Determinants of Neurological Outcome After Surgery for Brain Arteriovenous Malformation

Hartmann, Andreas; Stapf, Christian; Hofmeister, Christoph; Mohr, J. P.; Sciacca, Robert R.; Stein, Bennett M.; Faulstich, Andreas; Mast, H.

doi:10.1161/01.str.31.10.2361

Cited by 133 publications

(65 citation statements)

References 15 publications

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“…30 Although the Spetzler-Martin grading scale has been validated in numerous surgical treatment studies, the authors of some large-scale studies have refuted the notion that all elements of the scale are predictive of outcome. 12 Furthermore, the original authors noted that although this scale may be beneficial for comparing patient characteristics of different patient series, it might not accurately predict outcomes of patients treated with embolization or radiosurgery. In contrast, in this study we have found that the Spetzler-Martin grading scale accurately predicts outcome in patients undergoing Gamma Knife radiosurgery.…”

Section: Discussionmentioning

confidence: 99%

A practical grading scale for predicting outcome after radiosurgery for arteriovenous malformations: analysis of 1012 treated patients

Starke¹,

Yen²,

Ding³

et al. 2013

JNS

204

148

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Object. The authors performed a study to review outcomes following Gamma Knife radiosurgery for cerebral arteriovenous malformations (AVMs) and to create a practical scale to predict long-term outcome.Methods. Outcomes were reviewed in 1012 patients who were followed up for more than 2 years. Favorable outcome was defined as AVM obliteration and no posttreatment hemorrhage or permanent, symptomatic, radiationinduced complication. Preradiosurgery patient and AVM characteristics predictive of outcome in multivariate analysis were weighted according to their odds ratios to create the Virginia Radiosurgery AVM Scale.Results. The mean follow-up time was 8 years (range 2-20 years). Arteriovenous malformation obliteration occurred in 69% of patients. Postradiosurgery hemorrhage occurred in 88 patients, for a yearly incidence of 1.14%. Radiation-induced changes occurred in 387 patients (38.2%), symptoms in 100 (9.9%), and permanent deficits in 21 (2.1%). Favorable outcome was achieved in 649 patients (64.1%). The Virginia Radiosurgery AVM Scale was created such that patients were assigned 1 point each for having an AVM volume of 2-4 cm 3 , eloquent AVM location, or a history of hemorrhage, and 2 points for having an AVM volume greater than 4 cm 3 . Eighty percent of patients who had a score of 0-1 points had a favorable outcome, as did 70% who had a score of 2 points and 45% who had a score of 3-4 points. The Virginia Radiosurgery AVM Scale was still predictive of outcome after controlling for predictive Gamma Knife radiosurgery treatment parameters, including peripheral dose and number of isocenters, in a multivariate analysis. The Spetzler-Martin grading scale and the Radiosurgery-Based Grading Scale predicted favorable outcome, but the Virginia Radiosurgery AVM Scale provided the best assessment.Conclusions. Gamma Knife radiosurgery can be used to achieve long-term AVM obliteration and neurological preservation in a predictable fashion based on patient and AVM characteristics.

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Section: Discussionmentioning

confidence: 99%

A practical grading scale for predicting outcome after radiosurgery for arteriovenous malformations: analysis of 1012 treated patients

Starke¹,

Yen²,

Ding³

et al. 2013

JNS

204

148

View full text Add to dashboard Cite

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“…Even for AVMs classified as Spetzler-Martin Grade I or II, the risks of surgical complications vary from 0% to 20%. 11,13,24 While some of the neurological deficits gradually improve over time, it is very difficult to assess if we can legitimately offer those "immediate and single-phase risks" for children with plateau neurological states.…”

Section: Discussionmentioning

confidence: 99%

The long-term outcomes of radiosurgery for arteriovenous malformations in pediatric and adolescent populations

