Angioarchitecture of Brain AVM Determines the Presentation with Seizures: Proposed Scoring System

Shankar, Jai; Menezes, Ravi; Pohlmann‐Eden, Bernd; Wallace, Christopher; terBrugge, Karel G.; Krings, Timo

doi:10.3174/ajnr.a3361

Cited by 60 publications

(26 citation statements)

References 28 publications

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“…19 More recently, Shankar et al found a statistically significant association between seizures and AVMs with characteristics of high flow (including pial recruitment and perinidal angiogenesis, fistulization, and intranidal aneurysm) and venous outflow obstruction (including venous ectasia, pial long draining vein, venous outflow restriction draining vein, and pseudophlebitic cortical vein pattern). 16 The mechanism by which SRS leads to a reduction in seizures has not been fully elucidated. Improved cerebral hemodynamics following radiosurgical obliteration may contribute to control of seizures and other adverse symptoms.…”

Section: Discussionmentioning

confidence: 99%

Seizure outcomes after stereotactic radiosurgery for the treatment of cerebral arteriovenous malformations

Ditty

Omar

Foreman

et al. 2017

JNS

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OBJECTIVE Patients with cerebral arteriovenous malformations (AVMs) commonly present with seizure. Seizure outcomes in patients treated with stereotactic radiosurgery (SRS) are poorly defined. A case series of patients with cerebral AVMs treated with SRS is presented to evaluate long-term seizure outcome. METHODS A retrospective review of the medical record was performed, identifying 204 consecutive patients with AVMs treated with SRS between January 1991 and June 2012. Clinical and radiographic data were evaluated. Seizure outcome was measured using the Engel Epilepsy Surgery Outcome Scale. Mean duration of follow-up was 37.1 months (SD 38.3 months) with a minimum follow-up period of 1 month. RESULTS Of the 204 patients with cerebral AVMs treated with SRS, 78 patients (38.2%) presented with seizures and 49 of those patients were treated with antiepileptic drugs (AEDs). Following SRS, 63 (80.8%) of the 78 patients who had had seizures prior to SRS were seizure-free at a mean follow-up time of 37.2 months (SD 41.3 months). Of the 49 patients who had been treated with AEDs, 17 were still taking AEDs at last follow-up. Of the 126 patients who did not present with seizures prior to treatment with SRS, only 5 patients (4.0%) had seizures in the post-SRS period. There was no significant correlation between post-SRS seizure status and patient demographic features, comorbidities, AVM characteristics, history of operative intervention, pre- or posttreatment hemorrhage, or radiographic degree of AVM resolution. CONCLUSIONS Stereotactic radiosurgery for treatment of cerebral AVMs is effective at providing long-term control of seizures. A substantial number of patients who were treated with SRS were not only seizure free at their last follow-up, but had been successfully weaned from antiepileptic medications.

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Section: Discussionmentioning

confidence: 99%

Seizure outcomes after stereotactic radiosurgery for the treatment of cerebral arteriovenous malformations

Ditty

Omar

Foreman

et al. 2017

JNS

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“…Sun et al , in a study of 45 patients, found both compact AVM morphology and frontal or temporal location were associated with seizures, but again this study did not examine cross-sectional imaging findings 23. Finally, an analysis of angiographic features of AVMs by Shankar et al noted that a long pial course of a draining vein, fistulous component in the nidus, AVM location, and stenosis of the venous outflow correlated with seizures 24. The results of our study had some findings similar to, and some contradictory to, prior studies: younger patient age and larger AVM size were associated with seizures similar to the report of Hoh et al and a long draining vein was associated with seizures as Sun et al reported, but temporal lobe location was not associated with seizures as had been found by Hoh et al and Sun et al 22 23…”

Section: Discussionmentioning

confidence: 99%

“…The amount of tissue impaired depends on the length and course of the draining vein. If an epileptogenic area of brain is included in this territory, the patient will probably have a higher risk of seizure 24. Short draining veins might have little effect on venous drainage of normal parenchyma.…”

Section: Discussionmentioning

confidence: 99%

MR characteristics of unruptured intracranial arteriovenous malformations associated with seizure as initial clinical presentation

