Efficacy and morbidity of arc-therapy radiosurgery for cerebral arteriovenous malformations: a comparison with the natural history

2004 ◽  
Vol 58 (5) ◽  
pp. 1353-1363 ◽  
Author(s):  
Marc A Bollet ◽  
René Anxionnat ◽  
Isabelle Buchheit ◽  
Pierre Bey ◽  
Alexandre Cordebar ◽  
...  
Keyword(s):  
Natural History ◽  
Arteriovenous Malformations ◽  
Cerebral Arteriovenous Malformations ◽  
Arc Therapy

Advances in Radiosurgery for Arteriovenous Malformations of the Brain

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S50-S59 ◽  
Author(s):  
Benjamin A. Rubin ◽  
Andrew Brunswick ◽  
Howard Riina ◽  
Douglas Kondziolka
Keyword(s):  
Natural History ◽  
Stereotactic Radiosurgery ◽  
Endovascular Therapy ◽  
Arteriovenous Malformations ◽  
Morbidity And Mortality ◽  
Cerebral Arteriovenous Malformations ◽  
History Of ◽  
The Brain ◽  
Management Algorithms

Abstract Arteriovenous malformations of the brain are a considerable source of morbidity and mortality for patients who harbor them. Although our understanding of this disease has improved, it remains in evolution. Advances in our ability to treat these malformations and the modes by which we address them have also improved substantially. However, the variety of patient clinical and disease scenarios often leads us into challenging and complex management algorithms as we balance the risks of treatment against the natural history of the disease. The goal of this article is to provide a focused review of the natural history of cerebral arteriovenous malformations, to examine the role of stereotactic radiosurgery, to discuss the role of endovascular therapy as it relates to stereotactic radiosurgery, and to look toward future advances.

scholarly journals Natural history of brain arteriovenous malformations: a systematic review

2014 ◽  
Vol 37 (3) ◽  
pp. E7 ◽  
Author(s):  
Isaac Josh Abecassis ◽  
David S. Xu ◽  
H. Hunt Batjer ◽  
Bernard R. Bendok
Keyword(s):  
Natural History ◽  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Cerebral Arteriovenous Malformations ◽  
Brain Arteriovenous Malformations ◽  
Increased Risk ◽  
Risk Of Rupture ◽  
History Of ◽  
Arterial Aneurysms

Object The authors aimed to systematically review the literature to clarify the natural history of brain arteriovenous malformations (BAVMs). Methods The authors searched PubMed for one or more of the following terms: natural history, brain arteriovenous malformations, cerebral arteriovenous malformations, and risk of rupture. They included studies that reported annual rates of hemorrhage and that included either 100 patients or 5 years of treatment-free follow-up. Results The incidence of BAVMs is 1.12–1.42 cases per 100,000 person-years; 38%–68% of new cases are first-ever hemorrhage. The overall annual rates of hemorrhage for patients with untreated BAVMs range from 2.10% to 4.12%. Consistently implicated in subsequent hemorrhage are initial hemorrhagic presentation, exclusively deep venous drainage, and deep and infrantentorial brain location. The risk for rupture seems to be increased by large nidus size and concurrent arterial aneurysms, although these factors have not been studied as thoroughly. Venous stenosis has not been implicated in increased risk for rupture. Conclusions For patients with BAVMs, although the overall risk for hemorrhage seems to be 2.10%–4.12% per year, calculating an accurate risk profile for decision making involves clinical attention and accounting for specific features of the malformation.

scholarly journals Target Embolization of AVMs: Identification of Sites and Results of Treatment

2007 ◽  
Vol 13 (4) ◽  
pp. 389-394 ◽  
Author(s):  
D. Le Feuvre ◽  
A. Taylor
Keyword(s):  
Natural History ◽  
Neurological Deficit ◽  
Clinical Picture ◽  
Treatment Strategy ◽  
Arteriovenous Malformations ◽  
High Flow ◽  
Cerebral Arteriovenous Malformations ◽  
Venous Flow ◽  
Results Of Treatment ◽  
The Ideal

Although cure of cerebral arteriovenous malformations (AVMs) is the ideal goal it is often only possible with smaller sized lesions. This is certainly true if surgery or radiotherapy is used as the treatment strategy. Endovascular treatment, however, allows the possibility of partial treatment directed at specific areas of AVM architecture. With this in mind we retrospectively reviewed our cohort of AVMs to establish which morphological areas we had identified as targets and how the treatment of the AVM influenced the clinical picture. Over a 36-month period 42 AVMs were treated. In 22 of the patients who presented with a hemorrhage an intranidal aneurysm was identified as a target and treated in nine patients. Other patients presented with headaches (2), neurological deficit (4) and seizures (16) with two patients having their AVM picked up coincidentally. Targets identified included high flow fistulas (12), decreasing venous flow (17) and cure of the AVM (8). Results of targeted treatment showed a lower rehemorrhage rate than anticipated by the natural history. Patients cured did best and targeted embolization improved seizures in nine patients, neurological deficit in four patients and headache in 20 patients. Until safer methods exist to cure large AVMs the use of targeted embolization is acceptable as it protects patients against rehemorrhage and translates into an improvement in their clinical picture.

Incidental Unruptured Arteriovenous Malformation

2019 ◽  
pp. 193-202
Author(s):  
Nicholas C. Bambakidis ◽  
Jeffrey T. Nelson
Keyword(s):  
Decision Making ◽  
Natural History ◽  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Endovascular Embolization ◽  
Cerebral Arteriovenous Malformations ◽  
Eloquent Cortex ◽  
Multimodality Approach ◽  
The Brain ◽  
Efficacy Of Treatment

Abstract: Cerebral arteriovenous malformations are a rare cause of hemorrhage or seizure. They may occur anywhere in the brain and vary considerably in size, arterial and venous drainage, and the degree to which they involve eloquent cortex. Decision-making in terms of treatment depends on an analysis of the expected natural history, the expected number of at risk years, and the anticipated risks and efficacy of treatment. Treatment of unruptured arteriovenous malformations for the prevention of adverse sequelae often requires a multimodality approach, including consideration of the roles of surgical resection, endovascular embolization, and stereotactic radiosurgery. This chapter discusses the diagnosis and management of unruptured cerebral arteriovenous malformations.

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