scholarly journals Treatment of Spetzler-Martin Grade IV Cerebral Arteriovenous Malformations

1999 ◽  
Vol 27 (4) ◽  
pp. 261-264
Author(s):  
Kazuhiko NOZAKI ◽  
Nobuo HASHIMOTO ◽  
Susumu MIYAMOTO ◽  
Waro TAKI ◽  
Haruhiko KIKUCHI
Keyword(s):  
Arteriovenous Malformations ◽  
Cerebral Arteriovenous Malformations ◽  
Martin Grade

scholarly journals Microsurgery for cerebral arteriovenous malformations: subgroup outcomes in a consecutive series of 288 cases

2017 ◽  
Vol 126 (4) ◽  
pp. 1056-1063 ◽  
Author(s):  
Johannes Schramm ◽  
Karl Schaller ◽  
Jonas Esche ◽  
Azize Boström
Keyword(s):  
Arteriovenous Malformations ◽  
Consecutive Series ◽  
Cerebral Arteriovenous Malformations ◽  
Class A ◽  
Significant Deficit ◽  
Microsurgical Resection ◽  
Martin Grade ◽  
Grade Iii

OBJECTIVE The objective of this study was to review the outcomes after microsurgical resection of cerebral arteriovenous malformations (AVMs) from a consecutive single-surgeon series. Clinical and imaging data were analyzed to address the following questions concerning AVM treatment in the post-ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) era. 1) Are the patients who present with unruptured or ruptured AVMs doing better at long-term follow-up? 2) Is the differentiation between Ponce Class A (Spetzler-Martin Grade I and II) patients versus Ponce Class B and C patients (Spetzler-Martin Grade III and IV) meaningful and applicable to surgical practice? 3) How did the ARUBA-eligible patients of this surgical series compare with the results reported in ARUBA? METHODS Two hundred eighty-eight patients with cerebral AVMs underwent microsurgical resection between 1983 and 2012 performed by the same surgeon (J.S.). This is a prospective case collection study that represents a consecutive series. The results are based on prospectively collected, early-outcome data that were supplemented by retrospectively collected, follow-up data for 94% of those cases. The analyzed data included the initial presentation, Spetzler-Martin grade, obliteration rates, surgical and neurological complications, and frequency of pretreatment with embolization or radiosurgery. The total cohort was compared using “small-AVM,” Spetzler-Martin Grade I and II, and ARUBA-eligible AVM subgroups. RESULTS The initial presentation was hemorrhage in 50.0% and seizures in 43.1% of patients. The series included 53 Spetzler-Martin Grade I (18.4%), 114 Spetzler-Martin Grade II (39.6%), 90 Spetzler-Martin Grade III (31.3%), 28 Spetzler-Martin Grade IV (9.7%), and 3 Spetzler-Martin Grade V (1.0%) AVMs. There were 144 unruptured and 104 ARUBA-eligible cases. Preembolization was used in 39 cases (13.5%). The occlusion rates for the total series and small AVM subgroup were 99% and 98.7%, respectively. The mean follow-up duration was 64 months. Early neurological deterioration was seen in 39.2% of patients, of which 12.2% had permanent and 5.6% had permanent significant deficits, and the mortality rate was 1.7% (n = 5). Outcome was better for patients with AVMs smaller than 3 cm (permanent deficit in 7.8% and permanent significant deficit in 3.2% of patients) and Ponce Class A status (permanent deficit in 7.8% and significant deficit in 3.2% of patients). Unruptured AVMs showed slightly higher new deficit rates (but 0 instances of mortality) among all cases, and in the small AVM and Ponce Class A subgroups. Unruptured Spetzler-Martin Grade I and II lesions had the best outcome (1.8% permanent significant deficit), and ARUBA-eligible Spetzler-Martin Grade I and II lesions had a slightly higher rate of permanent significant deficits (3.2%). CONCLUSIONS Microsurgery has a very high cure rate. Focusing microsurgical AVM resection on unruptured lesions smaller than 3 cm or on Spetzler-Martin Grade I and II lesions is a good strategy for minimizing long-term morbidity. Well-selected microsurgical cases lead to better outcomes than with multimodal interventions, as in the ARUBA treatment arm, or conservative treatment alone. Long-term prospective data collection is valuable.

