Interventions for treating brain arteriovenous malformations in adults

Ross, Jenny; Salman, Rustam Al-Shahi

doi:10.1002/14651858.cd003436.pub3

Cited by 36 publications

(23 citation statements)

References 21 publications

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“…However, ARUBA was criticized because of its low enrollment rate, small sample size, short follow-up, high rate of adverse outcomes, under-representation of surgical treatment, and lack of treatment stratification. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] Its primary outcome after interventional treatment was higher than in previous cohorts treated with microsurgery or radiosurgery [23][24][25][26][27][28][29] without a clear explanation. It combined 3 different interventions into a single amorphous category and did not discriminate which modality was harmful.…”

Section: Discussionmentioning

confidence: 80%

Microsurgery for ARUBA Trial (A Randomized Trial of Unruptured Brain Arteriovenous Malformation)–Eligible Unruptured Brain Arteriovenous Malformations

Wong

Slomovic

Ibrahim

et al. 2017

Stroke

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Background and Purpose-The management of unruptured brain arteriovenous malformations (ubAVMs) remains controversial despite ARUBA trial (A Randomized Trial of Unruptured Brain Arteriovenous Malformation), a controlled trial that suggested superiority of conservative management over intervention. However, microsurgery occurred in only 14.9% of ARUBA intervention cases, raising concerns about the study's generalizability. Our purpose was to evaluate whether, in a larger ARUBA-eligible ubAVM population, microsurgery produces acceptable outcomes. Methods-Demographic data, AVM characteristics, and treatment outcomes were evaluated in 155 ARUBA-eligible bAVMs treated with microsurgery between 1994 and 2014. Outcomes were rates of early disabling deficits and permanent disabling deficits with modified Rankin Scale score ≥3 or any permanent neurological deficits with modified Rankin Scale score ≥1. Covariates associated with outcomes were determined by regression analysis. Results-Of

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Section: Discussionmentioning

confidence: 80%

Microsurgery for ARUBA Trial (A Randomized Trial of Unruptured Brain Arteriovenous Malformation)–Eligible Unruptured Brain Arteriovenous Malformations

Wong

Slomovic

Ibrahim

et al. 2017

Stroke

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“…1, 2 This type of vascular malformation represents the most frequent cause of intracranial hemorrhage in young adults and children. 3, 4 The second most common presenting symptom of brain AVMs is seizures. 5, 6 While the causes of epileptogenesis in AVMs are not fully understood, proposed contributory mechanisms include cerebral ischemia from neighboring arteriovenous shunting, gliosis, demyelination, hemosiderin deposition, and kindling of excitatory synapses.…”

Section: Introductionmentioning

confidence: 99%

Seizure Predictors and Control After Microsurgical Resection of Supratentorial Arteriovenous Malformations in 440 Patients

Englot¹,

Young²,

Han³

et al. 2012

Neurosurgery

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Background Seizures are a common symptom of supratentorial arteriovenous malformations (AVMs), and uncontrolled epilepsy can considerably reduce patient quality-of-life. Potential risk factors for epilepsy in patients with AVMs are poorly understood, and the importance of achieving seizure-freedom in their surgical treatment remains under-appreciated. Objective To characterize risks factors for pre-operative seizures and factors associated with post-operative seizure-freedom in patients with surgically resected supratentorial AVMs. Methods We analyzed prospectively-collected patient data for 440 patients who underwent microsurgical resection of supratentorial AVMs at our institution. Results Among 440 patients with supratentorial AVMs, 130 (30%) experienced pre-operative seizures, and 23 (18%) individuals with seizures progressed to medically refractory epilepsy. Seizures were associated with a history of AVM hemorrhage (RR 6.65, 95% CI 3.81-11.6), male gender (RR 2.07, 95% CI 1.26-3.39), and frontotemporal lesion location (RR 1.75, 95% CI 1.05-2.93). After resection, 96% of patients had a modified Engel class I outcome, characterized by seizure-freedom (80%) or only one post-operative seizure (16%) (mean follow-up 20.7 ± 2.3 months). Comparable rates of post-operative seizures were seen in patients with (7%) or without (3%) pre-operative seizures. AVMs with deep artery perforators were significantly associated with post-operative seizures (HR 4.35, 95% CI 1.61-11.7). Conclusion In the microsurgical treatment of supratentorial AVMs, hemorrhage, male gender, and frontotemporal location are associated with higher rates of pre-operative seizures, while deep artery perforators are associated with post-operative seizures. Achieving seizure-freedom is an important goal that can be achieved in the surgical treatment of AVMs, as epilepsy can significantly diminish patient quality-of-life.

