LB-005 Unruptured arteriovenous malformation intervention rate is inversely correlated with ruptured AVM discharge incidence

Background: Although it is well characterized in aneurysmal subarachnoid hemorrhage, vasospasm is exceedingly rare following cerebral arteriovenous malformation (AVM) rupture. Subsequently, this complication is poorly characterized with regard to delayed cerebral ischemia (DCI). We review cases of ruptured AVM to assess the frequency and severity of vasospasm on cerebral angiography, and DCI. Summary: We reviewed our institutional database of acute intracranial hemorrhages between 2005 and 2014. We identified patients with cerebral AVM rupture and evidence of vasospasm, which was confirmed with digital subtraction angiography (DSA). Cerebral angiograms were evaluated by 2 blinded neurointerventionalists for vasospasm. Statistical analyses were conducted on the angiographic results and variables of interest to determine predictors and associations of vasospasm and DCI. Thirty-six patients with acute intracranial hemorrhage due to ruptured cerebral AVM subsequently underwent cerebral angiography. The interrater reliability for vasospasm was 0.81. The incidence of vasospasm was 13.9% and the incidence of subsequent DCI was 11.1%. A significant relationship existed between isolated intraventricular hemorrhage and vasospasm (p = 0.001) and subsequent DCI (p = 0.006). Radiographic vasospasm was associated with DCI in 80% of the patients (p < 0.0001). No statistical significance existed between subarachnoid hemorrhage and the development of vasospasm or DCI (p = 1.000 and p = 0.626, respectively). All differences were significant at a 99% level of significance. Key Message: In cases of ruptured AVM, isolated intraventricular hemorrhage appears to be an independent risk factor for vasospasm and DCI. Vasospasm must be considered during late neurological deterioration following AVM hemorrhage, especially in the setting of isolated intraventricular hemorrhage.

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The Ruptured Arteriovenous Malformation Grading Scale (RAGS): An Extension of the Hunt and Hess Scale to Predict Clinical Outcome for Patients With Ruptured Brain Arteriovenous Malformations

Neurosurgery ◽

10.1093/neuros/nyz404 ◽

2019 ◽

Vol 87 (2) ◽

pp. 193-199 ◽

Cited By ~ 1

Author(s):

Michael A Silva ◽

Pui Man Rosalind Lai ◽

Rose Du ◽

Mohammad A Aziz-Sultan ◽

Nirav J Patel

Keyword(s):

Clinical Outcome ◽

Arteriovenous Malformation ◽

Venous Drainage ◽

Receiver Operating Curve ◽

Simple Extension ◽

Grading Systems ◽

Ruptured Avm ◽

Grading Scale ◽

Ordinal Logistic Regression Model

Abstract BACKGROUND Arteriovenous malformation (AVM) rupture is highly morbid. Outcomes after AVM rupture differ from other types of brain hemorrhage. There are no specific widely used grading systems designed to predict clinical outcome after AVM rupture. OBJECTIVE To develop an all-comers scoring system to grade patients with AVM rupture and predict clinical outcome more accurately than grading systems currently in use. METHODS We retrospectively reviewed patients who presented to our institution with a ruptured AVM. Using change in modified Rankin Score (mRS) as our response variable, we generated an ordinal logistic regression model to test for significant predictor variables. The full model was sequentially condensed until the simplest model with the highest area under the receiver operating curve (AUROC) was achieved. RESULTS A total of 115 patients who presented with ruptured AVMs were included in the study, with a mean follow-up time of 4 yr. The Ruptured AVM Grading Scale (RAGS) consists of the Hunt and Hess (HH) score (1-5), patient age (<35 = 0, 35-70 = 1, and >70 = 2), deep venous drainage (1), and eloquence (1). The RAGS score outperformed other neurosurgical grading scales in predicting change in mRS, with an AUROC greater than 0.80 across all follow-up periods. CONCLUSION The RAGS score is a simple extension of the HH scale that predicts clinical outcome after AVM rupture more accurately than other grading systems.