Resectability of Spetzler-Martin grade IV and V cerebral arteriovenous malformations

2000 ◽  
Vol 7 ◽  
pp. 78-81 ◽  
Author(s):  
Kazuhiko Nozaki ◽  
Nobuo Hashimoto ◽  
Susumu Miyamoto ◽  
Haruhiko Kikuchi
Keyword(s):  
Arteriovenous Malformations ◽  
Cerebral Arteriovenous Malformations ◽  
Martin Grade

scholarly journals Surgical Treatment of Spetzler-Martin Grade III to V Cerebral Arteriovenous Malformations: 10 Years Experience in Kyoto University

2012 ◽  
Vol 52 (12) ◽  
pp. 852-858 ◽  
Author(s):  
Yasushi TAKAGI ◽  
Jun C. TAKAHASHI ◽  
Kazumichi YOSHIDA ◽  
Akira ISHII ◽  
Nobuo HASHIMOTO ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Arteriovenous Malformations ◽  
Cerebral Arteriovenous Malformations ◽  
Martin Grade ◽  
Grade Iii

Repeated linac-based radiosurgery in high-grade cerebral arteriovenous-malformations (AVM) Spetzler–Martin grade III to IV previously treated with radiosurgery

2011 ◽  
Vol 98 (2) ◽  
pp. 217-222 ◽  
Author(s):  
Henrik Hauswald ◽  
Stefanie Milker-Zabel ◽  
Florian Sterzing ◽  
Wolfgang Schlegel ◽  
Juergen Debus ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
High Grade ◽  
Cerebral Arteriovenous Malformations ◽  
Previously Treated ◽  
Martin Grade ◽  
Grade Iii

Abstract TP446: Noninvasive Evaluation of Cerebral Arteriovenous Malformations by 4D-CT Angiography using 320-detector row CT

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Hiroyuki Tajiri ◽  
Lee Jin ◽  
Toshitaka Tsukiyama ◽  
Yumiko Suzuki
Keyword(s):  
Arteriovenous Malformations ◽  
Average Score ◽  
Noninvasive Evaluation ◽  
Cerebral Arteriovenous Malformations ◽  
Promising Technique ◽  
Conventional Angiography ◽  
Grading Scale ◽  
Martin Grade ◽  
Cerebral Avms

Background and Purpose: Patients with higher Spetzler-Martin grade cerebral arteriovenous malformations (AVMs) are associated with poorer neurologic and clinical outcomes. Four dimensional computed tomography angiography (4D-CTA) is newly and promising technique in the diagnosis of patients with cerebral arteriovenous malformations (AVMs). The purpose of this retrospective study was to investigate the utility of 4D-CTA using whole-brain 320- detector row CT for assessing cerebral AVMs compared with conventional angiography (CA). Materials & Methods: Participants comprised patients admitted to our institution from November 2010 to March 2012 due to cerebral AVMs, who underwent both 4D-CTA and CA within 14days. The diagnosis of AVM was finally confirmed by CA. Two readers reviewed 4D-CTA and CA under consensus regarding detection rate of the AVMs, each component of the AVMs (feeders, nidi, drainers) which was scored using four-point grading scale (excellent=3, good=2, fair=1, poor=0), and the Spetzler-Martin (S-M) grade. Results: During study periods, eleven patients met our criteria. In every case, cerebral AVM was diagnosed by 4D-CTA. The average score for feeders, nidi, and drainers was 2.0, 2.3, and 2.5 in 4D-CTA and 2.4, 2.6, and 2.7 in CA, respectively. The average score of S-M grade was both 2.0, and matched in 11/11 patients. There were no significant differences statistically between two modalities (P<.005). Conclusion: 4D-CTA using 320-detector row CT is a very reliable method and offered diagnostic performance equivalent to CA in detecting and predicting S-M classification of cerebral AVMs.