Benson

Chiu

Flemming

et al. 2019

J NeuroIntervent Surg

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BackgroundPatients with intracranial arteriovenous malformations (AVMs) are at increased risk of seizures.ObjectiveTo identify MRI characteristics of unruptured intracranial AVMs associated with seizures at presentation.Materials and methodsA retrospective review was completed of patients diagnosed with unruptured intracranial AVMs on MRI between January 1, 2000 and December 31, 2016. Two blinded reviewers assessed demographics, lesion locality, and imaging and architectural characteristics of AVMs and surrounding parenchyma, including, but not limited to, AVM location, venous drainage pattern, venous varix, thrombosed venous varix, long draining vein, AVM-related gliosis, peri-AVM edema, and peri-AVM T2* signal. Findings were statistically analyzed for correlation with seizure using Student’s t-test for continuous variables and Χ2 test for categorical variables.ResultsOf 165 included patients, 57/165 (34.5%) patients were imaged as part of an investigation for seizures. Patients with seizures more commonly had peri-AVM edema (36.8%, compared with 11.1% of non-seizure patients, p<0.0001), peri-AVM T2* blooming (28.1% vs 7.4%; p=0.029), a venous pouch/varix (61.4% vs 31.5%, p=0.0003), long draining vein (91.2% vs 55.6%, p<0.0001), and larger size based on Spetzler-Martin grade categorization (p=0.006). By location, AVMs located in the frontal lobe, primary motor cortex, and primary sensory cortex were associated with seizures (p=0.004, p=0.001, and p=0.006, respectively); temporal lobe location was not associated with seizures (p=0.459).ConclusionsCertain MRI characteristics of unruptured intracranial AVMs are associated with seizures. Such correlations may assist in identifying the pathophysiological mechanisms by which AVMs cause seizures.

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“…Hol et al studied clinical predictors of seizure incidence and seizure outcomes in bAVMs patients with seizure and observed that male sex, age less than 65 years, bAVMs size greater than 3 cm, and bAVMs location in the temporal lobe are associated with pretreatment seizure [ 16 ]. Shankar et al analyzed angioarchitectural characteristics of unruptured bAVMs in a consecutive series of patients presenting with seizures and proposed that venous outflow stenosis, long pial draining vein and location of bAVMs are the strongest predictors of seizures [ 17 ]. A recent prospective study investigating seizures as the initial presentation of bAVMs found that predisposing factors include male sex, increasing bAVMs size, superficial venous drainage, and location in the frontal lobe and arterial border-zone [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with seizure occurrence and long-term seizure control in pediatric brain arteriovenous malformation: a retrospective analysis of 89 patients

et al. 2015

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BackgroundFew studies have examined seizures in pediatric brain arteriovenous malformation. In our study, risk factors associated with seizure occurrence and long-term seizure control outcomes after different treatments in pediatric arteriovenous malformation patients were investigated.MethodsA retrospective analysis was conducted with clinical data from a cohort of 89 pediatric brain arteriovenous malformation patients acquired between 2008 and 2013. Univariate and multivariate analyses were used to assess risk factors associated with seizure incidence. Patients who presented with seizure before treatment were evaluated using the Engel classification during the follow-up period.ResultsA higher risk of seizure occurrence was observed in large size and unruptured brain arteriovenous malformations using multivariate logistic regression analysis (p < 0.05). A total of 22 children, who presented with seizure before the interventions, were included in subsequent analysis. During a mean follow-up period of 2.3 years after the intervention, 12 (55 %) of these children were classified as Engel class I after treatment.ConclusionsSeizures were the most common symptom in unruptured bAVMs. Size of the brain arteriovenous malformation is highly significant to seizure occurrence. Patients with cerebral hemorrhage are prone to having an acute seizure occurrence. The different therapies examined all improved seizure control to varying degrees.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0402-5) contains supplementary material, which is available to authorized users.

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Angioarchitecture of Brain AVM Determines the Presentation with Seizures: Proposed Scoring System

Cited by 60 publications

References 28 publications

Seizure outcomes after stereotactic radiosurgery for the treatment of cerebral arteriovenous malformations

Seizure outcomes after stereotactic radiosurgery for the treatment of cerebral arteriovenous malformations

MR characteristics of unruptured intracranial arteriovenous malformations associated with seizure as initial clinical presentation

Factors associated with seizure occurrence and long-term seizure control in pediatric brain arteriovenous malformation: a retrospective analysis of 89 patients

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