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Republished: Intraventricular thrombolysis after endovascular treatment of a ruptured arteriovenous malformation

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2016-012408.rep ◽

2016 ◽

Vol 9 (2) ◽

pp. e8-e8 ◽

Cited By ~ 1

Author(s):

Arthur Wang ◽

Abhishek Ray ◽

Yin C Hu

Keyword(s):

Arteriovenous Malformation ◽

Thrombus Formation ◽

Intraventricular Haemorrhage ◽

External Ventricular Drainage ◽

Tissue Type ◽

Ventricular Catheter ◽

Intraventricular Administration ◽

Type Plasminogen Activator ◽

Ruptured Avm ◽

Case Basis

Intraventricular haemorrhage (IVH) secondary to arteriovenous malformation (AVM) rupture carries significant morbidity and mortality. External ventricular drainage of IVH is frequently complicated by thrombus formation within the ventricular catheter and therefore often unsuccessful at treating hydrocephalus in this setting. Intraventricular administration of recombinant tissue-type plasminogen activator (rtPA) has proved successful in the treatment of spontaneous panventricular haemorrhage. However, usage of rtPA is contraindicated in the setting of a ruptured AVM or aneurysm in which the bleeding source has not been secured. There are only a few reports of intraventricular thrombolysis in the treatment of IVH from AVM rupture. We present the case of successful application of rtPA to treat IVH after endovascularly securing the haemorrhage site of the AVM. Intraventricular thrombolysis remains an option for the treatment of IVH in the setting of AVM rupture and should be considered on a case-by-case basis.

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Compartments in arteriovenous malformation nidi demonstrated with rotational three-dimensional digital subtraction angiography by using selective microcatheterization

Journal of Neurosurgery ◽

10.3171/jns.2002.96.4.0770 ◽

2002 ◽

Vol 96 (4) ◽

pp. 770-774 ◽

Cited By ~ 19

Author(s):

Yukinari Kakizawa ◽

Hisashi Nagashima ◽

Fusakazu Oya ◽

Kiyoshi Ito ◽

Yuichiro Tanaka ◽

...

Keyword(s):

Arteriovenous Malformation ◽

Digital Subtraction Angiography ◽

Three Dimensional ◽

Treatment Strategies ◽

Digital Subtraction ◽

3D Images ◽

Content Type ◽

Ruptured Avm ◽

Martin Grade ◽

Fine Print

✓ Although in several histological studies of arteriovenous malformation (AVM) nidi the presence of compartments has been documented, no clinical study has been published. The present study was conducted to determine the presence of nidus compartments in clinical cases by using a new radiographic method. Two patients with unruptured and one with a ruptured AVM (all Spetzler—Martin Grade III) were studied. A microcatheter was superselectively introduced into each of two or three feeding arteries of the AVMs under three-dimensional (3D) angiographic guidance to obtain 3D images of the nidus by using rotational digital subtraction angiography. On 3D images the different feeding arteries were found to be independent from one another, which allowed the authors to confirm the presence of compartments. On the other hand, separate feeding arteries often had a common draining vessel. Compartments in AVM nidi were demonstrated by a novel rotational 3D angiographic procedure by using superselective microcatheterization, which should be useful for designing treatment strategies for large and complex AVMs.

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Case Report: Gyral Brain Arteriovenous Malformation with Presentation Isolated From Intraventricular Hemorrhage

International Journal Of Scientific Advances ◽

10.51542/ijscia.v2i5.10 ◽

2021 ◽

Vol 2 (5) ◽

Author(s):

Rizky Fawzyana Sarengat ◽

Achmad Firdaus Sani

Keyword(s):

