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Article: Pediatric spinal vascular malformations: Diagnosis and treatment

Moftakhar, Parham / Hetts, Steven W.

Journal of Pediatric Neuroradiology

(Neurointerventions in Children)

2013 Volume 02, Issue 03, Page(s) 283–292

Abstract: Spinal vascular malformations in children differ in several ways from those found in adults. Genetic syndromes are more common in the pediatric population. Onset of symptoms and clinical presentation is often more acute than in adults. Angioarchitecture ... ...

Series title	Neurointerventions in Children
Abstract	Spinal vascular malformations in children differ in several ways from those found in adults. Genetic syndromes are more common in the pediatric population. Onset of symptoms and clinical presentation is often more acute than in adults. Angioarchitecture of the various spinal vascular malformations differs from adults, with relative overrepresentation of perimedullary arteriovenous fistulas and nidal arteriovenous malformations and a dearth of dural fistulas. Fortunately, excellent results can often be obtained with endovascular or surgical intervention. This review will briefly examine the anatomy, genetics, clinical presentation, imaging, treatment, and outcomes of spinal vascular malformations in children.
Keywords	Spinal cord ; vascular malformation ; pediatric ; endovascular
Language	English
Publishing date	2013-09-01
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ISSN	1309-6745 ; 1309-6680
ISSN (online)	1309-6745
ISSN	1309-6680
DOI	10.3233/PNR-13067
Database	Thieme publisher's database

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Article ; Online: Vascular myelopathies.

Moftakhar, Parham / Hetts, Steven W / Ko, Nerissa U

Seminars in neurology

2012 Volume 32, Issue 2, Page(s) 146–153

Abstract: Vascular abnormalities of the spinal cord are an important cause of myelopathy. Clinicians need to be aware of these disorders as they can present with a variety of neurologic symptoms ranging from acute spinal neurologic emergencies, relapsing/remitting ...

Abstract	Vascular abnormalities of the spinal cord are an important cause of myelopathy. Clinicians need to be aware of these disorders as they can present with a variety of neurologic symptoms ranging from acute spinal neurologic emergencies, relapsing/remitting spells to gradually progressive dysfunction. The unique topography and vascular anatomy of the spinal cord lends to the variety of clinical presentations. Both ischemic and hemorrhagic insults can occur. Increased clinical suspicion, better detection with newer imaging modalities and early treatment can often impact outcomes. The authors review clinical diagnoses, novel imaging, and advanced treatment modalities for the most common causes of vascular myelopathy.
MeSH term(s)	Arteriovenous Fistula/diagnosis ; Arteriovenous Fistula/physiopathology ; Arteriovenous Fistula/therapy ; Arteriovenous Malformations/diagnosis ; Arteriovenous Malformations/physiopathology ; Arteriovenous Malformations/therapy ; Central Nervous System Vascular Malformations/diagnosis ; Central Nervous System Vascular Malformations/physiopathology ; Central Nervous System Vascular Malformations/therapy ; Diagnosis, Differential ; Female ; Hemangioma, Cavernous/diagnosis ; Hemangioma, Cavernous/physiopathology ; Hemangioma, Cavernous/therapy ; Humans ; Male ; Middle Aged ; Spinal Cord Ischemia/diagnosis ; Spinal Cord Ischemia/physiopathology ; Spinal Cord Ischemia/therapy ; Vascular Diseases/diagnosis ; Vascular Diseases/physiopathology ; Vascular Diseases/therapy
Language	English
Publishing date	2012-04
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	603165-1
ISSN	1098-9021 ; 0271-8235
ISSN (online)	1098-9021
ISSN	0271-8235
DOI	10.1055/s-0032-1322585
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Article ; Online: Fibromatosis presenting as a sacrococcygeal mass.

Grewal, Navanjun S / Moftakhar, Parham / Frykman, Philip K

Journal of pediatric surgery

2009 Volume 44, Issue 3, Page(s) 637–639

Abstract: Most children older than a year who present with a sacrococcygeal mass have a malignant tumor. We describe an 8-year-old child with of a sacrococcygeal soft tissue mass that was completely resected with histologic findings consistent with fibromatosis. ... ...

Abstract	Most children older than a year who present with a sacrococcygeal mass have a malignant tumor. We describe an 8-year-old child with of a sacrococcygeal soft tissue mass that was completely resected with histologic findings consistent with fibromatosis. Fibromatosis is a deep-seated, musculoaponeurotic, borderline tumor that is rare in childhood and has a high incidence of local recurrence even after margin-free resection. We review and discuss management strategies for treatment of fibromatosis in children. This case represents the first report of fibromatosis presenting as a sacrococcygeal mass.
MeSH term(s)	Child ; Female ; Fibroma/diagnosis ; Fibroma/surgery ; Humans ; Magnetic Resonance Imaging ; Sacrococcygeal Region ; Soft Tissue Neoplasms/diagnosis ; Soft Tissue Neoplasms/surgery
Language	English
Publishing date	2009-03
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	80165-3
ISSN	1531-5037 ; 0022-3468
ISSN (online)	1531-5037
ISSN	0022-3468
DOI	10.1016/j.jpedsurg.2008.10.073
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Article ; Online: Aquaporin expression in the brains of patients with or without cerebral amyloid angiopathy.