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“…30 There have been no randomized controlled trials to compare seizure outcomes following AVM treatment vs conservative management. 31 Therefore, we conducted a prospective, population-based, observational cohort study and analyzed it to compare the risk of a first seizure, the risk of epilepsy, and the chances of achieving 2-year seizure freedom, for adults undergoing AVM treatment or conservative management. nhs.uk).…”

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confidence: 99%

Seizure risk with AVM treatment or conservative management

Josephson¹,

Bhattacharya²,

Counsell³

et al. 2012

Neurology

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Methods:We used annual general practitioner follow-up, patient questionnaires, and medical records surveillance to quantify the 5-year risk of seizures and the chances of achieving 2-year seizure freedom for adults undergoing AVM treatment compared to adults managed conservatively in a prospective, population-based observational study of adults in Scotland, newly diagnosed with an AVM in 1999-2003. Results:We identified 229 adults with a new diagnosis of an AVM, of whom two-thirds received AVM treatment (154/229; 67%) during 1,862 person-years of follow-up (median completeness of follow-up 97%). There was no significant difference in the proportions with a first or recurrent seizure over 5 years following AVM treatment, compared to the first 5 years following clinical presentation in conservatively managed adults, in analyses stratified by mode of presentation (intracerebral hemorrhage, 35% vs 26%, p ϭ 0.5; seizure, 67% vs 72%, p ϭ 0.6; incidental, 21% vs 10%, p ϭ 0.4). For patients with epilepsy, the chances of achieving 2-year seizure freedom during 5-year follow-up were similar following AVM treatment (n ϭ 39; 52%, 95% confidence interval [CI] 36% to 68%) or conservative management (n ϭ 21; 57%, 95% CI 35% to 79%; p ϭ 0.7). Conclusions:In this observational study, there was no difference in the 5-year risk of seizures with AVM treatment or conservative management, irrespective of whether the AVM had presented with hemorrhage or epileptic seizures. Neurology Adults with a brain arteriovenous malformation (AVM) are at risk of epileptic seizures, especially when the AVM is supratentorial (in the temporal lobe in particular) and after intracerebral hemorrhage (ICH) has occurred.1 The main aim of AVM treatment is to reduce the risk of AVM-related ICH, but invasive procedures might also reduce the risk of seizures by obliterating epileptogenic foci. Conversely, surgical excision, endovascular embolization, and stereotactic radiosurgery could also raise the risk of seizures.Case series have reported conflicting results about seizure control following AVM treatment: surgery has been associated with better, 2-7 unchanged, or worse seizure control 8 -10 ; the effect of stereotactic radiosurgery has been promising, 11-21 although a delayed increase in seizure fre-

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Interventions for treating brain arteriovenous malformations in adults

Cited by 36 publications

References 21 publications

Microsurgery for ARUBA Trial (A Randomized Trial of Unruptured Brain Arteriovenous Malformation)–Eligible Unruptured Brain Arteriovenous Malformations

Microsurgery for ARUBA Trial (A Randomized Trial of Unruptured Brain Arteriovenous Malformation)–Eligible Unruptured Brain Arteriovenous Malformations

Seizure Predictors and Control After Microsurgical Resection of Supratentorial Arteriovenous Malformations in 440 Patients

Seizure risk with AVM treatment or conservative management

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