Association of Infratentorial Brain Arteriovenous Malformations With Hemorrhage at Initial Presentation

Khaw, Alexander V.; Mohr, J. P.; Sciacca, Robert R.; Schumacher, H. C.; Hartmann, Andreas; Pile‐Spellman, John; Mast, H.; Stapf, Christian

doi:10.1161/01.str.0000117093.59726.f9

Cited by 158 publications

(80 citation statements)

References 27 publications

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“…Forty-six percent of patients presented with an intracranial hemorrhage, which was consistent with the rate of 52% provided by meta-analysis data. 13,22,38 In the study reported here, the annual overall rate of hemorrhage during the latency interval was 1%. This is a reflection of the finding that all 4 (5%) hemorrhages occurred during the first year after treatment, which is comparable to results for motor cortex AVMs.…”

Section: Decision Makingmentioning

confidence: 47%

Stereotactic radiosurgery for sylvian fissure arteriovenous malformations with emphasis on hemorrhage risks and seizure outcomes

Bowden

Kano

Tonetti

et al. 2014

JNS

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Object Sylvian fissure arteriovenous malformations (AVMs) present substantial management challenges because of the critical adjacent blood vessels and functional brain. The authors investigated the outcomes, especially hemorrhage and seizure activity, after stereotactic radiosurgery (SRS) of AVMs within or adjacent to the sylvian fissure. Methods This retrospective single-institution analysis examined the authors' experiences with Gamma Knife surgery for AVMs of the sylvian fissure in cases treated from 1987 through 2009. During this time, 87 patients underwent SRS for AVMs in the region of the sylvian fissure. Before undergoing SRS, 40 (46%) of these patients had experienced hemorrhage and 36 (41%) had had seizures. The median target volume of the AVM was 3.85 cm3 (range 0.1–17.7 cm3), and the median marginal dose of radiation was 20 Gy (range 13–25 Gy). Results Over a median follow-up period of 64 months (range 3–275 months), AVM obliteration was confirmed by MRI or angiography for 43 patients. The actuarial rates of confirmation of total obliteration were 35% at 3 years, 60% at 4 and 5 years, and 76% at 10 years. Of the 36 patients who had experienced seizures before SRS, 19 (53%) achieved outcomes of Engel class I after treatment. The rate of seizure improvement was 29% at 3 years, 36% at 5 years, 50% at 10 years, and 60% at 15 years. No seizures developed after SRS in patients who had been seizure free before treatment. The actuarial rate of AVM hemorrhage after SRS was 5% at 1, 5, and 10 years. This rate equated to an annual hemorrhage rate during the latency interval of 1%; no hemorrhages occurred after confirmed obliteration. No permanent neurological deficits developed as an adverse effect of radiation; however, delayed cyst formation occurred in 3 patients. Conclusions Stereotactic radiosurgery was an effective treatment for AVMs within the region of the sylvian fissure, particularly for smaller-volume AVMs. After SRS, a low rate of hemorrhage and improved seizure control were also evident.

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Section: Decision Makingmentioning

confidence: 47%

Stereotactic radiosurgery for sylvian fissure arteriovenous malformations with emphasis on hemorrhage risks and seizure outcomes

Bowden

Kano

Tonetti

et al. 2014

JNS

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“…34 In addition to the aforementioned surgical series, numerous recent observational studies have also demonstrated the greater rate of hemorrhagic presentation among patients with these lesions, 11,17,28,32,39 with only a few exceptions. 9,20,22 In a multivariate analysis targeted at elucidating the relationship between infratentorial location and hemorrhagic presentation, Khaw et al 19 demonstrated that infratentorial AVMs were almost twice as likely to present with hemorrhage as supratentorial AVMs. Similarly, in the Toronto Study group 32 21 (60%) of 35 patients with infratentorial AVMs presented with hemorrhage, compared with 125 (35%) of 355 patients with supratentorial AVMs and 88 (29%) of 299 patients with superficial AVMs.…”

mentioning

confidence: 99%

Posterior fossa arteriovenous malformations

Arnaout¹,

Gross

Eddleman³

et al. 2009

FOC

116

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Arteriovenous malformations (AVMs) of the posterior fossa are complex neurovascular lesions that are less common than their supratentorial counterparts, accounting for < 15% of all AVMs. The majority of patients with these lesions present with intracranial hemorrhage, a factor that has been consistently shown to increase one's risk for subsequent bleeding. Studies have additionally shown a posterior fossa or deep AVM location to portend a more aggressive natural history. The authors reviewed the literature on posterior fossa AVMs, finding their annual rupture rates to be as high as 11.6%, an important factor that underscores the importance of aggressive treatment of lesions amenable to intervention as therapeutic options and results continue to improve.

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“…17 Variants that were reported to be predictive of BAVM rupture but were not expanded in the recommended protocol were defined with reference to previous studies. [18][19][20] BAVM location was dichotomized into deep (basal ganglia, thalamus, cerebellum, and corpus callosum) and superficial (all other locations). A posterior fossa location was defined as brain stem, cerebellum, or both.…”

Section: Neuroradiologic Reviewmentioning

confidence: 99%

Periventricular Location as a Risk Factor for Hemorrhage and Severe Clinical Presentation in Pediatric Patients with Untreated Brain Arteriovenous Malformations

Ma¹,

Huang²,

Chen³

et al. 2015

AJNR Am J Neuroradiol

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Association of Infratentorial Brain Arteriovenous Malformations With Hemorrhage at Initial Presentation

Abstract: Background and Purpose-The goal of this study was to analyze the association of hemorrhagic presentation with infratentorial brain arteriovenous malformations (AVMs). Methods-The

Cited by 158 publications

References 27 publications

Stereotactic radiosurgery for sylvian fissure arteriovenous malformations with emphasis on hemorrhage risks and seizure outcomes

Stereotactic radiosurgery for sylvian fissure arteriovenous malformations with emphasis on hemorrhage risks and seizure outcomes

Posterior fossa arteriovenous malformations

Periventricular Location as a Risk Factor for Hemorrhage and Severe Clinical Presentation in Pediatric Patients with Untreated Brain Arteriovenous Malformations

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