scholarly journals Brain Arteriovenous Malformations Classifications: A Surgical Point of View

2021 ◽  
pp. 101-106
Author(s):  
Giovanni Marco Sicuri ◽  
Nicola Galante ◽  
Roberto Stefini
Keyword(s):  
Surgical Management ◽  
Arteriovenous Malformations ◽  
Point Of View ◽  
Treatment Modalities ◽  
Extensive Discussion ◽  
Classification Schemes ◽  
Brain Arteriovenous Malformations ◽  
Intracerebral Hemorrhages ◽  
The Subject

AbstractBrain arteriovenous malformations (AVMs) classification has been the subject of extensive discussion. The aim of our work was to review the main classification schemes proposed in the literature, which can be summarized in four main groups: (a) traditional schemes oriented to evaluate the operability of AVMs have been joined by (b) specific classifications that evaluate the outcome and the predictability of obliteration of other treatment modalities and (c) others that evaluate the outcome of intracerebral hemorrhages in ruptured AVMs. Eventually, (d) topographical classifications that categorize the subtypes of AVMs located in specific anatomical regions have been drawn. For each classification, we discuss the implications on surgical management.

scholarly journals Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

2020 ◽  
Author(s):  
Chen Yu ◽  
Xiangyu Meng ◽  
Li Ma ◽  
Yang Zhao ◽  
Ye Gu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Questionnaire Survey ◽  
Arteriovenous Malformations ◽  
Large Population ◽  
Mainland China ◽  
Treatment Modalities ◽  
Web Based ◽  
Brain Arteriovenous Malformations ◽  
Intraoperative Management ◽  
Hemorrhagic Risk

Abstract Background: In the benefit of the large population and rapid economic growth, the interventional techniques and equipment for brain arteriovenous malformations (bAVMs) in mainland China have been rapidly improved. Chinese neurosurgical cerebrovascular physicians have accumulated rich experience and made pioneering explorations. This study aims to summarize the experience and treatment progress of bAVMs in mainland China.Methods: We performed a web-based nationwide questionnaire survey among 67 tertiary neurosurgical institutions that had acknowledged treating bAVMs in the primary survey. Our questionnaire included clinical characteristics, radiological findings, intervention indications/contraindications, intervention timing, and intraoperative management of different treatment modalities. Results: A total of 63 participants from 49 (73.1%) tertiary neurosurgical institutions responded to our questionnaire. 42 (66.7%) were neurosurgeons, 13 (20.6%) were neurointerventionists, and 8 (12.7%) were radiosurgeons. Approximately 3500 to 4000 cases of bAVMs were treated annually in these 49 departments. All participants agreed that the conclusions of ARUBA are debatable. Flow-related aneurysms, deep venous drainage, and arteriovenous fistula were considered as common hemorrhagic risk factors. Unruptured SM IV-V bAVMs, giant bAVMs, pediatric bAVMs, elderly bAVMs, and eloquent bAVMs were not absolute contraindications to intervention. Maximum lesion occlusion and minimal functional impairment were the principles of intervention management. Most of the neurosurgeons and neurointerventionists recommended early intervention (<30 days) for ruptured bAVMs, and the radiosurgeons suggested intervention in the chronic phase or recovery phase (P<0.01), and preferably 3 months after bleeding. Multi-modality strategies were thought effective for complex bAVMs and more exploration of individualized intraoperative management was necessary.Conclusions: Intervention was acceptable for specific selected unruptured bAVMs in mainland China, especially in patients with hemorrhagic risk factors. The application of multidisciplinary cerebrovascular team and multicenter large-sample international registry study might be the next work for Chinese neurosurgical cerebrovascular physicians.Trial registration: ClinicalTrials.gov NCT04136860.

scholarly journals Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

2020 ◽  
Author(s):  
Chen Yu ◽  
Xiangyu Meng ◽  
Li Ma ◽  
Yang Zhao ◽  
Ye Gu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Questionnaire Survey ◽  
Arteriovenous Malformations ◽  
Large Population ◽  
Mainland China ◽  
Treatment Modalities ◽  
Web Based ◽  
Brain Arteriovenous Malformations ◽  
Intraoperative Management ◽  
Hemorrhagic Risk

