scholarly journals The Natural History of Brain Arteriovenous Malformations

2017 ◽  
Vol 36 (03) ◽  
pp. 153-159
Author(s):  
Carlos Peres ◽  
Vitor Yamaki ◽  
Eberval Figueiredo
Keyword(s):  
Natural History ◽  
Arteriovenous Malformations ◽  
Functional Performance ◽  
Brain Infarction ◽  
Treatment Decision ◽  
Venous Drainage ◽  
Brain Arteriovenous Malformations ◽  
Risk Of Rupture ◽  
Choice Of Treatment ◽  
History Of

AbstractBrain arteriovenous malformations (AVMs) are relatively rare lesions with irreversible consequences in the context of hemorrhage. They are characterized by direct connections between arteries and veins without an intervening capillary network. The natural history of brain AVMs is controversial in the literature, with low evidence level gathered in the papers published, and with large divergence of results among them. A detailed understanding of the natural history is critical for treatment decision. The risk of development of deleterious outcomes such as hemorrhage or brain infarction should always be considered when submitting a patient to the risks of treatment. Several factors related to the patient and to the AVMs are determinants in the natural history of this disease. The topography, size, morphology and angioarchitecture of AVMs determine the risk of rupture. Large AVMs, those located in the posterior fossa and with deep venous drainage, have higher risk of rupture. Due to divergence in the literature regarding the natural history of AVMs, the choice of treatment should also consider experiences acquired over the years from reference centers with a high number of AVMs treated per year. We determined 7 variables that should be considered during the decision to treat an AVM: 1) previous hemorrhage; 2) aneurysm associated to the AVM; 3) direct arteriovenous fistula; 4) factors related to the nidus; 5) age and habits (smoking, sedentary lifestyle, diet quality); 6) the functional performance of the patient; 7) psychological factors.

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 Risk of Rupture and Risks of Endovascular Management of Unruptured Brain Arteriovenous Malformations

2014 ◽  
Vol 20 (4) ◽  
pp. 495-501 ◽  
Author(s):  
Xun Shen ◽  
Jie Liu ◽  
Xianli Lv ◽  
Youxiang Li
Keyword(s):  
Natural History ◽  
Arteriovenous Malformations ◽  
Morbidity And Mortality ◽  
Endovascular Management ◽  
Brain Arteriovenous Malformations ◽  
Risk Of Rupture ◽  
Cumulative Rate ◽  
History Of ◽  
Group 2 ◽  
Group 1

This study reports the natural history of unruptured brain arteriovenous malformations (AVMs) and the risks involved in their endovascular management. A total of 242 patients at our center were enrolled in the study, which had retrospective and prospective components. We retrospectively assessed the morbidity and mortality related to endovascular management in 125 patients with unruptured AVMs. We prospectively assessed the natural history of unruptured AVMs in 117 patients with newly diagnosed unruptured AVMs; 48 of the patients had no history of seizure (Group 1), whereas 69 had a history of seizure from the lesion (Group 2). The retrospective group was also divided into patients with and without seizures. The cumulative rate of rupture of AVMs in Group 2 was less than 0.8% per year, while the rate was approximately sixfold higher (5.1% per year) in Group 1. The overall cumulative rate of rupture of AVMs was less than 3.0% per year. The overall rate of endovascular management-related morbidity and mortality was 10.6% in Group 2 and 11.9% in Group 1 at 30 days and was 25.9% and 13.6%, respectively, at one year. There was no independent predictor of a poor endovascular outcome. The likelihood of rupture of unruptured AVMs was exceedingly low among patients in Group 2 and was substantially higher among those in Group 1. The risk of morbidity and mortality related to endovascular management greatly exceeded the six-year risk of rupture among patients in Group 2. Endovascular management of an AVM should not be performed to eliminate or to improve seizure frequency.

Natural History of Brain Arteriovenous Malformations

Neurosurgery ◽  
2008 ◽  
Vol 62 (6) ◽  
pp. 1402
Author(s):  
Aki Laakso ◽  
Reza Dashti ◽  
Seppo Juvela ◽  
Kristjan Väärt ◽  
Mika Niemela ◽  
...  
Keyword(s):  
Natural History ◽  
Arteriovenous Malformations ◽  
Brain Arteriovenous Malformations ◽  
History Of

A Single-Center, Prospective Analysis of the Natural History of Hemorrhage from Brain Arteriovenous Malformations with or without Associated Aneurysms

Neurosurgery ◽  
2005 ◽  
Vol 57 (2) ◽  
pp. 396-397 ◽  
Author(s):  
Leodante B. da Costa ◽  
Christopher M. Wallace ◽  
Karel TerBrugge ◽  
Robert Willinsky ◽  
Michael Tymianski
Keyword(s):  
Natural History ◽  
Arteriovenous Malformations ◽  
Prospective Analysis ◽  
Single Center ◽  
Brain Arteriovenous Malformations ◽  
History Of

Thalamic and Basal Ganglia Arteriovenous Malformations: Redefining “Inoperable”

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS63-ONS68 ◽  
Author(s):  
Edward A.M. Duckworth ◽  
Bradley Gross ◽  
H. Hunt Batjer
Keyword(s):  
Basal Ganglia ◽  
Natural History ◽  
Stereotactic Radiosurgery ◽  
Surgical Resection ◽  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Lesion Size ◽  
Small Lesion ◽  
History Of ◽  
Microsurgical Techniques

Abstract Deep Arteriovenous Malformations of the basal ganglia and thalamus have an aggressive natural history and present a therapeutic challenge. More often than not, these lesions are deemed “inoperable” and are treated expectantly or with stereotactic radiosurgery. In some cases, clinical details combined with an opportune route of access dictate surgical resection. History of hemorrhage, small lesion size, and deep venous drainage each add to the aggressive natural history of these malformations. Interestingly, these same factors can point toward surgery. We present a discussion of the microsurgical techniques involved in managing these lesions, with an emphasis on situations that allow these lesions to be approached surgically.

