Multidisciplinary care of occipital arteriovenous malformations: effect on nonhemorrhagic headache, vision, and outcome in a series of 135 patients

Dehdashti, Amir R.; Thines, L.; Willinsky, Robert A.; terBrugge, Karel G.; Schwartz, Michael L.; Tymianski, Michael; Wallace, M Christopher

doi:10.3171/2009.11.jns09884

Cited by 32 publications

(30 citation statements)

References 33 publications

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“…13,21 However, the natural history rate for visual field deficits in optic radiation AVMs is largely unavailable. In this study 36% of patients with a prior hemorrhage and 12% of those without had a visual field deficit at presentation, rates consistent with the results of Dehdashti et al 5 Microsurgical publications have documented rates of visual deficit from a prior hemorrhage as 26%-77%. 18,24 If these data are extrapolated based on an annual AVM hemorrhage rate between 2% and 4%, the risk of a visual deficit alone remains notable in the untreated population.…”

Section: Decision Making and Visual Fieldssupporting

confidence: 79%

“…The median margin dose was 19 Gy (14-25 Gy), and the maximum median dose was 36 Gy (25-50 Gy). The median number of isocenters used was 4 (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. At the conclusion of treatment, all patients received 20-40 mg of intravenous methylprednisolone.…”

Section: Results Patient Population and Avm Characteristicsmentioning

confidence: 99%

“…5,32 Previous studies have indicated that a homonymous visual field deficit occurs in 67%-81% of patients with a previous hemorrhage and in 25%-36% of unruptured AVM cases in the occipital lobe. 13,21 However, the natural history rate for visual field deficits in optic radiation AVMs is largely unavailable.…”

Section: Decision Making and Visual Fieldsmentioning

confidence: 99%

“…The reported rate of visual field deficits after the microsurgical management of AVMs in the occipital lobe ranges from 17% to 33%. [1][2][3]5 Sinclair et al reported on multimodal treatments for occipital lobe AVMs, with a surgical risk of 17% and a visual field deficit occurring in 21.7% of patients after combined embolization and surgery. 34 Dehdashti et al concluded that they would not recommend surgery unless the patient was aware of the risks, as the surgical arm of their study had a much higher rate of visual field deficits.…”

Section: Decision Making and Visual Fieldsmentioning

confidence: 99%

“…1,3 Unfortunately, such deficits can be a significant disability that negatively impacts quality of life and can worsen long-term rehabilitation outcomes, especially when a homonymous hemianopia has occurred. 5,8,32 A sparse collection of reports highlighting multimodality AVM treatment paradigms and visual field deficits has been published. However, an updated study focused on SRS treatment has been absent.…”

mentioning

confidence: 99%

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Stereotactic radiosurgery for arteriovenous malformations of the postgeniculate visual pathway

Bowden

Kano

Caparosa

et al. 2015

JNS

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ManageMent options for arteriovenous malformations (AVMs) have expanded and evolved over time. However, the underlying goal of intervention remains complete obliteration of the AVM and maintenance of neurological function. 16,40,41 The rates of AVM occlusion after a single Gamma Knife surgery generally range from 70% to 80% over a 5-year observation period. 6,11,19,25 In addition, stereotactic radiosurgery (SRS) has a relatively low risk profile for adverse radiation effects (AREs). 23The lateral geniculate nucleus gives rise to the sublenticular and retrolenticular segments of the optic radiation that travel through the temporal and parietal lobes, respectively, on a path that terminates in the striate cortex. Because the distance and fragility of these pathways create the opportunity for disruption by an AVM, associabbreviatioNs ARE = adverse radiation effect; AVM = arteriovenous malformation; SRS = stereotactic radiosurgery. submitted January 8, 2014. accepted October 14, 2014. iNclude wheN citiNg Published online November 28, 2014; DOI: 10.3171/2014.10.JNS1453. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. Dr. Lunsford is a consultant and stockholder for AB Elekta. , and 19 Gy (range 14-25 Gy) was the median margin dose. Obliteration of the AVM was confirmed in 80 patients after a single SRS procedure at a median follow-up of 74 months (range 5-297 months). The actuarial rate of total obliteration was 67% at 4 years. Arteriovenous malformations with a volume < 5 cm 3 had obliteration rates of 60% at 3 years and 79% at 4 years. The delivered margin dose proved significant given that 82% of patients receiving ≥ 22 Gy had complete obliteration. The AVM was completely obliterated in an additional 18 patients after they underwent repeat SRS. At a median of 25 months (range 11-107 months) after SRS, 9 patients developed new or worsened visual field deficits. One patient developed a complete homonymous hemianopia, and 8 patients developed quadrantanopias. The actuarial risk of sustaining a new visual deficit was 3% at 3 years, 5% at 5 years, and 8% at 10 years. Fifteen patients had hemorrhage during the latency period, resulting in death in 9 of the patients. The annual hemorrhage rate during the latency interval was 2%, and no hemorrhages occurred after confirmed obliteration. coNclusioNs Despite an overall treatment mortality of 5%, related to latency interval hemorrhage, SRS was associated with only a 5.6% risk of new visual deficit and a final obliteration rate close to 80% in patients with AVMs of the postgeniculate visual pathway.

