Multicenter assessment of morbidity associated with cerebral arteriovenous malformation hemorrhages

Fukuda, Keiko; Majumdar, Monica; Masoud, Hesham; Nguyen, Thanh N.; Honarmand, A; Shaibani, Ali; Ansari, Sameer A.; Tan, Lee A.; Chen, Michael

doi:10.1136/neurintsurg-2016-012485

Cited by 42 publications

(27 citation statements)

References 16 publications

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“…5 ICH, ICH volume, intraventricular hemorrhage, and Glasgow Coma Scale have been associated with outcome in BAVM rupture. 1,6 In this retrospective cohort, S100B elevation appears to be a stronger prognostic marker than any of the imaging markers studied. S100Bmax48>0.5 µg/L demonstrated higher sensitivity and specificity than an ICH volume ≥60 mL in predicting in-hospital mortality.…”

Section: Discussionmentioning

confidence: 73%

S100B Serum Elevation Predicts In-Hospital Mortality After Brain Arteriovenous Malformation Rupture

Shotar

Amouyal

Jacquens

et al. 2019

Stroke

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B rain arteriovenous malformation (BAVM) rupture is the leading cause of morbidity and mortality in this disease. Predicting outcome after BAVM rupture has mainly relied on demographic, clinical, and imaging markers. 1 S100B serum level elevation has been found to be associated with severity of neurological insult in neurocritically ill patients. 2 The present study aimed to determine whether elevation of S100B is associated with in-hospital mortality after BAVM rupture. Methods Data Availability Study data are available from the corresponding author on reasonable request. Patients Records of patients with BAVM ruptures admitted between January 1, 2003, and December 1, 2018, were retrospectively reviewed. Hemorrhages within 7 days of a partial embolization were excluded. All patients were admitted within 24 hours of hemorrhage. One hundred thirteen ruptures included in this study were previously included in a report of long-term outcome after BAVM rupture. 1 Ethical Statement The ethics committee of our institution approved this study. The need for patients' informed consent was waived. S100B Protein Serum Level Admission S100B serum level and subsequent sampling within the following 48 hours were retrospectively recorded. In most patients, samples were drawn on admission and daily afterwards. Admission samples were unavailable for a minority of patients, and some patients had several samples drawn on the same day (because of acute deterioration for instance). Clinicians were aware of S100B levels in real time. Since December 2, 2010, S100B has been assayed on ModularE170 analyzer (Roche, Mannheim, Germany). Results assessed before that date were measured on a LiaisonXL (Diasorin, Saluggia, Italy); therefore, these values were corrected as ([concentration]-0.01)/2.28, according to the linear regression between the 2 Background and Purpose-S100B protein serum elevation has been associated with poor prognosis in neurologically ill patients. The purpose of this study is to determine whether elevation of S100B is associated with increased in-hospital mortality after brain arteriovenous malformation rupture. Methods-This is a retrospective study of patients admitted for brain arteriovenous malformation rupture. The study population was divided into derivation and validation cohorts. Univariate followed by multivariate logistic regression was used to determine whether elevation of S100B serum levels above 0.5 µg/L during the first 48 hours after admission (S100Bmax48) was associated with in-hospital mortality. Results-Two hundred and three ruptures met inclusion criteria. Twenty-three led to in-hospital mortality (11%). Mean S100Bmax48 was 0.49±0.62 µg/L. In the derivation cohort (n=101 ruptures), multivariate analysis found Glasgow coma scale score ≤8 (odds ratio, 21; 95% CI, 2-216; 0.001) and an S100Bmax48>0.5 µg/L (odds ratio, 19; 95% CI, 2-188; P=0.001) to be associated with in-hospital mortality. When applied to the validation cohort (n=102 ruptures), the same model found only S100Bmax48>0.5 µg/L (odds ratio, 8; 9...

