Classification of AVMs

Morcos, Jacques J.; Spetzler, Robert F.; Mizutani, T.

doi:10.3171/jns.1995.83.4.0761

Cited by 2 publications

(2 citation statements)

References 17 publications

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“…Clinical data were retrieved, including age at diagnosis, sex, modified Rankin Score (mRS), AVM location and hemisphere, SM grading [ 5 ], symptoms at initial diagnosis, date and symptoms at last follow-up, rebleeding occurrence, and the incidence of treatment-induced toxicity, including epileptic seizures or new-onset focal neurological deficits (hemiparesis, hypoesthesia, and cranial nerve deficits). In patients who underwent embolization, SM grades were recorded before and after embolization.…”

Section: Methodsmentioning

confidence: 99%

“…Complete obliteration is the only strategy to abrogate the risk of AVM bleeding. While small AVMs in non-eloquent brain areas are best managed with complete microsurgical resection, more complex malformations (those with a grade of IV–V according to the Spetzler-Martin (SM) classification [ 5 ] are usually considered inoperable due to their eloquent localization or deep venous drainage. SRS is an established alternative strategy for treating such lesions [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Image-guided robotic radiosurgery for the treatment of arteriovenous malformations

et al. 2022

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Background Cerebral arteriovenous malformations (AVMs) are challenging lesions, often requiring multimodal interventions; however, data on the efficacy of stereotactic radiosurgery for cerebral AVMs are limited. This study aimed to evaluate the clinical and radiographic results following robotic radiosurgery, alone or in combination with endovascular treatment, and to investigate factors associated with obliteration and complications in patients with AVM. Methods We retrospectively analyzed the clinical and imaging characteristics of 123 patients with AVMs of all Spetzler-Martin grades treated at two institutions by robotic radiosurgery in single-fraction doses (CyberKnife). Embolization was performed before radiosurgery in a subset of patients to attempt to downgrade the lesions. Factors associated with AVM obliteration and complications (toxicity) were identified via univariate and multivariate analyses. Results The median follow-up time was 48.1 months (range, 3.6–123 months). Five patients were lost to follow-up. The obliteration rate in the 59 patients with a follow-up period exceeding four years was 72.8%. Complete obliteration and partial remission were achieved in 67 (56.8%) and 31 (26.3%) cases, respectively, whereas no change was observed in 20 cases (17.8%). Embolization was performed in 54/123 cases (43.9%). Complete and partial obliteration were achieved in 29 (55.7%) and 14 (26.9%) embolized patients, respectively. In the multivariate analysis, the factors associated with obliteration were age (p = .018) and the Spetzler-Martin grade (p = .041). Treatment-induced toxicity (radiation necrosis and/or edema) was observed in 15 cases (12.7%), rebleeding occurred in three cases (2.5%), and the rate of mortality associated with rebleeding was 1.7%. Conclusions CyberKnife radiosurgery is a valid approach for treating AVMs of all Spetzler-Martin-grades, with satisfactory obliteration rates, low toxicity, and a relatively rare incidence of rebleeding.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Image-guided robotic radiosurgery for the treatment of arteriovenous malformations

et al. 2022

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A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults

Al‐Shahi¹

2001

Brain

435

177

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By systematically reviewing the literature, we have found that there is very little information about the frequency and clinical course of arteriovenous malformations (AVMs) of the brain in adults because the methods of most studies have been flawed, and AVMs tend to be treated once they are discovered. The incidence of AVMs is approximately 1 per 100 000 per year in unselected populations, and the point prevalence in adults is approximately 18 per 100 000. AVMs account for between 1 and 2% of all strokes, 3% of strokes in young adults, 9% of subarachnoid haemorrhages and, of all primary intracerebral haemorrhages, they are responsible for 4% overall, but for as much as one-third in young adults. AVMs are far less common causes of first presentations with unprovoked seizures (1%), and of people presenting with headaches in the absence of neurological signs (0.3%). At the time of detection, at least 15% of people affected by AVMs are asymptomatic, about one-fifth present with seizures and for approximately two-thirds of them the dominant mode of presentation is with intracranial haemorrhage. The limited high quality data available on prognosis suggest that long-term crude annual case fatality is 1-1.5%, the crude annual risk of first occurrence of haemorrhage from an unruptured AVM is approximately 2%, but the risk of recurrent haemorrhage may be as high as 18% in the first year, with uncertainty about the risk thereafter. For untreated AVMs, the annual risk of developing de novo seizures is 1%. There is a pressing need for large, prospective studies of the frequency and clinical course of AVMs in well-defined, stable populations, taking account of their prognostic heterogeneity.

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Classification of AVMs

Cited by 2 publications

References 17 publications

Image-guided robotic radiosurgery for the treatment of arteriovenous malformations

Image-guided robotic radiosurgery for the treatment of arteriovenous malformations

A systematic review of the frequency and prognosis of arteriovenous malformations of the brain in adults

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