Abstract Background:In the benefit of the large population and rapid economic growth, the interventional techniques and equipment for brain arteriovenous malformations (bAVMs) in mainland China have been rapidly improved. Chinese neurosurgical cerebrovascular physicians have accumulated rich experience and made pioneering explorations. This study aims to summarize the experience and treatment progress of bAVMs in mainland China.Methods:We performed a web-based nationwide questionnaire survey among 67 tertiary neurosurgical institutions that had acknowledged treating bAVMs in the primary survey. Our questionnaire included clinical characteristics, radiological findings, intervention indications/contraindications, intervention timing, and intraoperative management of different treatment modalities. Results:A total of 63 participants from 49 (73.1%) tertiary neurosurgical institutions responded to our questionnaire. 42 (66.7%) were neurosurgeons, 13 (20.6%) were neurointerventionists, and 8 (12.7%) were radiosurgeons. Approximately 3500 to 4000 cases of bAVMs were treated annually in these 49 departments. All participants agreed that the conclusions of ARUBA are debatable. Flow-related aneurysms, deep venous drainage, and arteriovenous fistula were considered as common hemorrhagic risk factors. Unruptured SM IV-V bAVMs, giant bAVMs, pediatric bAVMs, elderly bAVMs, and eloquent bAVMs were not absolute contraindications to intervention. Maximum lesion occlusion and minimal functional impairment were the principles of intervention management. Most of the neurosurgeons and neurointerventionists recommended early intervention (<30 days) for ruptured bAVMs, and the radiosurgeons suggested intervention in the chronic phase or recovery phase (P<0.01), and preferably 3 months after bleeding. Multi-modality strategies were thought effective for complex bAVMs and more exploration of individualized intraoperative management was necessary.Conclusions:Intervention was acceptable for specific selected unruptured bAVMs in mainland China, especially in patients with hemorrhagic risk factors. The application of multidisciplinary cerebrovascular team and multicenter large-sample international registry study might be the next work for Chinese neurosurgical cerebrovascular physicians.

scholarly journals Updates in arteriovenous malformation management: the post-ARUBA era

2019 ◽  
Vol 5 (1) ◽  
pp. 34-39 ◽  
Author(s):  
James Feghali ◽  
Judy Huang
Keyword(s):  
Arteriovenous Malformations ◽  
Observational Studies ◽  
Interventional Therapy ◽  
Treatment Modalities ◽  
Low Grade ◽  
Randomised Trials ◽  
Brain Arteriovenous Malformations ◽  
Favourable Safety ◽  
Cure Rates

Brain arteriovenous malformations (AVMs) are complex and heterogeneous lesions that can rupture, causing significant morbidity and mortality. While ruptured lesions are usually treated, the management of unruptured AVMs remains unclear. A Randomized trial of Unruptured Brain Arteriovenous Malformations (ARUBA) was the first trial conducted to compare the effects of medical and interventional therapy. Although it concluded that medical therapy was superior in preventing stroke and death over a follow-up period of 33 months, the findings were met with intense criticism regarding several aspects of study design, progression, and analysis/conclusion. Namely, the increased use of stand-alone embolisation relative to microsurgery in a cohort with predominantly low-grade lesions combined with a short follow-up period amplified treatment risk. Subsequently, several observational studies were conducted on ARUBA-eligible patients to investigate the safety and efficacy of microsurgery, radiosurgery, and endovascular embolisation over longer follow-up periods. These reports showed that favourable safety profiles and cure rates can be achieved with appropriate patient selection and judicious use of different treatment modalities in multidisciplinary centres. Since large prospective randomised trials on AVMs may not be feasible, it is important to make use of practice-based data beyond the flawed ARUBA study to optimise patients’ lifetime outcomes.

scholarly journals Radiosurgery-Based AVM Scale Is Proposed for Combined Embolization and Gamma Knife Surgery for Brain Arteriovenous Malformations

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiangyu Meng ◽  
Hongwei He ◽  
Peng Liu ◽  
Dezhi Gao ◽  
Yu Chen ◽  
...  
Keyword(s):  
Treatment Group ◽  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Combined Treatment ◽  
Group Analysis ◽  
Gamma Knife Surgery ◽  
Treatment Modalities ◽  
Factors Associated ◽  
Obliteration Rate ◽  
Brain Arteriovenous Malformations

