scholarly journals Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

2020 ◽  
Author(s):  
Chen Yu ◽  
Xiangyu Meng ◽  
Li Ma ◽  
Yang Zhao ◽  
Ye Gu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Questionnaire Survey ◽  
Arteriovenous Malformations ◽  
Large Population ◽  
Mainland China ◽  
Treatment Modalities ◽  
Web Based ◽  
Brain Arteriovenous Malformations ◽  
Intraoperative Management ◽  
Hemorrhagic Risk

Abstract Background: In the benefit of the large population and rapid economic growth, the interventional techniques and equipment for brain arteriovenous malformations (bAVMs) in mainland China have been rapidly improved. Chinese neurosurgical cerebrovascular physicians have accumulated rich experience and made pioneering explorations. This study aims to summarize the experience and treatment progress of bAVMs in mainland China.Methods: We performed a web-based nationwide questionnaire survey among 67 tertiary neurosurgical institutions that had acknowledged treating bAVMs in the primary survey. Our questionnaire included clinical characteristics, radiological findings, intervention indications/contraindications, intervention timing, and intraoperative management of different treatment modalities. Results: A total of 63 participants from 49 (73.1%) tertiary neurosurgical institutions responded to our questionnaire. 42 (66.7%) were neurosurgeons, 13 (20.6%) were neurointerventionists, and 8 (12.7%) were radiosurgeons. Approximately 3500 to 4000 cases of bAVMs were treated annually in these 49 departments. All participants agreed that the conclusions of ARUBA are debatable. Flow-related aneurysms, deep venous drainage, and arteriovenous fistula were considered as common hemorrhagic risk factors. Unruptured SM IV-V bAVMs, giant bAVMs, pediatric bAVMs, elderly bAVMs, and eloquent bAVMs were not absolute contraindications to intervention. Maximum lesion occlusion and minimal functional impairment were the principles of intervention management. Most of the neurosurgeons and neurointerventionists recommended early intervention (<30 days) for ruptured bAVMs, and the radiosurgeons suggested intervention in the chronic phase or recovery phase (P<0.01), and preferably 3 months after bleeding. Multi-modality strategies were thought effective for complex bAVMs and more exploration of individualized intraoperative management was necessary.Conclusions: Intervention was acceptable for specific selected unruptured bAVMs in mainland China, especially in patients with hemorrhagic risk factors. The application of multidisciplinary cerebrovascular team and multicenter large-sample international registry study might be the next work for Chinese neurosurgical cerebrovascular physicians.Trial registration: ClinicalTrials.gov NCT04136860.

scholarly journals Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

2020 ◽  
Author(s):  
Chen Yu ◽  
Xiangyu Meng ◽  
Li Ma ◽  
Yang Zhao ◽  
Ye Gu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Questionnaire Survey ◽  
Arteriovenous Malformations ◽  
Large Population ◽  
Mainland China ◽  
Treatment Modalities ◽  
Web Based ◽  
Brain Arteriovenous Malformations ◽  
Intraoperative Management ◽  
Hemorrhagic Risk

Abstract Background:In the benefit of the large population and rapid economic growth, the interventional techniques and equipment for brain arteriovenous malformations (bAVMs) in mainland China have been rapidly improved. Chinese neurosurgical cerebrovascular physicians have accumulated rich experience and made pioneering explorations. This study aims to summarize the experience and treatment progress of bAVMs in mainland China.Methods:We performed a web-based nationwide questionnaire survey among 67 tertiary neurosurgical institutions that had acknowledged treating bAVMs in the primary survey. Our questionnaire included clinical characteristics, radiological findings, intervention indications/contraindications, intervention timing, and intraoperative management of different treatment modalities. Results:A total of 63 participants from 49 (73.1%) tertiary neurosurgical institutions responded to our questionnaire. 42 (66.7%) were neurosurgeons, 13 (20.6%) were neurointerventionists, and 8 (12.7%) were radiosurgeons. Approximately 3500 to 4000 cases of bAVMs were treated annually in these 49 departments. All participants agreed that the conclusions of ARUBA are debatable. Flow-related aneurysms, deep venous drainage, and arteriovenous fistula were considered as common hemorrhagic risk factors. Unruptured SM IV-V bAVMs, giant bAVMs, pediatric bAVMs, elderly bAVMs, and eloquent bAVMs were not absolute contraindications to intervention. Maximum lesion occlusion and minimal functional impairment were the principles of intervention management. Most of the neurosurgeons and neurointerventionists recommended early intervention (<30 days) for ruptured bAVMs, and the radiosurgeons suggested intervention in the chronic phase or recovery phase (P<0.01), and preferably 3 months after bleeding. Multi-modality strategies were thought effective for complex bAVMs and more exploration of individualized intraoperative management was necessary.Conclusions:Intervention was acceptable for specific selected unruptured bAVMs in mainland China, especially in patients with hemorrhagic risk factors. The application of multidisciplinary cerebrovascular team and multicenter large-sample international registry study might be the next work for Chinese neurosurgical cerebrovascular physicians.

scholarly journals Perioperative care in brain arteriovenous malformations

2012 ◽  
Vol 31 (03) ◽  
pp. 146-150
Author(s):  
Arthur Maynart Pereira Oliveira ◽  
Eberval Gadelha de Figueiredo ◽  
Bernardo Assumpção de Monaco ◽  
Jorge Dornellys da Silva Lapa ◽  
João Welberthon Matos Queiroz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Perioperative Care ◽  
Arteriovenous Malformations ◽  
Factors Associated ◽  
Brain Arteriovenous Malformations ◽  
Intraoperative Management

