Early surgery for ruptured cerebral arteriovenous malformations

Kuhmonen, Johanna; Piippo, Anna; Väärt, Kristjan; Karataş, Ayşe; Ishii, Keisuke; Winkler, Peter; Niemelä, Mika; Porras, Matti; Hernesniemi, Juha

doi:10.1007/3-211-27911-3_17

Cited by 44 publications

(36 citation statements)

References 15 publications

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“…Kuhmonen et al [7] reported 49 patients with ruptured bAVMs, aged between 2 months and 78 years, and showed that clinical outcome correlated significantly with the Hunt and Hess grade, intraventricular hemorrhage and age; however, it appeared that patients with poor conscious levels were distributed among groups of good and poor outcomes; thus a single parameter such as conscious level is not informative enough in daily clinical practice. Similar results appeared in another two reports [2,9].…”

Section: Discussionmentioning

confidence: 99%

“…In the literature, clinical outcome of patients with ruptured bAVMs with respect to patients’ admission condition has been discussed in several reports [5,6,7,9], but information about prognostic parameters applicable to daily clinical practice is still lacking. Kuhmonen et al [7] reported 49 patients with ruptured bAVMs, aged between 2 months and 78 years, and showed that clinical outcome correlated significantly with the Hunt and Hess grade, intraventricular hemorrhage and age; however, it appeared that patients with poor conscious levels were distributed among groups of good and poor outcomes; thus a single parameter such as conscious level is not informative enough in daily clinical practice.…”

Section: Discussionmentioning

confidence: 99%

“…The goal of treatment of bAVMs is elimination of a bAVM with minimal damage to the surrounding brain tissue; however, once a bAVM is ruptured, damage to the brain is done and the severity of hemorrhage becomes more important in affecting clinical outcome than other intrinsic characteristics of a bAVM [5,7,8]. Although all children with ruptured bAVMs are usually managed aggressively even when they are in poor clinical states, a better understanding of the relationship between clinical outcome and admission parameters is still invaluable.…”

Section: Discussionmentioning

confidence: 99%

“…It is important to understand how clinical outcome is related to clinical and imaging parameters on admission in these children; however, even taking into account both adult and pediatric patients with ruptured bAVMs, there are only a few published reports focusing on the study of this relationship [5,6,7,8,9]. These reports have generated some evidence to support a long-held belief that clinical outcome of these patients seems to correlate with the severity of hemorrhage, but apart from characterizing the severity of hemorrhage by the conscious level [5,7] and adverse predictive value of third nerve palsy [6], they were insufficient to provide more detailed information such as the degree of impairment of consciousness which may have an adverse predictive value and the significance of other clinical or imaging parameters on admission. In addition, it is likely that children with bAVMs have a better prognosis than adult patients [8,10], and should be studied separately.…”

Section: Introductionmentioning

confidence: 99%

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Ruptured Brain Arteriovenous Malformations in Children: Correlation of Clinical Outcome with Admission Parameters

Wong

Fong

2010

Pediatr Neurosurg

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Aims: To gain a better understanding of how clinical outcome in children with ruptured brain arteriovenous malformations (bAVMs) correlates with clinical and imaging parameters on admission. Methods: The authors retrospectively reviewed patients with bAVMs, aged 18 or below, managed at their hospital between January 1992 and December 2008. Clinical outcome was assessed using the modified Rankin Scale (mRS). Patients with ruptured bAVMs were analyzed; their clinical parameters and computerized tomography findings on admission were recorded. Clinical outcome was then evaluated against admission scores using the Glasgow Coma Scale (GCS), the World Federation of Neurosurgical Societies Grading System of Subarachnoid Hemorrhage (WFNS-SAH), the Spetzler-Martin grade, the intracerebral hemorrhage score and 2 other independent parameters, namely pupillary response and significant focal neurological injuries. Spearman’s correlation coefficient, linear regression analysis and multivariate logistic regression analysis were used for data analysis. Results: 40 pediatric patients with bAVMs were found and 32 of them presented with hemorrhage (80%). In the 32 children with ruptured bAVMS, follow-up ranged between 7 and 204 months (median 100.5 months). The complete excision/obliteration rate as confirmed by digital subtraction angiography was 73.3%. The mRS scores at the last follow-up were: grades 0–II in 87.5%; grades IV–V in 6.25%, and grade VI in 6.25%. The Spetzler-Martin grade, the intracerebral hemorrhage score, the WFNS-SAH grade, the GCS scores, and a combined scoring scale consisting of the GCS, pupillary response and significant focal neurological injuries correlated significantly with clinical outcome 6 months after hemorrhage. However, on the scatter diagrams, it appeared that only the combined scoring scale might be valid for clinical practice. Multivariate logistic regression analysis showed that the combined scoring scale was a statistically significant independent predictor of clinical outcome 6 months after hemorrhage. Conclusion: In this series of pediatric patients with ruptured bAVMs, although various grading scales correlated significantly with clinical outcome 6 months after hemorrhage, only the combined scoring scale might have the potential to be applied to predict clinical outcome in these children.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Ruptured Brain Arteriovenous Malformations in Children: Correlation of Clinical Outcome with Admission Parameters

