In Reply: Risk of First Hemorrhage of Brain Arteriovenous Malformations During Pregnancy: A Systematic Review of the Literature

Abstract BACKGROUND Recommendations on the management of brain arteriovenous malformations (bAVM) with respect to pregnancy are based upon conflicting literature. OBJECTIVE To systematically review the reported risk and annualized rate of first intracranial hemorrhage (ICH) from bAVM during pregnancy and puerperium. METHODS MEDLINE, EMBASE, and Scopus databases were searched for relevant articles in English published before April 2018. Studies providing a quantitative risk of ICH in bAVM during pregnancy were eligible. RESULTS From 7 initially eligible studies, 3 studies met the criteria for providing quantitative risk of first ICH bAVM during pregnancy. Data from 47 bAVM ICH during pregnancy across 4 cohorts were extracted for analysis. Due to differences in methodology and definitions of exposure period, it was not appropriate to combine the cases. The annualized risk of first ICH during pregnancy for these 4 cohorts was 3.0% (95% confidence interval [CI]: 1.7-5.2%); 3.5% (95% CI: 2.4-4.5%); 8.6% (95% CI: 1.8-25%); and 30% (95% CI: 18-49%). Only the last result from the last cohort could be considered significantly increased in comparison with the nonpregnant period (relative rate 6.8, 95% CI: 3.6-13). The limited number of eligible studies and variability in results highlighted the need for enhanced rigor of future research. CONCLUSION There is no conclusive evidence of an increased risk of first hemorrhage during pregnancy from bAVM. Because advice to women with bAVM may influence the management of pregnancy or bAVM with significant consequences, we believe that a retrospective multicenter, case crossover study is urgently required.

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Transvenous embolization of brain arteriovenous malformations: a systematic review and meta-analysis

Journal of Neurosurgical Sciences ◽

10.23736/s0390-5616.18.04342-4 ◽

2019 ◽

Vol 63 (4) ◽

Cited By ~ 2

Author(s):

Yi-Bin Fang ◽

Jun-Soo Byun ◽

Jian-Min Liu ◽

Timo Krings ◽

Vitor M. Pereira ◽

...

Keyword(s):

Systematic Review ◽

Arteriovenous Malformations ◽

Meta Analysis ◽

Transvenous Embolization ◽

Brain Arteriovenous Malformations

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Familial occurrence of brain arteriovenous malformations: a systematic review

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp.2006.112227 ◽

2007 ◽

Vol 78 (11) ◽

pp. 1213-1217 ◽

Cited By ~ 48

Author(s):

J van Beijnum ◽

H B van der Worp ◽

H M Schippers ◽

O van Nieuwenhuizen ◽

L J Kappelle ◽

...

Keyword(s):

Systematic Review ◽

Arteriovenous Malformations ◽

Familial Occurrence ◽

Brain Arteriovenous Malformations

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Volume-staged versus dose-staged stereotactic radiosurgery outcomes for large brain arteriovenous malformations: a systematic review

Journal of Neurosurgery ◽

10.3171/2016.9.jns161571 ◽

2018 ◽

Vol 128 (1) ◽

pp. 154-164 ◽

Cited By ~ 15

Author(s):

Adeel Ilyas ◽

Ching-Jen Chen ◽

Dale Ding ◽

Davis G. Taylor ◽

Shayan Moosa ◽

...