Impact of Partial Embolization on the Natural History of Brain Arteriovenous Malformations

Neurosurgery ◽  
2006 ◽  
Vol 58 (2) ◽  
pp. 400
Author(s):  
Leodante DaCosta ◽  
Karel ter Brugge ◽  
Robert Willinsky ◽  
M Christopher Wallace ◽  
Michael Tymianski
Keyword(s):  
Natural History ◽  
Arteriovenous Malformations ◽  
Brain Arteriovenous Malformations ◽  
History Of

Deep arteriovenous malformations of the basal ganglia and thalamus: natural history

2003 ◽  
Vol 98 (4) ◽  
pp. 747-750 ◽  
Author(s):  
Ian G. Fleetwood ◽  
Mary L. Marcellus ◽  
Richard P. Levy ◽  
Michael P. Marks ◽  
Gary K. Steinberg
Keyword(s):  
Basal Ganglia ◽  
Natural History ◽  
Arteriovenous Malformations ◽  
Venous Drainage ◽  
Neurological Injury ◽  
Content Type ◽  
Hemorrhagic Event ◽  
History Of ◽  
Risk Of Hemorrhage ◽  
Fine Print

Object. Patients with arteriovenous malformations (AVMs) in a deep location and with deep venous drainage are thought to be at higher risk for hemorrhage than those with AVMs in other locations. Despite this, the natural history of AVMs of the basal ganglia and thalamus has not been well studied. Methods. The authors retrospectively evaluated a cohort of 96 patients with AVMs in the basal ganglia and thalamus with respect to the tendency of these lesions to hemorrhage between the time of detection and their eventual successful management. The 96 patients studied had a mean age of 22.7 years at diagnosis, and 51% were male. Intracranial hemorrhage (ICH) was the event leading to clinical detection in 69 patients (71.9%), and 85.5% of these patients were left with hemiparesis. After diagnosis, 25 patients bled a total of 49 times. The cumulative clinical follow up after detection but before surgical management was 500.2 patient-years. The risk of hemorrhage after detection of an AVM of the basal ganglia or thalamus was 9.8% per patient-year. Conclusions. The rate of ICH in patients with AVMs of the basal ganglia or thalamus (9.8%/year) is much higher than the rate in patients with AVMs in other locations (2–4%/year). The risk of incurring a neurological deficit with each hemorrhagic event is high. Treatment of these patients at specialized centers is recommended to prevent neurological injury from a spontaneous ICH.

scholarly journals Multidisciplinary Care of Unruptured Brain Arteriovenous Malformations to Improve Symptomatic Headache and the Onset, Progression, and Outcomes of Unruptured Brain Arteriovenous Malformations

2017 ◽  
Vol 1 (21;1) ◽  
pp. E127-E136
Author(s):  
Chuan-Zhi Chuan-Zhi
Keyword(s):  
Natural History ◽  
Arteriovenous Malformations ◽  
Multidisciplinary Care ◽  
Medical Group ◽  
Brain Arteriovenous Malformations ◽  
Quality Life ◽  
Symptomatic Headache ◽  
History Of ◽  
Multidisciplinary Group ◽  
Symptomatic Headaches

Background: Symptomatic headaches attributed to unruptured brain arteriovenous malformations (ubAVMs) are very common and affect patients’ quality life, but multidisciplinary care of ubAVMs to improve symptomatic headache remains unclear. Objective: The objective is to identify the features of symptomatic headaches, and to obtain headache outcomes following multidisciplinary care of ubAVMs, as well as provide background on the natural history of ubAVMs. Study Design: The features of symptomatic headaches and headache outcomes were analyzed in a large cohort of cases after multidisciplinary care of ubAVMs. We have also provided information on the natural history of ubAVMs Setting: This study was conducted at the Department of Neurosurgery of Zhujiang Hospital where 336 patients from 1998 to 2014 were reviewed by a multidiscipline team. Only 124 patients were eligible. Methods: The demographics, clinical features, imaging features, and headache details of eligible patients were reviewed. An 11-point pain scale score was used to assess symptomatic headaches before, during, and after treatment. The headache outcomes, death or stroke, and adverse functional outcomes (modified Rankin Scale score ≥ 2, mRS ≥ 2) were assessed following multidisciplinary care of ubAVMs. Results: Twenty-three (56.1%) of 41 patients had migraine-like headaches located in occipital lobe (P < 0.001), while forty (63.5%) of 63 patients had tension-type-like headaches located in frontotemporal lobe (P < 0.001). For patients with tension-type-like or all types of headache, headache improvement differed between the multidisciplinary group and medical group (87.8% vs. 31.8%, P < 0.001; 85.7% vs. 40.7%, P < 0.001). The risk of death or stroke did not differ between multidisciplinary group and medical group (P = 0.393), whereas the risk of adverse functional outcome (mRS ≥ 2) differed significantly by long-time follow-up (23.0% vs.10.0%, P = 0.022). Limitations: This study provides the initial experience to support multidisciplinary care for ubAVMs to improve symptomatic headaches and patients’ quality life, but based on the retrospective study with inherent limitations, larger samples and multi-center trials are needed on this interesting issue. Conclusions: Occipital ubAVM is more likely to present with migraine-like headache, while frontotemporal ubAVM tends to present with tension-type-like headache. The effectiveness of multidisciplinary care for ubAVM to improve headache has been shown, but the natural history of ubAVM patients with headache remains unclear. Key Words: Unruptured brain arteriovenous malformations, headache, headache improvement, natural history

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