Background and purpose: To evaluate whether a radiosurgery-based arteriovenous malformation (AVM) scale (RBAS) could be used to predict obliteration of brain arteriovenous malformations (bAVMs) supposed for combined endovascular embolization (EMB) and gamma knife surgery (GKS) treatment.Methods: bAVM patients who underwent GKS with or without previous EMB from January 2011 to December 2016 at our institution were retrospectively reviewed. The patients were categorized into a combined treatment group and a GKS group. A 1:1 propensity score matching (PSM) was used to match the two groups. Pre-EMB and pre-GKS RBAS were assessed for every patient. Multivariate analysis was performed to find factors associated with complete obliteration in the combined treatment group. Survival analysis based on sub-groups according to RBAS was performed to compare obliteration rate and find cutoffs for appropriate treatment modalities.Results: A total of 96 patients were involved, and each group comprised 48 patients. There was no difference between the two groups in terms of obliteration rate (75.0 vs. 83.3%, p = 0.174). Pre-EMB RBAS (p = 0.010) and the number of feeding arteries (p = 0.014) were independent factors associated with obliteration rate in the combined treatment group. For the combined treatment patients, sub-group analysis according to pre-EMB RBAS (score &lt;1.0, 1.0–1.5, and &gt;1.5) showed statistical difference in obliteration rate (p = 0.002). Sub-group analysis according to RBAS between the two groups showed that the obliteration rate of the GKS group is significantly higher than the combined group when RBAS &gt;1.5 (47.4 vs. 66.7%, p = 0.036).Conclusions: The RBAS is proposed to be efficient in predicting obliteration of bAVMs supposed to receive combined EMB and GKS treatment. Patients with RBAS &gt;1.5 are inclined to be more suitable for GKS instead of the combined treatment.

scholarly journals Stereotactic Radiosurgery for Brain Arteriovenous Malformations

2018 ◽  
Vol 25 (3) ◽  
pp. 205-216
Author(s):  
Leonardo Frighetto ◽  
Timóteo Abrantes de Lacerda Almeida ◽  
Matheus Pintos Brunet ◽  
Pedro Radalle Biasi ◽  
Paulo Petry Oppitz ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Treatment Modalities ◽  
Benign Lesions ◽  
Modern Approach ◽  
Stereotactic Radiation ◽  
Brain Arteriovenous Malformations ◽  
Radiation Delivery ◽  
Technological Advances ◽  
Brain Avms

Stereotactic radiosurgery is an established treatment modality in the management of brain arteriovenous malformations (AVMs). Technological advances in radiation delivery systems associated with improvements in neuroimaging have recently changed radiosurgery indications and results. Besides this advances, and the association with microsurgery and embolization, the management of these benign lesions are still controversial. AVMs in eloquent areas and those with large volumes remain a challenge for all treatment modalities. This article discusses the modern approach of radiosurgery for brain AVMs including new options such as combined approaches and the use of hipofractionated stereotactic radiation for large and high flow lesions.

Brain Arteriovenous Malformations: Impact of Neurologic Status, Bleeding, and Type of Treatment on Final Outcome

2020 ◽  
Author(s):  
Sara García-Duque ◽  
Roberto García-Leal ◽  
Begoña Iza-Vallejo ◽  
Enrique Castro-Reyes ◽  
Fernando Fortea ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Arteriovenous Malformations ◽  
Clinical Status ◽  
Outcome Data ◽  
Neurologic Outcome ◽  
Treatment Modalities ◽  
Brain Arteriovenous Malformations ◽  
Poor Outcome ◽  
Neurologic Status