Arteriovenous Malformation ◽

Intraventricular Hemorrhage ◽

Clinical Manifestations ◽

Chief Complaint ◽

Communicating Hydrocephalus ◽

Brain Arteriovenous Malformation ◽

Centrum Semiovale ◽

History Of ◽

Ruptured Avm ◽

Grade 3

Introduction: Brain Arteriovenous Malformation (BAVM) is a rare disease with an incidence rate of 1.3 out of 100,000 people. The most common clinical manifestations in BAVM patients are intracranial hemorrhage. There were 38.5% of BAVM patients who had intraventricular hemorrhage (IVH), and the rate of IVH without parenchymal bleeding in the ruptured AVM is 7.8%. We reported a case of BAVM with intraventricular hemorrhage presentation without intracerebral hemorrhage (isolated IVH). Case: Male, 15 years old, with a chief complaint of acute decreased consciousness on activity, followed by vomiting and general onset seizures. There was no history of hypertension or trauma before. From the neurological examination, the GCS is 225, and there were positive pathological reflexes on both sides. From a head CT scan without contrast, we found IVH in bilateral lateral ventricles, ventricle III and ventricle IV, communicating hydrocephalus, and brain edema. Head and Neck Computed Tomography Angiography (CTA) found a compact AVM in the left centrum semiovale-cortex parietal (Spetzler Martin AVM grading system grade 3). Patients underwent EVD surgery for hydrocephalus. The following steps are cerebral DSA as the gold standard for AVM diagnostic and targeted embolization to prevent further bleeding. Conclusion: One of the causes of Isolated Intraventricular Hemorrhage (IIVH) is AVM. In this case, although the topography of AVM is in the gyral, it can cause IIVH manifestation if there is contact between the AVM nidus and the ventricle.

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Acute surgical management of children with ruptured brain arteriovenous malformation

Journal of Neurosurgery Pediatrics ◽

10.3171/2020.8.peds20479 ◽

2021 ◽

pp. 1-9

Author(s):

Sarah Stricker ◽

Grégoire Boulouis ◽

Sandro Benichi ◽

Marie Bourgeois ◽

Florent Gariel ◽

...

Keyword(s):

Clinical Outcome ◽

Arteriovenous Malformation ◽

Intracranial Hypertension ◽

Volume Ratio ◽

Brain Arteriovenous Malformation ◽

Decompressive Hemicraniectomy ◽

Point Increase ◽

Additional Surgery ◽

Ruptured Avm ◽

Martin Grade

OBJECTIVERupture of brain arteriovenous malformation (AVM) is the main etiology of intracerebral hemorrhage (ICH) in children. Ensuing intracranial hypertension is among the modifiable prognosis factors and sometimes requires emergency hemorrhage evacuation (HE). The authors aimed to analyze variables associated with HE in children with ruptured AVM.METHODSThis study was a single-center retrospective analysis of children treated for ruptured AVM. The authors evaluated the occurrence of HE, its association with other acute surgical procedures (e.g., nidal excision, decompressive hemicraniectomy), and clinical outcome. Variables associated with each intervention were analyzed using univariable and multivariable models. Clinical outcome was assessed at 18 months using the ordinal King’s Outcome Scale for Childhood Head Injury.RESULTSA total of 104 patients were treated for 112 episodes of ruptured AVM between 2002 and 2018. In the 51 children (45.5% of cases) who underwent HE, 37 procedures were performed early (i.e., within 24 hours after initial cerebral imaging) and 14 late. Determinants of HE were a lower initial Glasgow Coma Scale score (adjusted odds ratio [aOR] 0.83, 95% CI 0.71–0.97 per point increase); higher ICH/brain volume ratio (aOR 18.6, 95% CI 13–26.5 per percent increase); superficial AVM location; and the presence of a brain herniation (aOR 3.7, 95% CI 1.3–10.4). Concurrent nidal surgery was acutely performed in 69% of Spetzler-Martin grade I–II ruptured AVMs and in 25% of Spetzler-Martin grade III lesions. Factors associated with nidal surgery were superficial AVMs, late HE, and absent alteration of consciousness at presentation. Only 8 cases required additional surgery due to intracranial hypertension. At 18 months, overall mortality was less than 4%, 58% of patients had a favorable outcome regardless of surgical intervention, and 87% were functioning independently.CONCLUSIONSHE is a lifesaving procedure performed in approximately half of the children who suffer AVM rupture. The good overall outcome justifies intensive initial management.

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