AbstractThe authors provide a review of brain arteriovenous malformations, initially reviewing epidemiological and etiological aspects in addition to the pathophysiology and risk factors associated with bleeding. The emphasis of this review is directed to the clinical and care should be taken since the diagnosis of this pathology, intraoperative management on the viewpoint of the anesthesiologist to the potential complications that occur after resection of the lesion.

scholarly journals Admission risk factors for cerebral vasospasm in ruptured brain arteriovenous malformations: An observational study

Critical Care ◽  
2011 ◽  
Vol 15 (4) ◽  
pp. R190 ◽  
Author(s):  
Vibol Chhor ◽  
Yannick Le Manach ◽  
Fréderic Clarençon ◽  
Aurélien Nouet ◽  
Jean-Louis Daban ◽  
...  
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Cerebral Vasospasm ◽  
Arteriovenous Malformations ◽  
Brain Arteriovenous Malformations

scholarly journals Brain Arteriovenous Malformations Classifications: A Surgical Point of View

2021 ◽  
pp. 101-106
Author(s):  
Giovanni Marco Sicuri ◽  
Nicola Galante ◽  
Roberto Stefini
Keyword(s):  
Surgical Management ◽  
Arteriovenous Malformations ◽  
Point Of View ◽  
Treatment Modalities ◽  
Extensive Discussion ◽  
Classification Schemes ◽  
Brain Arteriovenous Malformations ◽  
Intracerebral Hemorrhages ◽  
The Subject

AbstractBrain arteriovenous malformations (AVMs) classification has been the subject of extensive discussion. The aim of our work was to review the main classification schemes proposed in the literature, which can be summarized in four main groups: (a) traditional schemes oriented to evaluate the operability of AVMs have been joined by (b) specific classifications that evaluate the outcome and the predictability of obliteration of other treatment modalities and (c) others that evaluate the outcome of intracerebral hemorrhages in ruptured AVMs. Eventually, (d) topographical classifications that categorize the subtypes of AVMs located in specific anatomical regions have been drawn. For each classification, we discuss the implications on surgical management.

NATURAL HISTORY OF BRAIN ARTERIOVENOUS MALFORMATIONS

Neurosurgery ◽  
2008 ◽  
Vol 63 (5) ◽  
pp. 823-831 ◽  
Author(s):  
Juha A. Hernesniemi ◽  
Reza Dashti ◽  
Seppo Juvela ◽  
Kristjan Väärt ◽  
Mika Niemelä ◽  
...  
Keyword(s):  
Risk Factors ◽  
Arteriovenous Malformations ◽  
Univariate Analysis ◽  
Incidence Rates ◽  
Cox Proportional Hazards ◽  
Follow Up Study ◽  
Brain Arteriovenous Malformations ◽  
Long Term Follow Up

Abstract OBJECTIVE Long-term follow-up studies in patients with brain arteriovenous malformations (AVM) have yielded contradictory results regarding both risk factors for rupture and annual rupture rate. We performed a long-term follow-up study in an unselected, consecutive patient population with AVMs admitted to the Department of Neurosurgery at Helsinki University Central Hospital between 1942 and 2005. METHODS Patients with untreated AVMs were followed from admission until death, occurrence of AVM rupture, initiation of treatment, or until the end of 2005. Patients with at least 1 month of follow-up were included in further analysis. Annual and cumulative incidence rates of AVM rupture as well as several potential risk factors for rupture were analyzed using Kaplan-Meier life table analyses and Cox proportional hazards regression models. RESULTS We identified 238 patients with a mean follow-up period of 13.5 years (range, 1 month–53.1 years). The average annual risk of hemorrhage from AVMs was 2.4%. The risk was highest during the first 5 years after diagnosis, decreasing thereafter. Risk factors predicting subsequent AVM hemorrhage in univariate analysis were young age, previous rupture, deep and infratentorial locations, and exclusively deep venous drainage. Previous rupture, large AVM size, and infratentorial and deep locations were independent risk factors according to multivariate models. CONCLUSION According to this long-term follow-up study, AVMs with previous rupture and large size, as well as with infratentorial and deep locations have the highest risk of subsequent hemorrhage. This risk is highest during the first few years after diagnosis but remains significant for decades.

scholarly journals Updates in arteriovenous malformation management: the post-ARUBA era

2019 ◽  
Vol 5 (1) ◽  
pp. 34-39 ◽  
Author(s):  
James Feghali ◽  
Judy Huang
Keyword(s):  
Arteriovenous Malformations ◽  
Observational Studies ◽  
Interventional Therapy ◽  
Treatment Modalities ◽  
Low Grade ◽  
Randomised Trials ◽  
Brain Arteriovenous Malformations ◽  
Favourable Safety ◽  
Cure Rates

Brain arteriovenous malformations (AVMs) are complex and heterogeneous lesions that can rupture, causing significant morbidity and mortality. While ruptured lesions are usually treated, the management of unruptured AVMs remains unclear. A Randomized trial of Unruptured Brain Arteriovenous Malformations (ARUBA) was the first trial conducted to compare the effects of medical and interventional therapy. Although it concluded that medical therapy was superior in preventing stroke and death over a follow-up period of 33 months, the findings were met with intense criticism regarding several aspects of study design, progression, and analysis/conclusion. Namely, the increased use of stand-alone embolisation relative to microsurgery in a cohort with predominantly low-grade lesions combined with a short follow-up period amplified treatment risk. Subsequently, several observational studies were conducted on ARUBA-eligible patients to investigate the safety and efficacy of microsurgery, radiosurgery, and endovascular embolisation over longer follow-up periods. These reports showed that favourable safety profiles and cure rates can be achieved with appropriate patient selection and judicious use of different treatment modalities in multidisciplinary centres. Since large prospective randomised trials on AVMs may not be feasible, it is important to make use of practice-based data beyond the flawed ARUBA study to optimise patients’ lifetime outcomes.

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