Expert consensus on the management of brain arteriovenous malformations

Kato, Yōkō; Dong, Van He; Chaddad-Neto, Feres; Takizawa, Kazuyasu; Izumo, Tsuyoshi; Fukuda, Hitoshi; Hara, Takayuki; Kikuta, Ken-ichiro; Nakai, Yasunobu; Endo, Toshiki; Kurita, Hiroki; Xu, Bin; Beneš, Vladimı́r; Raftopoulos, Christian; Pavesi, Giacomo; Hodaie, Mojgan; Sharma, Rajan; Agarwal, Harshal; Mohan, Krishna; Liew, B S

doi:10.4103/ajns.ajns_234_19

Cited by 48 publications

(49 citation statements)

References 51 publications

(115 reference statements)

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“…Just over half the adult recurrences were treated by surgical excision, stereotactic radiosurgery (SRS) was the next most common option. A systematic review in 2018 that included paediatric cases found that surgery (59%) and SRS (37%) were the most common methods of treatment [4] and a recent consensus paper recommended that recurrent lesions be treated surgically [33].…”

Section: Discussionmentioning

confidence: 99%

Cerebral Arteriovenous Malformation Recurrence After Complete Surgical Excision in an Adult: Case Report and Review of the Literature

Loh

2021

Cureus

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Angiographically confirmed complete surgical excision of brain arteriovenous malformations (bAVMs) is conventionally considered curative. Recurrence in adults is rarely encountered; only 18 cases have been reported in the English literature over the past 30 years. The potential for recurrence and consequent need for routine long-term follow-up are important considerations in the management of these lesions. We report a case of a 23-year-old female with a recurrent bAVM discovered incidentally on routine imaging three years after complete surgical excision. We review the existing literature and discuss the options for surveillance and management.

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Section: Discussionmentioning

confidence: 99%

Cerebral Arteriovenous Malformation Recurrence After Complete Surgical Excision in an Adult: Case Report and Review of the Literature

Loh

2021

Cureus

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“…Surgery is the treatment of choice in AVMs. 13,14 Complete resection ensures cure of the lesion. Stereotactic radiosurgery causes progressive occlusion of vessels, but unfortunately the effect occurs in time, and until 1-2 years the nidus is still active.…”

Section: Discussionmentioning

confidence: 99%

“…15 Conservative treatment and stereotactic radiosurgery can be tried in patients with small, unruptured, located in eloquent areas AVMs. 13 Surgical principles are represented by early coagulation of feeding arteries, circumferential dissection of the nidus progressing deep and, after complete arterial disconnection of the nidus occlusion of draining veins. 10 We do not perform preoperative embolization of AVMs because it carries the risk of intraprocedural nidus rupture and developing normal perfusion pressure breakthrough.…”

Section: Discussionmentioning

confidence: 99%

Overview of patients with vascular pathology and cost analysis of medical care – research market for an entrepreneurial project