Abstract Background Well-designed studies assessing the treatment outcome of brain arteriovenous malformations (AVMs) are infrequent and have not consistently included all of the available treatment modalities, making their results not completely generalizable. Moreover, the predictors of poor outcome are not well defined. Methods We performed an observational retrospective study of AVM patients. We included patients with clinical, radiologic, and outcome data, with a minimum follow-up of 1 year. Neurologic outcome was documented using the modified Rankin Scale (mRS) at the AVM diagnosis and 30 days after the treatment. Results There were 117 patients, with equal male/female proportion. The mean follow-up time was 51 months. Treatment distribution in the Spetzler–Martin grades I–III was as follows: 52 (54.6%) surgery, 31 (32.35%) radiosurgery, 2 (0.02%) embolization, and 11 (12%) conservative follow-up. Treatment distribution in Spetzler–Martin grades IV and V was as follows: 4 (20%) surgery, 7 (35%) radiosurgery, and 10 (45%) conservative follow-up. Poor neurologic outcome (mRS ≥ 3) was significantly associated with poor clinical status at diagnosis (Glasgow Coma Scale [GCS] score< 14; odds ratio [OR]: 0.20; 95% confidence interval [CI]: 0.001–0.396; p = 0.010). The rupture of the AVM was associated with poor neurologic outcome. The Lawton–Young Supplementary scale (LYSS) proved to be the most effective in predicting poor outcome. The existence of seizures, treatment-related complications, and conservative treatment was associated with the worsening of the mRS score, whereas the existence of hemorrhage was associated with the likelihood of disability. Conclusion Our results suggest that poor neurologic status at diagnosis, AVM rupture, and conservative treatment were associated with worse outcome. Hemorrhage as initial presentation is related to disability, not with mRS worsening. The LYSS appeared to be the best method to predict outcome.

Endovascular treatment as the main approach for Spetzler–Martin grade III brain arteriovenous malformations

2020 ◽  
pp. neurintsurg-2020-016450
Author(s):  
Humain Baharvahdat ◽  
Raphaël Blanc ◽  
Robert Fahed ◽  
Ashkan Pooyan ◽  
Ashkan Mowla ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Malformations ◽  
Neurological Deficits ◽  
Treatment Modalities ◽  
Hemorrhagic Complication ◽  
Brain Arteriovenous Malformations ◽  
Poor Outcome ◽  
Complete Exclusion ◽  
Grade Iii

BackgroundBecause Spetzler–Martin (SM) grade III brain arteriovenous malformations (bAVMs) constitute a heterogeneous group of lesions with various combination of sizes, eloquence, and venous drainage patterns, their management is usually challenging. The aim of this study is to evaluate the clinical/imaging outcomes and the procedural safety of endovascular approach as the main treatment for the cure of SM grade III bAVMs.MethodsIn this retrospective study, prospectively collected data of SM grade III bAVMs treated by endovascular techniques between 2010 and 2018 at our hospital were reviewed. Patients older than 16 years with angiographic follow-up of at least 6 months after endovascular treatment were entered in the study. The patients had a mean follow-up of 12 months. The data were assessed for clinical outcome (modified Rankin Scale), permanent neurological deficit, post-operative complications, and optimal imaging outcome, defined by complete exclusion of AVM. The independent predictive variables of poor outcome or hemorrhagic complication were assessed using binary logistic regression.ResultsSixty-five patients with 65 AVMs were included in the study. Mean age of the patients was 40.0±14.4. Most common presentation was hemorrhage (61.5%). The patients underwent one to eight endovascular procedures (median=2). Mean nidus diameter was 30.2±13.0. A complete obliteration of AVM was achieved in 57 patients (87.7%). Post-procedure significant hemorrhagic and ischemic complications were seen in 13 (20%) and five (7.7%) patients respectively, leading to five (7.7%) transient and four (6.2%) permanent neurological deficits. Eight patients (12.3%) experienced worsening of mRS after embolization. Ten patients (15.4%) had poor outcome (mRS 3–5) at follow-up and two (3%) died.ConclusionsEndovascular treatment can achieve a high rate of complete exclusion of grade III AVM but may be associated (as in other treatment modalities) with significant important complications.Clinical trial registration numberNCT02879071.

A Modified Chair Geometry for Whole Body Counting

1976 ◽  
Vol 15 (05) ◽  
pp. 246-247
Author(s):  
S. C. Jain ◽  
G. C. Bhola ◽  
A. Nagaratnam ◽  
M. M. Gupta
Keyword(s):  
Marked Improvement ◽  
Point Of View ◽  
Whole Body ◽  
Spatial Response ◽  
Body Counting ◽  
The Subject ◽  
Whole Body Counting ◽  
The Buddha

SummaryIn the Marinelli chair, a geometry widely used in whole body counting, the lower part of the leg is seen quite inefficiently by the detector. The present paper describes an attempt to modify the standard chair geometry to minimise this limitation. The subject sits crossed-legged in the “Buddha Posture” in the standard chair. Studies with humanoid phantoms and a volunteer sitting in the Buddha posture show that this modification brings marked improvement over the Marinelli chair both from the point of view of sensitivity and uniformity of spatial response.

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