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.

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 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.

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.

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

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

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

scholarly journals Surgical selection and outcomes among elderly patients with brain arteriovenous malformations

2020 ◽  
Vol 49 (4) ◽  
pp. E9
Author(s):  
Jan-Karl Burkhardt ◽  
Ethan A. Winkler ◽  
Joshua S. Catapano ◽  
Robert F. Spetzler ◽  
Michael T. Lawton
Keyword(s):  
Elderly Patients ◽  
Arteriovenous Malformations ◽  
Age Groups ◽  
The Elderly ◽  
Preoperative Embolization ◽  
Neurological Outcomes ◽  
Brain Arteriovenous Malformations ◽  
Group 2 ◽  
Brain Avms ◽  
Group 1

OBJECTIVEStudies of resection of brain arteriovenous malformations (AVMs) in the elderly population are scarce. This study examined factors influencing patient selection and surgical outcome among elderly patients.METHODSPatients 65 years of age and older who underwent resection of an unruptured or ruptured brain AVM treated by two surgeons at two centers were identified. Patient demographic characteristics, AVM characteristics, clinical presentation, and outcomes measured using the modified Rankin Scale (mRS) were analyzed. For subgroup analyses, patients were dichotomized into two age groups (group 1, 65–69 years old; group 2, ≥ 70 years old).RESULTSOverall, 112 patients were included in this study (group 1, n = 61; group 2, n = 51). Most of the patients presented with hemorrhage (71%), a small nidus (< 3 cm, 79%), and a low Spetzler-Martin (SM) grade (grade I or II, 63%) and were favorable surgical candidates according to the supplemented SM grade (supplemented SM grade < 7, 79%). A smaller AVM nidus was statistically significantly more likely to be present in patients with infratentorial AVMs (p = 0.006) and with a compact AVM nidus structure (p = 0.02). A larger AVM nidus was more likely to be treated with preoperative embolization (p < 0.001). Overall outcome was favorable (mRS scores 0–3) in 71% of the patients and was statistically independent from age group or AVM grading. Patients with ruptured AVMs at presentation had significantly better preoperative mRS scores (p < 0.001) and more favorable mRS scores at the last follow-up (p = 0.04) than patients with unruptured AVMs.CONCLUSIONSOutcomes were favorable after AVM resection in both groups of patients. Elderly patients with brain AVMs treated microsurgically were notable for small nidus size, AVM rupture, and low SM grades. Microsurgical resection is an important treatment modality for elderly patients with AVMs, and supplemented SM grading is a useful tool for the selection of patients who are most likely to achieve good neurological outcomes after resection.

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