European consensus conference on unruptured brain AVMs treatment (Supported by EANS, ESMINT, EGKS, and SINCH)

Cenzato, Marco; Boccardi, Edoardo; Beghi, Ettore; Vajkoczy, Peter; Szikora, István; Motti, Enrico; Regli, Luca; Raabe, Andreas; Eliava, Shalva; Gruber, Andreas; Meling, Torstein R.; Niemelä, Mika; Pasqualin, A.; Golanov, Andrey; Karlsson, Bengt; Kemeny, Andras; Liščák, Roman; Lippitz, Bodo; Radatz, Matthias; Camera, Alessandro La; Chapot, René; Işlak, Civan; Spelle, Laurent; Debernardi, Alberto; Agostoni, Elio; Revay, Martina; Morgan, M.

doi:10.1007/s00701-017-3154-8

Cited by 72 publications

(44 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The complexity of brain AVMs makes them a heterogeneous group of lesions, with several factors assumed possible to affect the risk of rupture with subsequent hemorrhagic stroke . Since brain AVMs can be associated with a potentially severe natural history, determining the rupture risk is crucial to establish the appropriate treatment …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Grades of brain arteriovenous malformations and risk of hemorrhage and death

Stefani

Ribeiro

Mohr

2019

Ann Clin Transl Neurol

View full text Add to dashboard Cite

Objective To assess the relationship of the grade of unruptured and untreated Brain Arteriovenous Malformations (AVMs), with the risk of subsequent stroke and death during follow‐up. Methods This prospective study was drawn from a cohort of adult patients with unruptured AVMs, who participated in the conservative treatment arm (medical management only for headache or seizures) of the randomized clinical trial of unruptured brain AVMs (ARUBA study). The grade of AVMs (Spetzler–Martin scale) was dichotomized into categories: AVMs of grades I and II were considered low grade; AVMs of grades III and IV were considered high grade. There were no grade V AVM patients in ARUBA. The primary outcome was symptomatic stroke (hemorrhagic or ischemic – documented by imaging) or death. Results The conservative treatment group had 123 patients (“as treated” analysis). 71 (57.7%) had lesions characterized for this analysis as low‐grade lesions and 52 (42.2%) as high grade. From the total of 10 (8.13%) primary outcomes, three occurred (4.22%) in low‐grade AVMs and seven (13.46%) in high‐grade AVMs (P = 0.0942). Interpretation Statistical analysis of the cohort of patients with unruptured and untreated AVMs from ARUBA study showed that the graduation categories (Spetzler–Martin grades) were not associated with the outcome of subsequent stroke or death.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Demonstrating the disagreement regarding the role of size in hemorrhagic risk, some authors have pointed out that large AVMs (>3 cm) are associated with a higher risk of subsequent bleeding . Brain AVMs with large sizes may present in nonhemorrhagic forms, which could lead to an overestimation of hemorrhage rate in small AVMs .…”

Section: Discussionmentioning

confidence: 99%

Grades of brain arteriovenous malformations and risk of hemorrhage and death

Stefani

Ribeiro

Mohr

2019

Ann Clin Transl Neurol

View full text Add to dashboard Cite

show abstract

“…For patients with unruptured bAVMs of higher grades, treatment may be proposed based on a very individualized decision. If treatment is indicated, the primary strategy should be defined by a multidisciplinary team prior to commencing treatment and should aim at complete eradication of the bAVM [3].…”

Section: Discussionmentioning

confidence: 99%

“…However, the ARUBA study has been heavily criticized because of its perceived lack of external validity, the wide heterogeneity of treatment modalities, and the scarcity of patients treated with microsurgery [12,16]. More recently, a European consensus conference, on behalf of the European Association of Neurosurgical Societies (EANS), the European Society of Interventional Therapy (ESMINT), and the European Society for Radiosurgery (EGKS), stated that BThe results of a randomized trial (ARUBA) cannot be applied equally for all unruptured brain arteriovenous malformation (uBAVM) and for all treatment modalities^ [3].…”

Section: Treatmentmentioning

confidence: 99%

To treat or not to treat brain AVMs—that’s still the question

Meling

2017

Acta Neurochir

Self Cite

View full text Add to dashboard Cite

“…No matter in the SM Grade Scale(8), or the Lawton-Young Grade Scale(24), or the new prediction scale of postoperative neurofunctional deficit-HDVL Grade Scale(25), eloquence is the key evaluation criteria. Generally, limited visual deficit and mild aphasia were acceptable because of the small impact on the quality of life(20), and bAVMs in the deep location or central motor cortex were considered as surgical contraindication(26,27). Lesion-to-eloquence distance (LED) <4.95mm was indicated as an independent predictor for postoperative neurofunctional deficits(25).…”

mentioning

confidence: 99%

Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

Chen¹,

Meng²,

Li³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background:In the benefit of the large population and rapid economic growth, the interventional techniques and equipment for brain arteriovenous malformations (bAVMs) in mainland China have been rapidly improved. Chinese neurosurgical cerebrovascular physicians have accumulated rich experience and made pioneering explorations. This study aims to summarize the experience and treatment progress of bAVMs in mainland China.Methods:We performed a web-based nationwide questionnaire survey among 67 tertiary neurosurgical institutions that had acknowledged treating bAVMs in the primary survey. Our questionnaire included clinical characteristics, radiological findings, intervention indications/contraindications, intervention timing, and intraoperative management of different treatment modalities. Results:A total of 63 participants from 49 (73.1%) tertiary neurosurgical institutions responded to our questionnaire. 42 (66.7%) were neurosurgeons, 13 (20.6%) were neurointerventionists, and 8 (12.7%) were radiosurgeons. Approximately 3500 to 4000 cases of bAVMs were treated annually in these 49 departments. All participants agreed that the conclusions of ARUBA are debatable. Flow-related aneurysms, deep venous drainage, and arteriovenous fistula were considered as common hemorrhagic risk factors. Unruptured SM IV-V bAVMs, giant bAVMs, pediatric bAVMs, elderly bAVMs, and eloquent bAVMs were not absolute contraindications to intervention. Maximum lesion occlusion and minimal functional impairment were the principles of intervention management. Most of the neurosurgeons and neurointerventionists recommended early intervention (<30 days) for ruptured bAVMs, and the radiosurgeons suggested intervention in the chronic phase or recovery phase (P<0.01), and preferably 3 months after bleeding. Multi-modality strategies were thought effective for complex bAVMs and more exploration of individualized intraoperative management was necessary.Conclusions:Intervention was acceptable for specific selected unruptured bAVMs in mainland China, especially in patients with hemorrhagic risk factors. The application of multidisciplinary cerebrovascular team and multicenter large-sample international registry study might be the next work for Chinese neurosurgical cerebrovascular physicians.

show abstract

European consensus conference on unruptured brain AVMs treatment (Supported by EANS, ESMINT, EGKS, and SINCH)

Cited by 72 publications

References 40 publications

Grades of brain arteriovenous malformations and risk of hemorrhage and death

Grades of brain arteriovenous malformations and risk of hemorrhage and death

To treat or not to treat brain AVMs—that’s still the question

Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

Contact Info

Product

Resources

About