Moftakhar, Parham / Lynch, Matthew D / Pomakian, Justine L / Vinters, Harry V

Journal of neuropathology and experimental neurology

2011 Volume 69, Issue 12, Page(s) 1201–1209

Abstract: Aquaporins have recently been identified as protein channels involved in water transport. These channels may play a role in the edema formation and alterations in microvascular function observed in Alzheimer disease (AD) and cerebral amyloid angiopathy ( ... ...

Abstract	Aquaporins have recently been identified as protein channels involved in water transport. These channels may play a role in the edema formation and alterations in microvascular function observed in Alzheimer disease (AD) and cerebral amyloid angiopathy (CAA). We investigated the expression of aquaporin 1 (AQP1) and aquaporin 4 (AQP4) in 24 human autopsy brains consisting of 18 with AD and varying degrees of CAA and 6 with no pathologic abnormalities using immunohistochemistry. In cases of AD and CAA, there was enhanced AQP4 expression compared with the age- and sex-matched controls. Aquaporin 4 immunoreactivity was prominent at the cerebrospinal fluid and brain interfaces, including subpial, subependymal, pericapillary, and periarteriolar spaces. Aquaporin 1 expression in AD and CAA cases was not different from that in age- and sex-matched controls. Double labeling studies demonstrated that both AQP1 and 4 were localized to astrocytes. Both enhanced AQP4 expression and its unique staining pattern suggest that these proteins may be important in the impaired water transport observed in AD and CAA.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Alzheimer Disease/metabolism ; Alzheimer Disease/pathology ; Aquaporin 1/biosynthesis ; Aquaporin 4/biosynthesis ; Brain/metabolism ; Brain/pathology ; Cerebral Amyloid Angiopathy/metabolism ; Cerebral Amyloid Angiopathy/pathology ; Female ; Gene Expression Regulation ; Humans ; Male
Chemical Substances	Aquaporin 4 ; Aquaporin 1 (146410-94-8)
Language	English
Publishing date	2011-01-01
Publishing country	England
Document type	Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	3088-0
ISSN	1554-6578 ; 0022-3069
ISSN (online)	1554-6578
ISSN	0022-3069
DOI	10.1097/NEN.0b013e3181fd252c
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Article: Vascular Myelopathies

Moftakhar, Parham / Hetts, Steven W. / Ko, Nerissa U.

Seminars in Neurology

(Myelopathies)

2012 Volume 32, Issue 02, Page(s) 146–153

Series title	Myelopathies
Abstract	Vascular abnormalities of the spinal cord are an important cause of myelopathy. Clinicians need to be aware of these disorders as they can present with a variety of neurologic symptoms ranging from acute spinal neurologic emergencies, relapsing/remitting spells to gradually progressive dysfunction. The unique topography and vascular anatomy of the spinal cord lends to the variety of clinical presentations. Both ischemic and hemorrhagic insults can occur. Increased clinical suspicion, better detection with newer imaging modalities and early treatment can often impact outcomes. The authors review clinical diagnoses, novel imaging, and advanced treatment modalities for the most common causes of vascular myelopathy.
Keywords	spinal cord ; arteriovenous malformation ; dural fistula ; cavernoma ; myelopathy
Language	English
Publishing date	2012-04-01
Publisher	Thieme Medical Publishers
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	603165-1
ISSN	1098-9021 ; 0271-8235
ISSN (online)	1098-9021
ISSN	0271-8235
DOI	10.1055/s-0032-1322585
Database	Thieme publisher's database

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Article ; Online: Spontaneous thrombosis of neonatal vein of Galen malformation.

Moftakhar, Parham / Danielpour, Moise / Maya, Marcel / Alexander, Michael J

Neurosurgical focus

2009 Volume 27, Issue 5, Page(s) E12

Abstract: Vein of Galen malformations are rare congenital intracranial vascular malformations. Based on reports in the literature, spontaneous thrombosis or regression of these lesions is rare. Patients have variable outcomes from an asymptomatic course to death. ... ...