Keyword(s):

Systematic Review ◽

Stereotactic Radiosurgery ◽

Arteriovenous Malformations ◽

Management Strategy ◽

Individual Patient Data ◽

Brain Arteriovenous Malformations ◽

Large Brain ◽

Radiation Induced ◽

The Mean ◽

Induced Changes

OBJECTIVESeveral recent studies have improved our understanding of the outcomes of volume-staged (VS) and dose-staged (DS) stereotactic radiosurgery (SRS) for the treatment of large (volume > 10 cm3) brain arteriovenous malformations (AVMs). In light of these recent additions to the literature, the aim of this systematic review is to provide an updated comparison of VS-SRS and DS-SRS for large AVMs.METHODSA systematic review of the literature was performed using PubMed to identify cohorts of 5 or more patients with large AVMs who had been treated with VS-SRS or DS-SRS. Baseline data and post-SRS outcomes were extracted for analysis.RESULTSA total of 11 VS-SRS and 10 DS-SRS studies comprising 299 and 219 eligible patients, respectively, were included for analysis. The mean obliteration rates for VS-SRS and DS-SRS were 41.2% (95% CI 31.4%–50.9%) and 32.3% (95% CI 15.9%–48.8%), respectively. Based on pooled individual patient data, the outcomes for patients treated with VS-SRS were obliteration in 40.3% (110/273), symptomatic radiation-induced changes (RICs) in 13.7% (44/322), post-SRS hemorrhage in 19.5% (50/256), and death in 7.4% (24/323); whereas the outcomes for patients treated with DS-SRS were obliteration in 32.7% (72/220), symptomatic RICs in 12.2% (31/254), post-SRS hemorrhage in 10.6% (30/282), and death in 4.6% (13/281).CONCLUSIONSVolume-staged SRS appears to afford higher obliteration rates than those achieved with DS-SRS, although with a less favorable complication profile. Therefore, VS-SRS or DS-SRS may be a reasonable treatment approach for large AVMs, either as stand-alone therapy or as a component of a multimodality management strategy.

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Cyst formation after stereotactic radiosurgery for brain arteriovenous malformations: a systematic review

Journal of Neurosurgery ◽

10.3171/2016.12.jns162478 ◽

2018 ◽

Vol 128 (5) ◽

pp. 1354-1363 ◽

Cited By ~ 10

Author(s):

Adeel Ilyas ◽

Ching-Jen Chen ◽

Dale Ding ◽

Panagiotis Mastorakos ◽

Davis G. Taylor ◽

...

Keyword(s):

Systematic Review ◽

Stereotactic Radiosurgery ◽

Arteriovenous Malformations ◽

Time Course ◽

Surgical Intervention ◽

Latency Period ◽

Cyst Formation ◽

Brain Arteriovenous Malformations ◽

The Mean

OBJECTIVECyst formation can occasionally occur after stereotactic radiosurgery (SRS) for brain arteriovenous malformations (AVMs). Given the limited data regarding post-SRS cyst formation in patients with AVM, the time course, natural history, and management of this delayed complication are poorly defined. The aim of this systematic review was to determine the incidence, time course, and optimal management of cyst formation after SRS for AVMs.METHODSA literature review was performed using PubMed to identify studies reporting cyst formation in AVM patients treated with SRS. Baseline and outcomes data, including the incidence and management of post-SRS cysts, were extracted from each study that reported follow-up duration. The mean time to cyst formation was calculated from the subset of studies that reported individual patient data.RESULTSBased on pooled data from 22 studies comprising the incidence analysis, the overall rate of post-SRS cyst formation was 3.0% (78/2619 patients). Among the 26 post-SRS cyst patients with available AVM obliteration data, nidal obliteration was achieved in 20 (76.9%). Of the 64 cyst patients with available symptomatology and management data, 21 (32.8%) were symptomatic; 21 cysts (32.8%) were treated with surgical intervention, whereas the remaining 43 (67.2%) were managed conservatively. Based on a subset of 19 studies reporting individual time-to-cyst-formation data from 63 patients, the mean latency period to post-SRS cyst formation was 78 months (6.5 years).CONCLUSIONSCyst formation is an uncommon complication after SRS for AVMs, with a relatively long latency period. The majority of post-SRS cysts are asymptomatic and can be managed conservatively, although enlarging or symptomatic cysts may require surgical intervention. Long-term follow-up of AVM patients is crucial to the appropriate diagnosis and management of post-SRS cysts.

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