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Section: Discussionmentioning

confidence: 73%

S100B Serum Elevation Predicts In-Hospital Mortality After Brain Arteriovenous Malformation Rupture

Shotar

Amouyal

Jacquens

et al. 2019

Stroke

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“…The hemorrhage risk is reported to be approximately 3%/year. Once a hemorrhage occurs, the possibilities of neurologic deficits and death are < 50% and < 10%, respectively 8,11,12. Therefore, the treatment goal is to eliminate the risk of hemorrhage, which can be achieved by isolating the nidus from the circulation.…”

Section: Gkrs For Arteriovenous Malformationmentioning

confidence: 99%

<p>Gamma Knife Radiosurgery For Brain Vascular Malformations: Current Evidence And Future Tasks</p>

Hasegawa¹,

Yamamoto

Shin³

et al. 2019

TCRM

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Gamma Knife radiosurgery (GKRS) has long been used for treating brain vascular malformations, including arteriovenous malformations (AVMs), dural arteriovenous fistulas (DAVFs), and cavernous malformations (CMs). Herein, current evidence and controversies regarding the role of stereotactic radiosurgery for vascular malformations are described. 1) It has already been established that GKRS achieves 70–85% obliteration rates after a 3–5-year latency period for small to medium-sized AVMs. However, late radiation-induced adverse events (RAEs) including cyst formation, encapsulated hematoma, and tumorigenesis have recently been recognized, and the associated risks, clinical courses, and outcomes are under investigation. SRS-based therapeutic strategies for relatively large AVMs, including staged GKRS and a combination of GKRS and embolization, continue to be developed, though their advantages and disadvantages warrant further investigation. The role of GKRS in managing unruptured AVMs remains controversial since a prospective trial showed no benefit of treatment, necessitating further consideration of this issue. 2) Regarding DAVFs, GKRS achieves 41–90% obliteration rates at the second post-GKRS year with a hemorrhage rate below 5%. Debate continues as to whether GKRS might serve as a first-line solo therapeutic modality given its latency period. Although the post-GKRS outcomes are thought to differ among lesion locations, further outcome analyses regarding DAVF locations are required. 3) GKRS is generally accepted as an alternative for small or medium-sized CMs in which surgery is considered to be too risky. The reported hemorrhage rates ranged from 0.5–5% after GKRS. Higher dose treatments (>15 Gy) were performed during the learning curve, while, with the current standard treatment, a dose range of 12–15 Gy is generally selected, and has resulted in acceptable complication rates (< 5%). Nevertheless, further elucidation of long-term outcomes is essential.

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“…Surgical resection is the treatment of choice for small accessible AVMs as it immediately and definitively eliminates future hemorrhage risk. However, the high flow rate of AVMs, as well as the increased risk of AVM-associated aneurysms, 4,7 makes surgical resection amongst the most challenging of all neurosurgical cases. Pre-operative embolization of AVMs to reduce blood flow and remove high-risk AVM features can significantly reduce the technical challenges of resection.…”

Section: 6mentioning

confidence: 99%

“…3 Hemorrhages from AVMs are associated with a nearly 10% mortality rate and significant morbidity, with up to 34% of patients having moderate to severe disabilities. 4 Previously ruptured AVMs have increased annual hemorrhage rates, 2 but a relatively low immediate risk of re-rupture. Unless mass effect from a hematoma demands acute intervention, treatment is often performed on an elective basis after weighing the expected natural history of a lesion versus its treatment-associated risks.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

Rennert

Steinberg

Cheung

et al. 2017

JoVE

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Arteriovenious malformations (AVMs) are associated with significant morbidity and mortality, and have a rupture risk of ~3% per year. Treatment of AVMs must be tailored specifically to the lesion, with surgical resection being the gold standard for small, accessible lesions. Pre-operative embolization of AVMs can reduce nidal blood flow and remove high-risk AVM features such as intranidal or venous aneurysms, thereby simplifying a challenging neurosurgical procedure. Herein, we describe our approach for the staged endovascular embolization and open resection of AVMs, and highlight the advantages of having a comprehensively trained neurovascular surgeon leading a multi-disciplinary clinical team. This includes planning the craniotomy and resection to immediately follow the final embolization stage, thereby using a single session of anesthesia for aggressive embolization, and rapid resection. Finally, we provide a representative case of a 22-year-old female with an unruptured right frontal AVM diagnosed during a seizure workup, who was successfully treated via staged embolizations followed by open surgical resection.

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Multicenter assessment of morbidity associated with cerebral arteriovenous malformation hemorrhages

Cited by 42 publications

References 16 publications

S100B Serum Elevation Predicts In-Hospital Mortality After Brain Arteriovenous Malformation Rupture

S100B Serum Elevation Predicts In-Hospital Mortality After Brain Arteriovenous Malformation Rupture

<p>Gamma Knife Radiosurgery For Brain Vascular Malformations: Current Evidence And Future Tasks</p>

Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations

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