Abstract	Vein of Galen malformations are rare congenital intracranial vascular malformations. Based on reports in the literature, spontaneous thrombosis or regression of these lesions is rare. Patients have variable outcomes from an asymptomatic course to death. The reasons behind spontaneous thrombosis are not entirely understood. Here the authors present a case of an infant diagnosed with a vein of Galen malformation in utero that subsequently went on to thrombose or regress. A review of the published cases on this phenomenon and the potential causality are discussed.
MeSH term(s)	Female ; Humans ; Infant, Newborn ; Pregnancy ; Prenatal Diagnosis ; Remission, Spontaneous ; Thrombosis/pathology ; Vein of Galen Malformations/pathology ; Venous Thrombosis/pathology
Language	English
Publishing date	2009-11
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2026589-X
ISSN	1092-0684 ; 1092-0684
ISSN (online)	1092-0684
ISSN	1092-0684
DOI	10.3171/2009.8.FOCUS09162
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Article ; Online: Cerebral arteriovenous malformations. Part 2: physiology.

Moftakhar, Parham / Hauptman, Jason S / Malkasian, Dennis / Martin, Neil A

Neurosurgical focus

2009 Volume 26, Issue 5, Page(s) E11

Abstract: Object: The scientific understanding of the nature of arteriovenous malformations (AVMs) in the brain is evolving. It is clear from current work that AVMs can undergo a variety of phenomena, including growth, remodeling, and/or regression-and the ... ...

Abstract	Object: The scientific understanding of the nature of arteriovenous malformations (AVMs) in the brain is evolving. It is clear from current work that AVMs can undergo a variety of phenomena, including growth, remodeling, and/or regression-and the responsible processes are both molecular and physiological. A review of these complex processes is critical to directing future therapeutic approaches. The authors performed a comprehensive review of the literature to evaluate current information regarding the genetics, pathophysiology, and behavior of AVMs. Methods: A comprehensive literature review was conducted using PubMed to reveal the angioarchitecture and cerebral hemodynamics of AVMS as they relate to lesion development. Results: Feeding artery pressures, brain AVM compartmentalization, venous drainage, flow phenomena, and vascular steal are discussed. Conclusions: The dynamic nature of brain AVMs is at least in part attributable to hemodynamic and flow-related phenomena. These forces acting on an evolving structure are critical to understanding the challenges in endovascular and surgical therapy. As knowledge in this field continues to progress, the natural history and predicted behavior of these AVMs will become more clearly elucidated.
MeSH term(s)	Animals ; Blood Pressure/physiology ; Brain/blood supply ; Brain/physiopathology ; Capillaries/pathology ; Capillaries/physiopathology ; Cerebral Arteries/abnormalities ; Cerebral Arteries/metabolism ; Cerebral Arteries/physiopathology ; Cerebral Veins/abnormalities ; Cerebral Veins/metabolism ; Cerebral Veins/physiopathology ; Cerebrovascular Circulation/genetics ; Hemodynamics/genetics ; Humans ; Intracranial Aneurysm/etiology ; Intracranial Aneurysm/physiopathology ; Intracranial Arteriovenous Malformations/complications ; Intracranial Arteriovenous Malformations/genetics ; Intracranial Arteriovenous Malformations/physiopathology
Language	English
Publishing date	2009-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2026589-X
ISSN	1092-0684 ; 1092-0684
ISSN (online)	1092-0684
ISSN	1092-0684
DOI	10.3171/2009.2.FOCUS09317
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Article ; Online: Cerebral arteriovenous malformations. Part 1: cellular and molecular biology.

Moftakhar, Parham / Hauptman, Jason S / Malkasian, Dennis / Martin, Neil A

Neurosurgical focus

2009 Volume 26, Issue 5, Page(s) E10

Abstract	Object: The scientific understanding of the nature of arteriovenous malformations (AVMs) in the brain is evolving. It is clear from current work that AVMs can undergo a variety of phenomena, including growth, remodeling, and/or regression-and the responsible processes are both molecular and physiological. A review of these complex processes is critical to directing future therapeutic approaches. The authors performed a comprehensive review of the literature to evaluate current information regarding the genetics, pathophysiology, and behavior of AVMs. Methods: A comprehensive literature review was conducted using PubMed to reveal the molecular biology of AVMs as it relates to their complex growth and behavior patterns. Results: Growth factors involved in AVMs include vascular endothelial growth factor, fibroblast growth factor, transforming growth factor beta, angiopoietins, fibronectin, laminin, integrin, and matrix metalloproteinases. Conclusions Understanding the complicated molecular milieu of developing AVMs is essential for defining their natural history. Growth factors, extracellular matrix proteins, and other molecular markers will be the key to unlocking novel targeted drug treatments for these brain malformations.
MeSH term(s)	Angiogenesis Inducing Agents/metabolism ; Angiogenic Proteins/genetics ; Angiogenic Proteins/metabolism ; Animals ; Biomarkers/analysis ; Biomarkers/metabolism ; Cerebral Arteries/abnormalities ; Cerebral Arteries/metabolism ; Cerebral Arteries/physiopathology ; Cerebral Veins/abnormalities ; Cerebral Veins/metabolism ; Cerebral Veins/physiopathology ; Endothelial Cells/metabolism ; Endothelial Cells/pathology ; Humans ; Intercellular Signaling Peptides and Proteins/genetics ; Intercellular Signaling Peptides and Proteins/metabolism ; Intracranial Arteriovenous Malformations/genetics ; Intracranial Arteriovenous Malformations/metabolism ; Intracranial Arteriovenous Malformations/physiopathology ; Neovascularization, Physiologic/genetics ; Signal Transduction/genetics
Chemical Substances	Angiogenesis Inducing Agents ; Angiogenic Proteins ; Biomarkers ; Intercellular Signaling Peptides and Proteins
Language	English
Publishing date	2009-05
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2026589-X
ISSN	1092-0684 ; 1092-0684
ISSN (online)	1092-0684
ISSN	1092-0684
DOI	10.3171/2009.2.FOCUS09316
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Article ; Online: Moyamoya disease in children with congenital dwarfing conditions.