Hanakita¹,

Koga²,

Shin³

et al. 2015

PED

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OBJECT Although stereotactic radiosurgery (SRS) has been accepted as a therapeutic option for arteriovenous malformations (AVMs) in children and adolescents, substantial data are still lacking regarding the outcomes of SRS for AVMs in this age group, especially long-term complications. This study aimed to clarify the long-term outcomes of SRS for the treatment of AVM in pediatric patients aged ≤ 18 years. METHODS Outcomes of 116 patients who were aged 4–18 years when they underwent SRS between 1990 and 2009 at the study institute were analyzed retrospectively. RESULTS The median follow-up period after SRS was 100 months, with 6 patients followed up for more than 20 years. Actuarial obliteration rates at 3 and 5 years after SRS were 68% and 88%, respectively. Five hemorrhages occurred in 851 patient-years of follow-up. The annual bleeding rate after SRS before obliteration was calculated as 1.3%, which decreased to 0.2% after obliteration. Shorter maximum nidus diameter (p = 0.02) and higher margin dose (p = 0.03) were associated with a higher obliteration rate. Ten patients experienced adverse events after SRS. Of them, 4 patients presented with delayed complications years after SRS (range 9–20 years after SRS). CONCLUSIONS SRS can reduce the risk of hemorrhage in pediatric and adolescent AVMs, with an acceptable risk of complications in the long term. However, adverse events such as expanding hematoma and radiation necrosis that can occur after substantial follow-up should be taken into account at the time that treatment decisions are made and informed consent is obtained.

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“…3,13 Whether our observation is related to mechanisms leading to an elevated risk for surgical therapy in women, as recently reported, remains to be determined. 13 None of our postoperative patients showed evidence for cerebral hyperemia and postoperative brain swelling suggesting normal perfusion pressure breakthrough, which is assumed to be one mechanism leading to hemorrhage after AVM resection. 14 Whether persistent dysplastic vessels after AVM removal account for an increased risk of postoperative ICH is subject to current debates.…”

Section: Discussionmentioning

confidence: 71%

Dysplastic Vessels After Surgery for Brain Arteriovenous Malformations

Stapf

Connolly

Schumacher

et al. 2002

Stroke

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Background and Purpose-The cause and clinical significance of residual dysplastic vessels after surgery for brain arteriovenous malformations (AVM) are unclear. We studied predictors and frequency of residual dysplastic vessels on cerebral angiography after AVM surgery. Methods-The 240 prospectively enrolled surgical patients from the New York AVM Databank underwent 269 AVM-related surgical procedures. Reported postoperative brain angiographic findings were classified post hoc as showing (1) persistent dysplastic vessels, (2) a residual AVM, (3) focal hyperemia in the surgical bed, (4) other changes, or (5) a normal angiogram. Univariate and multivariate models were applied to test for an association between residual dysplastic vessels and patient age, sex, preoperative AVM size, anatomic AVM location, number of embolization procedures before surgery, and the time interval between AVM surgery and the postoperative angiogram. Results-Of the 224 documented postoperative angiograms, 78 (35%) showed dysplastic vessels, 24 (11%) had evidence for a residual AVM, 16 (7%) showed focal hyperemia, 6 (2%) revealed other findings, and 100 (45%) were normal. The number of cases showing angiographic evidence for dysplastic vessels was significantly associated with increasing size of the AVM (in millimeter increments; Pϭ0.0001); the mean diameter of AVMs in patients showing dysplastic vessels after surgery was significantly larger (41 mm, SD Ϯ14) than in those without residual dysplastic vessels (27 mm, SD Ϯ13; PϽ0.001). Symptomatic postoperative intracerebral hemorrhage occurred in 4 patients (1%), in 2 of whom dysplastic vessels were seen on the postoperative angiogram. Conclusions-The findings suggest that persistent dysplastic vessels may be found in approximately one third of angiograms after AVM surgery. Preoperative AVM size was found to be an independent predictor for the occurrence of dysplastic vessels on the postoperative angiogram.

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Determinants of Neurological Outcome After Surgery for Brain Arteriovenous Malformation

Cited by 133 publications

References 15 publications

A practical grading scale for predicting outcome after radiosurgery for arteriovenous malformations: analysis of 1012 treated patients

A practical grading scale for predicting outcome after radiosurgery for arteriovenous malformations: analysis of 1012 treated patients

The long-term outcomes of radiosurgery for arteriovenous malformations in pediatric and adolescent populations

Dysplastic Vessels After Surgery for Brain Arteriovenous Malformations

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