Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Derdeyn, Colin P.; Zipfel, Gregory J.; Albuquerque, Felipe C.; Cooke, Daniel; Feldmann, Edward; Sheehan, Jason P.; Torner, James C.

doi:10.1161/str.0000000000000134

Cited by 268 publications

(276 citation statements)

References 257 publications

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“…The S-M grading scale was introduced to predict the outcome of surgical resection but can also be used to predict the radiosurgical outcome. Lower grades (grades I and II) are associated with a good result and less postoperative neurological deficit in comparison with grades IV and V [21][22][23].…”

Section: The Anatomic Areas Considered Neurologically Eloquent (A) Dmentioning

confidence: 94%

“…Treating physicians should also consider both early and late complications such as hemorrhage and convulsions. There are many grading systems that may help physicians to assess the risk of these complications, take appropriate intervention for each patient, predict prognosis, and standardize patient's evaluation for scientific study purposes [21][22][23].…”

Section: Grading Of Cavmsmentioning

confidence: 99%

“…There are certain lesions that should not be considered for surgery such as large AVM that invades eloquent critical area or diffuse nidus that involves crucial structure such as hypothalamus or brain stem (Figure 13), so the surgical resection of such lesions would necessarily be associated with significant neurological deficit or death. These AVMs are graded under separate category (grade VI) and considered as inoperable AVM [22,23].…”

Section: The Anatomic Areas Considered Neurologically Eloquent (A) Dmentioning

confidence: 99%

“…Group 3: Patients with S-M grade III cAVMs (a combination of medium size, eloquent location, and superficial venous drainage) have a poor surgical outcome similar to that of S-M grades IV and V [23].…”

Section: Figure 13 Grade IV Avm (Inoperable Avm) (A) Vertebral Angimentioning

confidence: 99%

“…This supplemental scoring system added three factors that affect patient's outcome (age, hemorrhagic presentation, and nidus configuration) ( Table 2). The supplementary grading scale named Lawton-Young supplementary grading scale has been authorized in a separate cohort of 1009 patients [21,23].…”

Section: Figure 13 Grade IV Avm (Inoperable Avm) (A) Vertebral Angimentioning

confidence: 99%

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Cerebral Arteriovenous Malformations (cAVMs): What Is New?

Ganaw¹,

Tharayil²,

Ehfeda³

et al. 2020

Vascular Malformations of the Central Nervous System

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Cerebral arteriovenous malformations (cAVMs) are rare congenital anomalies of cerebral blood vessels that result from maldevelopment of the capillary bed, permitting direct communication between cerebral arteries and veins. It usually occurs in the supratentorial area of the brain; however, it can occur anywhere in the brain and spinal cord. Most of the patients with cAVMs present with a variety of complaints such as seizures, intracerebral hemorrhage, headache, and progressive focal neurological deficit. Imaging such as CT, MRI, and angiography plays a vital role in diagnosis, grading, risk assessment, and posttherapeutic follow-up. The multidisciplinary team use three therapeutic modalities in the treatment of cAVMs. This chapter reviews the clinical presentations, diagnosis, classification, and treatment of cAVMs.

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Section: The Anatomic Areas Considered Neurologically Eloquent (A) Dmentioning

confidence: 94%

Section: Grading Of Cavmsmentioning

confidence: 99%

Section: The Anatomic Areas Considered Neurologically Eloquent (A) Dmentioning

confidence: 99%

Section: Figure 13 Grade IV Avm (Inoperable Avm) (A) Vertebral Angimentioning

confidence: 99%

Section: Figure 13 Grade IV Avm (Inoperable Avm) (A) Vertebral Angimentioning

confidence: 99%

See 3 more Smart Citations

Cerebral Arteriovenous Malformations (cAVMs): What Is New?