Sandu¹,

Fürtös²,

Gorgan³

2020

roneuro

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Introduction: Brain vascular pathology, aneurysms, arteriovenous malformations (AVMs), cavernomas, dural arteriovenous fistulas (DAVF), venous angiomas and capillary telangiectasia, represents a serious health problem worldwide. Aim: The aim of this article is to perform an analysis of patients with brain vascular pathology and to analyze costs of health services, a research market for an entrepreneurial project, in order to design guidelines for patients’ selection and treatment. Material and methods: We performed an observational, descriptive study of patients with vascular pathology, from 2018 to 2019. Results: A total of 153 patients with brain vascular pathology were admitted in our department. Mean age was 49.53 ± 13.997 years. Sex ratio was 0.86. Mean hospital stay was 11.33 ± 13.724 days. Seventy-four patients (48.37%) underwent surgery. Seventy-eight patients (50.98%) had cerebral aneurysms. Complications were seen in 24 patients (30.77%) and vasospasm in 32 cases (41.03%). Thirty-six patients underwent surgery. Outcome was favorable, according to mRS(p=0.001) and Karnofsky score(p=0.006).Thirty-three patients (21.57%) had brain AVMs. Twenty patients underwent surgery. Complications were seen in 4 cases (12.12%). The outcome was favourable, according to mRS(p=0.001) and Karnofsky score (p=0.002). Thirty-nine patients (25.49%) had cavernomas. Surgery was performed in 18 cases. The outcome was favourable, according to Engel Epilepsy Surgery Outcome Scale, mRS (p=0.000) and Karnofsky score (p =0.000). Costs of health services were correlated with longer hospitalization, higher mRS, lower Karnosfsky score, presence of complications and presence of vasospasm. Conclusions: Proper treatment of brain vascular pathology ensures a favourable outcome. Adequate patients’ selection and choosing the best treatment can reduce costs. Surgery is the treatment of choice in ruptured aneurysms, AVMs and cavernomas. Early surgery, with specific treatment of the vascular lesion and removal of intracranial blood ensures a better outcome, with lower medical costs. Prevention of complications, aggressive treatment of vasospasm reduces medical costs.

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“…Intracranial arteriovenous malformations (IAVMs) are congenital, heterogeneous, and rare vascular abnormalities that can cause intracranial hemorrhage, headache, seizure, and death [1]. IAVMs with an abnormal nidus of blood vessels shunt blood from the arterial to the venous system and bypass an intervening capillary bed [2].…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Combined Endovascular Embolization and Stereotactic Radiosurgery for Patients with Intracranial Arteriovenous Malformations: A Systematic Review and Meta-Analysis

Jiang

Zhang

Wan

et al. 2021

BioMed Research International

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Whether the use of endovascular embolization could provide additional benefits in patients treated with stereotactic radiosurgery (SRS) for intracranial arteriovenous malformations (IAVMs) remains controversial. The current meta-analysis was conducted to assess the efficacy and safety of SRS with and without prior endovascular embolization in patients with IAVMs. The electronic databases of PubMed, EmBase, and Cochrane Library were systematically searched for eligible studies published from inception to August 12, 2020. The pooled results for obliteration rate, rehemorrhage rate, and permanent neurological deficits were calculated by odds ratios (ORs) with 95% confidence intervals (CIs) using the random-effects model. The sensitivity analysis, subgroup analysis, and publication bias for investigated outcomes were also evaluated. Nineteen studies (two prospective and 17 retrospective studies) involving a total of 3,454 patients with IAVMs were selected for the final meta-analysis. We noted that prior embolization and SRS were associated with a lower obliteration rate compared with SRS alone (OR, 0.57; 95% CI, 0.44–0.74; P < 0.001 ). However, prior embolization and SRS were not associated with the risk of rehemorrhage (OR, 1.05; 95% CI, 0.81–1.34; P = 0.729 ) and permanent neurological deficits (OR, 0.80; 95% CI, 0.48–1.33; P = 0.385 ) compared with SRS alone. The sensitivity analysis suggested that prior embolization might reduce the risk of permanent neurological deficits in patients with IAVMs treated with SRS. The treatment effects of prior embolization in patients with IAVMs could be affected by nidus volume, margin dose, intervention, and follow-up duration. This study found that prior embolization was associated with a reduced risk of obliteration in patients with IAVMs treated with SRS. Moreover, prior embolization might reduce the risk of permanent neurological deficits in patients with IAVMs.

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Expert consensus on the management of brain arteriovenous malformations

Cited by 48 publications

References 51 publications

Cerebral Arteriovenous Malformation Recurrence After Complete Surgical Excision in an Adult: Case Report and Review of the Literature

Cerebral Arteriovenous Malformation Recurrence After Complete Surgical Excision in an Adult: Case Report and Review of the Literature

Overview of patients with vascular pathology and cost analysis of medical care – research market for an entrepreneurial project

Efficacy and Safety of Combined Endovascular Embolization and Stereotactic Radiosurgery for Patients with Intracranial Arteriovenous Malformations: A Systematic Review and Meta-Analysis

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