cochrane Database Syst Rev 9:CD003436. https://doi.org/10.1002/14651858.CD003436.pub4CrossRefPubMed

Titel: Targeted endovascular treatment for ruptured brain arteriovenous malformations
verfasst von: Kun Hou
Kan Xu
Xuan Chen
Tiefeng Ji
Yunbao Guo
Jinlu Yu
Publikationsdatum: 13.11.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Neurosurgical Review / Ausgabe 6/2020
Print ISSN: 0344-5607
Elektronische ISSN: 1437-2320
DOI: https://doi.org/10.1007/s10143-019-01205-1

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Targeted endovascular treatment for ruptured brain arteriovenous malformations

Abstract

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Im OP der Zukunft läuft nichts mehr ohne Kollege Roboter

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Update Chirurgie

Aktuelle BDC Leitlinien-Webinare

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

S2e-Leitlinie „Distale Radiusfraktur“

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Live-Webinar "Chronische Unterbauch- und Viszeralschmerzen in der Praxis managen"

Springer Medizin

Abstract

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Weitere Artikel der Ausgabe 6/2020

Influence of wide opening of the lateral ventricle on survival for supratentorial glioblastoma patients with radiotherapy and concomitant temozolomide-based chemotherapy

Fedor Krause (1857–1937): the father of neurosurgery

Neuropsychological impairment in adults with moyamoya angiopathy: preoperative assessment and correlation to MRI and H215O PET

Feasibility, safety, and utility of brain MRI for patients with non-MRI-conditioned CIED

Inflammation promotes progression of thrombi in intracranial thrombotic aneurysms

Natural history and clinical outcomes in patients with complex intracranial aneurysms: a review of 115 bypass cases and 22 nonsurgical cases

Update Chirurgie