Arteriovenous malformation presenting with epilepsy: a multimodal approach to diagnosis and treatment

Abstract

<jats:p>Arteriovenous malformation (AVM) presenting with epilepsy significantly impacts patient quality of life, and it should be considered very much a seizure disorder. Although hemorrhage prevention is the primary treatment aim of AVM surgery, seizure control should also be at the forefront of therapeutic management. Several hemodynamic and morphological characteristics of AVM have been identified to be associated with seizure presentation. This includes increased AVM flow, presence of long pial draining vein, venous outflow obstruction, and frontotemporal location, among other aspects. With the advent of high-throughput image processing and quantification methods, new radiographic attributes of AVM-related epilepsy have been identified. With respect to therapy, several treatment approaches are available, including conservative management or interventional modalities; this includes microsurgery, radiosurgery, and embolization or a combination thereof. Many studies, especially in the domain of microsurgery and radiosurgery, evaluate both techniques with respect to seizure outcomes. The advantage of microsurgery lies in superior AVM obliteration rates and swift seizure response. In addition, by incorporating electrophysiological monitoring during AVM resection, adjacent or even remote epileptogenic foci can be identified, leading to extended lesionectomy and improved seizure control. Radiosurgery, despite resulting in reduced AVM obliteration and prolonged time to seizure freedom, avoids the risks of surgery altogether and may provide seizure control through various antiepileptic mechanisms. Embolization continues to be used as an adjuvant for both microsurgery and radiosurgery. In this study, the authors review the latest imaging techniques in characterizing AVM-related epilepsy, in addition to reviewing each treatment modality.</jats:p>

Selective Endothelial Hyperactivation of Oncogenic KRAS Induces Brain Arteriovenous Malformations in Mice

“…These pathologic events might be the underlying mechanisms of bAVM-associated declines in sensory and motor functions as well as memory loss (see Fig 6D-L). Patients with bAVMs sometimes develop significant neurological disorders, including epilepsy, dementia, amyotrophic lateral sclerosis, or Parkinson's disease [57][58][59][60][61] ; therefore, further studies utilizing our approach can provide new insights into the pathogenesis of neurological diseases related to vascular malformation or vascular injury.…”

Chinese Cerebrovascular Neurosurgery Society and Chinese Interventional & Hybrid Operation Society, of Chinese Stroke Association Clinical Practice Guidelines for Management of Brain Arteriovenous Malformations in Eloquent Areas

“…However, Josephson et al ( 110 ) reported that AEDs had limited effect on reducing the seizure risk in patients with ruptured temporal bAVMs. If anticonvulsant therapy failed to control seizures, surgical management might be pursued ( 271 ).…”

Patient frailty association with cerebral arteriovenous malformation microsurgical outcomes and development of custom risk stratification score: an analysis of 16,721 nationwide admissions

“…Institutional studies have employed both hydrocephalus and epilepsy for risk stratification in AVM microsurgery. [22][23][24] We analyzed associations between patient frailty status and binary outcomes using multivariate logistic regression and reported odds ratios. To evaluate LOS and hospitalization costs, we used gamma regression with a logistic link function, idealized for modeling right-skewed, continuous outcomes, and reported β-coefficients (percentage change in the outcome relative to a reference category).…”