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.

The Role of Biological Effective Dose in Predicting Obliteration After Stereotactic Radiosurgery of Cerebral Arteriovenous Malformations

2021 ◽  
Vol 96 (5) ◽  
pp. 1157-1164
Author(s):  
Cody L. Nesvick ◽  
Christopher S. Graffeo ◽  
Paul D. Brown ◽  
Michael J. Link ◽  
Scott L. Stafford ◽  
...  
Keyword(s):  
Effective Dose ◽  
Stereotactic Radiosurgery ◽  
Arteriovenous Malformations ◽  
Biological Effective Dose ◽  
Cerebral Arteriovenous Malformations

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.

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.

Natural History of Arteriovenous Malformations of the Brain: A Clinical Study

Neurosurgery ◽  
1984 ◽  
Vol 15 (5) ◽  
pp. 658-662 ◽  
Author(s):  
Dan Fults ◽  
David L. Kelly
Keyword(s):  
Clinical Study ◽  
Natural History ◽  
Posterior Fossa ◽  
Arteriovenous Malformations ◽  
Intracranial Arteriovenous Malformations ◽  
Recurrent Hemorrhage ◽  
History Of ◽  
The Brain

Abstract The natural history of intracranial arteriovenous malformations (AVMs) was studied in 131 patients. The 83 patients managed nonsurgically and the 48 patients treated surgically were followed for an average of 8 years. Hemorrhage occurred in 61.8% of all patients. A second hemorrhage occurred in 67.4% of the survivors of the first hemorrhage. The mortality associated with recurrent hemorrhage did not increase significantly with successive episodes of hemorrhage. The rate of rebleeding was 17.9%/year initially, but declined to 3%/year after 5 years and then to 2%/year after 10 years. Among patients treated nonsurgically, the prognosis was more favorable for patients presenting with seizures than for patients presenting with hemorrhage. Patients in the seizure group had a 26.9% incidence of hemorrhage causing an 11.6% mortality; 40.5% of the patients in the hemorrhage group died. The prognosis was poor for patients with posterior fossa A V Ms; the mortality was 66.7% with the first hemorrhage. Recurrent posterior fossa hemorrhage was the rule in survivors, and most of those hemorrhages were fatal. The prognosis for children with AVMs was no different from that for adults.

Cerebral arteriovenous malformations

1984 ◽  
Vol 60 (1) ◽  
pp. 14-22 ◽  
Author(s):  
Alfred J. Luessenhop ◽  
Louis Rosa
Keyword(s):  
Arteriovenous Malformations ◽  
Neurological Dysfunction ◽  
Cerebral Arteriovenous Malformations ◽  
Natural Risk ◽  
Surgical Risk ◽  
Content Type ◽  
Mortality And Morbidity ◽  
The Brain ◽  
Fine Print

✓ To address the problems of surgical risk versus natural risk associated with cerebral arteriovenous malformations (AVM's), and the role of the intravascular operative approach, the authors have assessed a 20-year experience with 450 patients. Results of direct surgery in 90 patients indicate that for the smaller AVM's (Grades I and II), mortality and morbidity rates are lower than a reasonably projected natural risk. Hence, these patients are candidates for surgery in most instances. However, for more extensive AVM's (Grades III and IV), consideration of anticipated future years of exposure to natural risk and the location of the AVM in the brain are necessary for determining operability. In general, neither seizures nor incipient focal neurological dysfunction alone are indications for surgery, and the risks of disability or death from hemorrhage after the fifth decade of life are probably less than the surgical risks by present operative techniques. Considering the usual age of patients at the time of diagnosis, it is estimated that surgical risk is currently less than the natural risk for about 65% to 70% of all AVM patients. The categories of AVM's in which the angiographic effectiveness of the intravascular approach is the greatest correspond to the same categories of AVM's that can be surgically removed with low risk. The intravascular approach is most useful for management of large AVM's causing progressive neurological dysfunction or as a preliminary step to surgery in selected cases in which access to major feeding arteries is difficult. The authors believe that the future of the intravascular approach should be directed toward transforming large inoperable AVM's into operable ones, but that the overall capability for this with acceptable risk is uncertain at present.

scholarly journals Natural History of Arteriovenous Malformations of the Brain

1990 ◽  
Vol 18 (2) ◽  
pp. 148-152
Author(s):  
Tohru HORIKOSHI ◽  
Hideaki NUKUI ◽  
Masami KANEKO ◽  
Hideo SASAKI ◽  
Sigeru MITSUKA ◽  
...  
Keyword(s):  
Natural History ◽  
Arteriovenous Malformations ◽  
History Of ◽  
The Brain
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