| Identifier |
Vascular_Malformations_1080p_Lee |
| Title |
Vascular Malformations |
| Creator |
Andrew G. Lee, MD; Cyrus Daruwalla |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (CD) Baylor College of Medicine, Houston, Texas |
| Subject |
Capillary Telangiectasia; Developmental Venous Anomaly (DVA); Cavernous Malformation; Arteriovenous Malformation |
| Description |
Dr. Lee lectures medical students on the subject of vascular malformations. |
| Transcript |
All right today we want to talk to you a little bit about the word vascular malformation, and it's really important that we use the words correctly because it gets confusing, because this word "vascular malformation" actually encompasses the entire spectrum of things that could be malformed on the vessel side, and really it depends on the size of the vessel that's the problem. So if it's a capillary problem that is a telangiectasia, so it dilated capillaries but it's normal in its configuration it's just not doing anything, it looks like this little squiggly line here. Then you've got the venous version of it, which is a venous malformation and the venous malformation in the head we call a DVA. A developmental venous anomaly it looks like this a big vein and little twigs. You can see that these two are very low flow malformations and therefore their risk of hemorrhage is quite low. And then we've got this cavernous malformation. You might know it as hemangioma but I hate that word "cavernous hemangioma" and the reason I hate that word is it's not really a tumor, so a cavernous hemangioma is not really a neoplasm. It's composed of dilated cavernous endothelial line channels that have red cells inside of them but not really a tumor. It doesn't match the size it's got no neoplastic potential. However it's got a medium risk of hemorrhage. In fact, its characteristic is that it kind of bleeds and then stops and bleeds and then stops. That recurrence is super common. And then you've got the arterial venous malformation which is a high flow system because of the arterial flow, and this AVM is the one that's most likely to rupture. It's the one that really should be treated, so when we're doing a brain MRI, if we see an AVM, that one probably needs a standard catheter angiogram and probably is going to have to be treated. It's a cavernous malformation and it's a symptomatic or it's only bled once, we might not treat that. The cavernous malformation, if you do an angiogram on that, it won't show anything because it's not really hooked up to anything. The venous malformation and the capillary telangiectasia are super low flow and so we definitely generally don't do anything with those, so these can bleed but the risk of bleed is low. So this is low flow and low risk, this is high flow and high risk, this is no flow but medium risk. And all of these lesions can occur in your orbit. They don't have to be intracranial, and so normally we can tell the difference between a venous and a cavernous malformation just on the imaging study. So cavernous confirmations in the orbit as opposed to the cavernous malformation in the brain usually is an intraconal mass with relatively heterogeneous enhancement because it's got these cavernous channels in it. So it's actually one of the most common causes of an intraconal mass in an adult. So if we see a slowly progressive proptosis in an adult with a well circumscribed intraconal mass, we're really going to be thinking about cavernous malformation as the cause for that. Of course the only way to know is to take it out and path because there's other things on the differential diagnosis and really the only way to know about arteriovenous malformation is to have a standard catheter angiogram, but as MRA and CTA have improved, we're usually able to tell the difference between a cavernous malformation and another vascular malformation. And the cavernous malformation compress on the optic nerve and produce optic neuropathy. These other ones, the major risk is bleeding. |
| Date |
2021-06 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah, 10 N 1900 E SLC, UT 84112-5890 |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6rg1tss |
| Setname |
ehsl_novel_lee |
| ID |
1701593 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6rg1tss |
