Patterns of Brain Arteriovenous Malformation Treatment

Beijnum, Janneke van; Bhattacharya, J. J.; Counsell, Carl; Papanastassiou, Vakis; Ritchie, Vaughn; Roberts, Richard C.; Sellar, Robin; Warlow, Charles; Salman, Rustam Al-Shahi

doi:10.1161/strokeaha.108.523662

Cited by 20 publications

(13 citation statements)

References 36 publications

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“…Geographical differences could thus be expected in the choice of treatment, which is shown in Table 3. In accordance with other reports, we thus observe that preference and local expertise exert considerable influence on the selection of treatment modality [2].…”

Section: Treatment and Complicationssupporting

confidence: 92%

Multimodality treatment approach in children with cerebral arteriovenous malformation—a survey in the Danish population

et al. 2011

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Section: Treatment and Complicationssupporting

confidence: 92%

Multimodality treatment approach in children with cerebral arteriovenous malformation—a survey in the Danish population

et al. 2011

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“…[16] In two population based studies, 38% and 65% of patients with AVM had hemorrhage, with a peak incidence in the fifth decade of age. Although hemorrhage from an AVM can be disabling or deadly, the course in many non-operated high-grade AVMs (Spetzler Martin grades 4 and 5) can be quite benign, if compared with their intervention risk.…”

Section: Discussionmentioning

confidence: 99%

Angiographic and Clinical Assessment of Patients with Cerebral Arterio-Venous Malformations Treated with Microsurgery and Angioembolization

Janamiri¹,

Arjmand²,

Torkian³

2017

AJMCR

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Introuction: Brain Arteriovenous malformations (AVMs) are the leading cause of intracerebral hemorrhage in the young population. We set out to determine angiographic features of AVMs in pre-operative setting as well as angiographic and neurological and clinical assessment of these AVMs after treatment with either microsurgical approach or angio-embolization. Materials and Methods: From February 2011 to January 2016, 25 patients with cerebral AVMs were admitted to Shohada Tajrish Hospital. Patients underwent angiographic evaluation for AVM grading based on Spetzler Martin grading system. Also, patient's neurological status was recorded. Based on Spetzler Martin score and AVM size, patients underwent either microsurgical approach or angioembolization. Post-operatively, early and long-term neurological examination was performed and obliteration rate was assessed by post-operative imaging study. Results: There were 18 male and 7 female patients with mean age of 42.2 years who presented with cerebral hemorrhage followed by isolated new-onset seizure, progressive new focal neurological deficit and severe new-onset headache in decreasing manner. Seizure was significantly higher in patients with unruptured AVMs (P value <0.01). Angiographic study based on Spetzler-Martin grading system showed that most of the patients had grade 3 (32%), followed by grade 4 (28%), grade 2 (28%), grade 5 (8%) and grade 1 (4%). Most AVMs were eloquent with superficial drainage and small sized. Based on AVM size, trend for operation type in small and medium sized AVMs was microsurgical approach followed by angio-embolization. On the other hand, most patients with large-sized AVMs underwent angio-embolization followed by microsurgical approach. Early post-operative examination revealed more new neurological deficit in angio-embolization than microsurgery treated patients (P value <0.05). Improvement in neurological status was observed in microsurgery treated cases compared to angio-embolization (P value <0.05). Long-term follow up showed similar promising results in patients treated with microsurgery which was statistically significant (P value <0.05). Post-operative imaging study demonstrates complete obliteration in 12 patients out of 15 patients (80%) who underwent microsurgical approach. Complete obliteration was observed in 4 cases out of 10 patients (40%) who were treated with angio-embolization. (P value < 0.05). Conclusion: Although results of this study showed better results with microsurgical approach, choosing best treatment option for patients suffering from symptomatic AVMs depends on imaging studies, pre-operative grading and individual-based selection.

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“…18 Adults receiving interventional treatment inevitably incurred higher direct costs, and the influence of AVM nidus size was likely to be a reflection of the feasibility of treatment (in our dataset, 76% of those with a nidus Ͻ30 mm were treated, compared with 57% of those 30 to 59 mm and 14% of those Ն60 mm). 19 The burden associated with lost productivity was even greater than the healthcare costs (especially for those who died prematurely), reflecting the disabling (and sometimes fatal) nature of IVMs predominantly among adults of working age-these costs are likely to be even greater if considered over adults' lifetimes (especially in view of the risk of recurrent hemorrhage from IVMs). Just as the healthcare costs of CMs were much lower than AVMs, the costs of lost productivity seemed to be lower, too (Table 3, Pϭ0.1), but the lack of statistical significance may be a false-negative result attributable to the small sample size and the nonparametric statistics used.…”

Section: Discussionmentioning

confidence: 99%

Economic Burden of Intracranial Vascular Malformations in Adults

Miller

Quayyum

McNamee

et al. 2009

Stroke

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on behalf of the SIVMS Steering CommitteeBackground and Purpose-Although intracranial vascular malformations (IVMs) are the leading cause of intracerebral hemorrhage (ICH) in young adults, there has not been a cost-of-illness study on an unselected cohort. Methods-We measured the direct healthcare costs (inpatient, outpatient, intervention, and brain imaging) incurred by every adult within 3 years after their first presentation with a brain arteriovenous malformation (AVM) or cavernous malformation (CM) in a prospective, population-based study. We estimated the indirect cost of lost productivity for the whole cohort over the same period by projecting questionnaire responses from living consenting adults.

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Patterns of Brain Arteriovenous Malformation Treatment

Cited by 20 publications

References 36 publications

Multimodality treatment approach in children with cerebral arteriovenous malformation—a survey in the Danish population

Multimodality treatment approach in children with cerebral arteriovenous malformation—a survey in the Danish population

Angiographic and Clinical Assessment of Patients with Cerebral Arterio-Venous Malformations Treated with Microsurgery and Angioembolization

Economic Burden of Intracranial Vascular Malformations in Adults

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