Moftakhar, Parham / Smith, Edward R / Choulakian, Armen / Scott, R Michael / Danielpour, Moise

Pediatric neurosurgery

2010 Volume 46, Issue 5, Page(s) 373–380

Abstract: Congenital dwarfisms can be associated with a variety of vascular anomalies. Here, we describe 2 patients with congenital dwarfisms who presented with moyamoya syndrome and underwent indirect intracranial revascularization. The pathogenesis of moyamoya ... ...

Abstract	Congenital dwarfisms can be associated with a variety of vascular anomalies. Here, we describe 2 patients with congenital dwarfisms who presented with moyamoya syndrome and underwent indirect intracranial revascularization. The pathogenesis of moyamoya syndrome in this population is not well understood, but it is a major cause of stroke and early death in these patients, making their timely diagnosis and management critical.
MeSH term(s)	Adolescent ; Dwarfism/complications ; Dwarfism/diagnosis ; Dwarfism/surgery ; Female ; Humans ; Infant ; Male ; Moyamoya Disease/complications ; Moyamoya Disease/diagnosis ; Moyamoya Disease/surgery
Language	English
Publishing date	2010
Publishing country	Switzerland
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	1091757-3
ISSN	1423-0305 ; 1016-2291
ISSN (online)	1423-0305
ISSN	1016-2291
DOI	10.1159/000322017
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Article ; Online: Osseous and vascular anatomical variations within the C1-C2 complex: a radiographical study using computed tomography angiography.

Moftakhar, Parham / Gonzalez, Nestor R / Khoo, Larry T / Holly, Langston T

The international journal of medical robotics + computer assisted surgery : MRCAS

2008 Volume 4, Issue 2, Page(s) 158–164

Abstract: Background: One of the limiting factors of C1-C2 fixation is the location of the vertebral artery (VA). The authors sought to assess the potential variations in atlanto-axial VA anatomy using computed tomography angiography (CTA).: Methods: Detailed ... ...

Abstract	Background: One of the limiting factors of C1-C2 fixation is the location of the vertebral artery (VA). The authors sought to assess the potential variations in atlanto-axial VA anatomy using computed tomography angiography (CTA). Methods: Detailed measurements were made on digital images of 106 patients undergoing CTA at our institution (54 males, 52 females; mean age 56, range 20-86). Distances, diameters and angles of osseous and vascular elements of the atlanto-axial complex were measured. Results: Optimal C1 and C2 screw trajectories demonstrated wide variations among patients. The size of the VA groove or foramen was not predictive of exact arterial location or size. Conclusions: The size, location and path of the VA cannot be precisely predicted by the appearance of osseous structures such as the transverse foramina and/or the VA groove. CTA provides additional information regarding the atlanto-axial complex, and should be considered as a useful adjunct in the preoperative evaluation of select patients.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Angiography ; Atlanto-Axial Joint/blood supply ; Atlanto-Axial Joint/diagnostic imaging ; Axis, Cervical Vertebra/blood supply ; Axis, Cervical Vertebra/diagnostic imaging ; Bone Screws ; Cervical Atlas/blood supply ; Cervical Atlas/diagnostic imaging ; Female ; Humans ; Internal Fixators ; Male ; Middle Aged ; Models, Anatomic ; Tomography, X-Ray Computed ; Vertebral Artery/anatomy & histology
Language	English
Publishing date	2008-06
Publishing country	England
Document type	Journal Article
ZDB-ID	2151860-9
ISSN	1478-596X ; 1478-5951
ISSN (online)	1478-596X
ISSN	1478-5951
DOI	10.1002/rcs.193
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