Wong

Fong

2010

Pediatr Neurosurg

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“…Según la literatura actual, la metodología a seguir en este tipo de tratamiento no queda bien establecida. Existe una gran variabilidad sobre el número de sesiones, el intervalo entre procedimientos y el porcentaje de embolización prequirúrgica en los artículos publica-394-405 dos 7,10,18,21,22,24,25,26,43,46,49 . Debido a ello, presentamos una revisión basada en nuestra experiencia y la literatura sobre los pasos a seguir a la hora de llevar a cabo el tratamiento combinado embolización más cirugía.…”

Section: Aspectos Del Tratamiento Combinado Embolización Más Cirugíaunclassified

Manejo actual de las malformaciones arteriovenosas: Estudio retrospectivo de 31 casos y revisión de la literatura

Muñoz¹,

Clavel²,

Molet³

et al. 2007

Neurocirugía

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ResumenObjetivos. Establecer unos criterios terapéuticos en las malformaciones arteriovenosas (MAVs) grados III, IV y V de Spetzler y Martin y análisis de resultados en el subgrupo de tratamiento con embolización más cirugía.Material y métodos. Estudio retrospectivo de 31 pacientes con MAVs cerebrales tratados en nuestro servicio entre 1999 y 2004. Se trata de 19 mujeres y 12 hombres, con una edad media de 31,6 años (rango de 1 a 62a). La forma de presentación fue en un 77,4% hemorragia intracraneal, en un 12,9% crisis comicial y en un 3,2% cefalea, infarto isquémico y hallazgo casual en cada uno de ellos. En 29 casos se realizó arteriografía diagnóstica y en 2 casos el diagnóstico fue anatomopatológico. Según la clasificación de Spetzler y Martin, 10,3% fueron de Grado I, 24,1% de Grado II, 37,9% de Grado Ill, 24,1% de Grado IV y 3,4% de Grado V. Se clasificaron en 6 grupos según el tratamiento realizado (cirugía, embolización, radiocirugía, embolización más cirugía, embolización más radiocirugía y tratamiento conservador).Resultados. Las MAVs grado III, IV y V (19 pacientes) fueron tratadas en su mayoría por cirugía (6 casos) y embolización más cirugía (5 casos) pero también se utilizaron otras modalidades de tratamiento (embolización, radiocirugía y conservador). Los resultados funcionales de estos 3 subgrupos muestra un 36,8% (7 casos) de asintomáticos o con mínimos síntomas (Rankin m 0-1), un 52,6% (10 casos) de discapacidad leve pero independientes (Rankin m=2), un 5,3% (1 caso) de moderada discapacidad (Rankin m=3), y un 5,3% (1 caso) de mortalidad. En el manejo combinado embolización más cirugía de malformaciones complejas, se observa un alto porcentaje de sangrado postembolización que motivó cirugía precoz con buen resultado funcional. Hubo un caso de mortalidad postquirúrgica.Conclusiones. En el tratamiento de las MAVs cerebrales se debe tener en cuenta factores como la historia natural, la forma de presentación (hemorragia), las características angioestructurales (presencia de aporte arterial profundo, aneurismas), la escala de Spetzler y Martin y el estado clínico del paciente. En el tratamiento con embolización más cirugía es recomendable obtener una embolización prequirúrgica subtotal > 50%, no ocluir más del 50% por sesión, mantener un intervalo entre sesiones de embolización entre 4 y 6 semanas y un intervalo entre última embolización y cirugía entre 1 y 3 semanas.

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