Ganaw¹,

Tharayil²,

Ehfeda³

et al. 2020

Vascular Malformations of the Central Nervous System

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Development and Validation of a Scoring System for Hemorrhage Risk in Brain Arteriovenous Malformations

Han

Meng

et al. 2023

JAMA Netw Open

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ImportanceThe dilemma between natural rupture risk and adverse outcomes of intervention is of major concern for patients with unruptured arteriovenous malformations (AVMs). The existing risk score for AVM rupture includes factors that are controversial and lacks prospective validation.ObjectiveTo develop and robustly validate a reliable scoring system to predict the rupture risk of AVMs.Design, Setting, and ParticipantsThis prognostic study developed a prediction model derived from a single-center cohort (derivation cohort) and validated in a multicenter external cohort (multicenter external validation cohort) and a cohort of patients receiving conservative treatment management (conservative treatment validation cohort). Patients were recruited from a nationwide multicenter prospective collaboration registry in China. A total of 4135 patients were enrolled in the registry between August 1, 2011, and September 1, 2021. Of those, 3962 patients were included in the study (3585 in the derivation cohort and 377 in the multicenter external validation cohort); 1028 patients from the derivation cohort who had time-to-event data and prerupture imaging results were included in the conservative treatment validation cohort. Data were analyzed from March 10 to June 21, 2022.Main Outcomes and MeasuresA scoring system was developed based on risk factors identified from a literature review and a robust selection process. Patients were stratified into different risk groups based on scores to calculate hemorrhage-free probability in future years, and Kaplan-Meier curves were plotted to visualize risk stratification. Receiver operating characteristic curves were used to assess the discrimination of models. Univariable analyses (logistic regression analysis for descriptive data and Cox regression analysis for survival data) were used to compare baseline information and assess bias.ResultsAmong 3962 patients (2311 men [58.3%]; median [IQR] age, 26.1 [14.6-35.5] years), 3585 patients (2100 men [58.6%]; median [IQR] age, 25.9 [14.6-35.0] years) were included in the derivation cohort, and 377 patients (211 men [56.0%]; median [IQR] age, 26.4 [14.5-39.2] years) were included in the multicenter external validation cohort. Thirty-six hemorrhages occurred over a median (IQR) follow-up of 4.2 (0.3-6.0) years among 1028 patients in the conservative treatment validation cohort. Four risk factors were used to develop the scoring system: ventricular system involvement, venous aneurysm, deep location, and exclusively deep drainage (VALE). The VALE scoring system performed well in all 3 cohorts, with areas under the receiver operating characteristic curve of 0.77 (95% CI, 0.75-0.78) in the derivation cohort, 0.85 (95% CI, 0.81-0.89) in the multicenter external validation cohort, and 0.73 (95% CI, 0.65-0.81) in the conservative treatment validation cohort. The 10-year hemorrhage-free rate was 95.5% (95% CI, 87.1%-100%) in the low-risk group, 92.8% (95% CI, 88.8%-97.0%) in the moderate-risk group, and 75.8% (95% CI, 65.1%-88.3%) in the high-risk group; the model discrimination was significant when comparing these rates between the high-risk group and the low- and moderate-risk groups (P &lt; .001 for both comparisons).Conclusions and RelevanceIn this prognostic study, the VALE scoring system was developed to distinguish rupture risk among patients with AVMs. The stratification of unruptured AVMs may enable patients with low risk of rupture to avoid unnecessary interventions. These findings suggest that the scoring system is a reliable and applicable tool that can be used to facilitate patient and physician decision-making and reduce unnecessary interventions or unexpected AVM ruptures.

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Interventions for treating brain arteriovenous malformations in adults

Zuurbier

Salman

2019

Cochrane Database of Systematic Reviews

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Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Cited by 268 publications

References 257 publications

Cerebral Arteriovenous Malformations (cAVMs): What Is New?

Cerebral Arteriovenous Malformations (cAVMs): What Is New?

Development and Validation of a Scoring System for Hemorrhage Risk in Brain Arteriovenous Malformations

Interventions for treating brain arteriovenous malformations in adults

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