scholarly journals Neurological morbidity and mortality associated with the endovascular treatment of cerebral arteriovenous malformations before and during the Onyx era

2015 ◽  
Vol 122 (6) ◽  
pp. 1492-1497 ◽  
Author(s):  
R. Webster Crowley ◽  
Andrew F. Ducruet ◽  
M. Yashar S. Kalani ◽  
Louis J. Kim ◽  
Felipe C. Albuquerque ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Arteriovenous Malformations ◽  
Morbidity And Mortality ◽  
Neurological Deficits ◽  
Embolic Agent ◽  
Cerebral Arteriovenous Malformations ◽  
Neurological Morbidity ◽  
Martin Grade ◽  
The Mean ◽  
Cerebral Avms

OBJECT The widespread implementation of the embolic agent Onyx has changed the endovascular management of cerebral arteriovenous malformations (AVMs). Recent data suggest that outcomes following embolization and resection may have worsened in the Onyx era. It has been hypothesized that there may be increased complications with Onyx embolization and increased surgical aggressiveness in patients treated with Onyx. In this study the authors analyzed their institutional experience with the endovascular treatment of cerebral AVMs prior to and after the introduction of Onyx to determine factors associated with periprocedural neurological morbidity and mortality. METHODS A retrospective review was performed of all patients with cerebral AVMs undergoing embolization at the Barrow Neurological Institute from 1995 to 2012. RESULTS Endovascular treatment of 342 cerebral AVMs was performed over 446 treatment sessions (mean age 37.8 years, range 1–83 years). Clinical presentation included hemorrhage in 47.6%, seizures in 21.9%, headaches in 11.1%, and no symptoms in 10% of cases. The endovascular pretreatment strategy was preoperative in 78.9%, preradiosurgery in 9.1%, palliative in 5.3%, targeted in 4.4%, and curative in 2.3%. The median Spetzler-Martin grade was III. The mean number of arteries embolized was 3.5 (range 0–13 arteries), and the mean number of treatment sessions was 1.3 (range 1–4 sessions). Onyx was used in 105 AVMs (30.7%), and N-butyl cyanoacrylate (NBCA) without Onyx was used in 229 AVMs (67%). AVMs treated with Onyx had a higher mean number of arterial pedicles embolized than did NBCA cases (4.3 ± 2.7 vs 3.2 ± 2.4, respectively; p < 0.001) and a greater number of sessions (1.5 ± 0.7 vs 1.2 ± 0.5, respectively; p < 0.05). Unexpected immediate postprocedural permanent neurological deficits were present in 9.6% of AVMs, while transient deficits were present in 1.8%. There was 1 death (0.3%). Spetzler-Martin grade was not associated with differences in outcome, as permanent neurological deficits were observed in 12%, 9%, 13%, 11%, and 13% of AVMs for Spetzler-Martin Grades I–V, respectively (p = 0.91). The use of Onyx compared with NBCA was not associated with differences in periprocedural morbidity (p = 0.23). This lack of a difference persisted even when controlling for number of arteries and sessions (p = 0.14). Sex was not associated with differences in outcome. CONCLUSIONS Permanent and transient postprocedural neurological deficits were noted in 9.6% and 1.8% of all cases, respectively. AVM grade was not associated with endovascular outcome. Despite the greater number of sessions required and arteries embolized for Onyx cases, there was no statistically significant difference in the risk of neurological deficits following cerebral AVM embolization with Onyx and NBCA.