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Section: Decision Making and Visual Fieldssupporting

confidence: 79%

Section: Results Patient Population and Avm Characteristicsmentioning

confidence: 99%

Section: Decision Making and Visual Fieldsmentioning

confidence: 99%

Section: Decision Making and Visual Fieldsmentioning

confidence: 99%

mentioning

confidence: 99%

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Stereotactic radiosurgery for arteriovenous malformations of the postgeniculate visual pathway

Bowden

Kano

Caparosa

et al. 2015

JNS

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Brain Arteriovenous Malformations: Evidence-Based Diagnosis and Treatment

Cooke¹,

Ghodke²,

Halbach³

et al. 2013

Evidence-Based Neuroimaging Diagnosis and Treatment

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Surgical Treatment of Unruptured Brain AVMs: Short- and Long-Term Results

Eliava

Gorozhanin

Shekhtman

et al. 2021

Acta Neurochirurgica Supplement

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Unruptured brain AVMs (bAVMs) remain a controversial subject for practicing neurosurgeons, especially in the light of ARUBA and other observational studies. This retrospective study aims to analyze our experience with unruptured bAVMs to see whether it is beneficial in the long-term and how it corresponds to large literature trials. The study comprised 160 adult patients with unruptured bAVMs surgically treated in Burdenko NMC (Moscow) in 2009–2017. Mean age: 33.4 ± 10лет. Clinical presentations were: seizures in 99 (61.9%), chronical headaches—49 (30.6%), ischemic symptoms—4 (2.5%), asymptomatic in 8 (5%) patients. Spetzler-Martin scale: I—18 pt. (11.3%), II—71 pt. (44.4%), III—60 pt. (37.5%), IV—11 pt. (6.8%). Good outcomes (mRS = 0–2) at discharge were achieved in 149 (93.1%), satisfactory (mRS—3)—9 (5.6%). Follow-up was complete for 97 (60.6%) patients, mean—59.3 (13–108 month). Excellent outcomes (mRS = 0–1) reached in 94.8%. For epilepsy patients, Engel I outcome was found in 50 (84.8%); for chronic headaches, 43 (66.1%) patients reported improvement. Postoperative visual field defects were followed in 22 of 55 (40%), complete recovery was reported in 6 (27%) and partial recovery in 8 (36%) patients. Overall, our results support the conclusion that surgery for low-grade bAVMs (S-M I–II) is a beneficial, low-risk option.

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Multidisciplinary care of occipital arteriovenous malformations: effect on nonhemorrhagic headache, vision, and outcome in a series of 135 patients

Cited by 32 publications

References 33 publications

Stereotactic radiosurgery for arteriovenous malformations of the postgeniculate visual pathway

Stereotactic radiosurgery for arteriovenous malformations of the postgeniculate visual pathway

Brain Arteriovenous Malformations: Evidence-Based Diagnosis and Treatment

Surgical Treatment of Unruptured Brain AVMs: Short- and Long-Term Results

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