Abstract 190: Hemorrhage of Cerebral Arteriovenous Malformations Significantly Alters Stereotactic Radiosurgery Outcomes

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Dale Ding ◽  
Chun-Po Yen ◽  
Robert M Starke ◽  
Zhiyuan Xu ◽  
Jason P Sheehan
Keyword(s):  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Latency Period ◽  
Cerebral Arteriovenous Malformations ◽  
Patient Demographics ◽  
Complete Obliteration ◽  
Radiation Induced ◽  
Prescription Dose ◽  
Martin Grade ◽  
Induced Changes

Introduction: Intracranial hemorrhage is simultaneously the most frequent and most debilitating manifestation of cerebral arteriovenous malformations (AVM), but its impact on success and complications of radiosurgery has not been rigorously assessed. In this case-control study, we define the effect of prior hemorrhage on AVM radiosurgery outcomes. Methods: From a prospective, institutional database of 1400 AVM patients treated with Gamma Knife radiosurgery, unruptured and ruptured AVMs were matched in a 1:1 fashion, blinded to outcome, based on patient demographics, prior embolization, AVM size (mean volume of unruptured AVMs 3.7 cm3 versus ruptured AVMs 3.5 cm3, P=0.195), Spetzler-Martin grade and radiosurgical treatment parameters (mean prescription dose for unruptured AVMs 20.9 Gy versus ruptured AVMs 21.0 Gy, P=0.837). There were 270 patients in each cohort. Matched statistical analyses were used to compare the baseline characteristics, obliteration rates, post-radiosurgery latency period hemorrhage risks, and incidences of radiation-induced changes (RIC) between the two cohorts. Results: The actuarial obliteration rates of the two cohorts were similar (unruptured AVMs: 38%, 58%, 76% at 3, 5, 10 years, respectively; ruptured AVMs: 40%, 60%, 73% at 3, 5, 10 years, respectively; P=0.592). However, for embolized AVMs, complete obliteration was more likely to be achieved in unruptured lesions (unruptured AVMs: 25%, 32%, 54% at 3, 5, 10 years, respectively; ruptured AVMs: 18%, 27%, 42% at 3, 5, 10 years, respectively; P=0.038). Prior AVM rupture resulted in a higher annual risk of post-radiosurgery latency period hemorrhage (ruptured AVMs 2.3% versus unruptured AVMs 1.1%, P=0.025) but a lower rate of cumulative and symptomatic RIC (cumulative RIC: ruptured AVMs 30.4% versus unruptured AVMs 48.9%, P<0.0001; symptomatic RIC: ruptured AVMs 7.0% versus unruptured AVMs 12.2%, P=0.041, respectively). The rates of permanent RIC were similar between the unruptured (2.2%) and ruptured (1.9%) AVM cohorts (P=0.761). Conclusion: Prior AVM rupture significantly alters the risk of latency period hemorrhage and RIC following radiosurgery. These effects should be taken into consideration with the multidisciplinary management of AVM patients.

Factors related to complete occlusion of arteriovenous malformations after gamma knife radiosurgery

2000 ◽  
Vol 93 (supplement_3) ◽  
pp. 96-101 ◽  
Author(s):  
Jong Hee Chang ◽  
Jin Woo Chang ◽  
Yong Gou Park ◽  
Sang Sup Chung
Keyword(s):  
Gamma Knife ◽  
Arteriovenous Malformations ◽  
Gamma Knife Radiosurgery ◽  
Maximum Diameter ◽  
Content Type ◽  
Complete Occlusion ◽  
Factors Associated ◽  
Martin Grade ◽  
Fine Print

Object. The authors sought to evaluate the effects of gamma knife radiosurgery (GKS) on cerebral arteriovenous malformations (AVMs) and the factors associated with complete occlusion. Methods. A total of 301 radiosurgical procedures for 277 cerebral AVMs were performed between December 1988 and December 1999. Two hundred seventy-eight lesions in 254 patients who were treated with GKS from May 1992 to December 1999 were analyzed. Several clinical and radiological parameters were evaluated. Conclusions. The total obliteration rate for the cases with an adequate radiological follow up of more than 2 years was 78.9%. In multivariate analysis, maximum diameter, angiographically delineated shape of the AVM nidus, and the number of draining veins significantly influenced the result of radiosurgery. In addition, margin radiation dose, Spetzler—Martin grade, and the flow pattern of the AVM nidus also had some influence on the outcome. In addition to the size, topography, and radiosurgical parameters of AVMs, it would seem to be necessary to consider the angioarchitectural and hemodynamic aspects to select proper candidates for radiosurgery.

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