Posterior Fossa Arteriovenous Malformations: Experience with 14 Patients and a Systematic Review of the Literature

Corniola, Marco Vincenzo; Meling, Torstein R.; Bijlenga, Philippe; Bernava, Gianmarco; Machi, Paolo; Schaller, Karl

doi:10.1055/s-0039-1691820

Cited by 3 publications

(1 citation statement)

References 53 publications

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“…In contrast, in the ruptured AVMs subgroup only 62% of the patients had a similar outcome. Other authors reported that hemorrhagic presentation is associated with less favorable postoperative outcome, although the condition of patients can improve over time [ 2 , 3 , 13 ]. Lawton et al also stress the fact that patients with ruptured AVMs have a worse clinical presentation, which can mask the outcome, and therefore, the risk of neurological worsening associated with unruptured AVMs following surgical resection should not be underestimated [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of posterior fossa arteriovenous malformations: a single center experience

Miron,

Prună,

Visarion

et al. 2024

Acta Neurochir

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Background Posterior fossa arterio-venous malformations (pfAVMs) are challenging lesions due to the anatomical particularities of the posterior fossa, and the high incidence of hemorrhagic presentation. The two most important goals when treating AVMs are preserving neurological function and preventing rupture, or a second hemorrhage. The aim of this study was to analyze the clinical and imaging features of pfAVMs to identify the factors that influence the prognosis of these patients. Methods We conducted a single-center retrospective observational study that included patients treated at our institution with pfAVMs between January 1997 and December 2021. Results A total of 48 patients were included. A good modified Rankin score (mRS) was observed in 33 cases (69%) at presentation. Thirty-four patients (71%) presented with a ruptured AVM. Out of these, 19 patients (40%) had intraventricular hemorrhage. Microsurgical resection was performed in 33 cases (69%), while in the other cases, the patients opted for conservative management (7 cases, 15%), stereotactic radiosurgery (SRS) (6 cases, 12%), or endovascular treatment (2 cases, 4%). Patients ≤ 30 years old were more prone to hemorrhagic presentation (OR: 5.23; 95% CI: 1.42–17.19; p = 0.024) and this remained an independent risk factor for rupture after multivariate analysis as well (OR: 4.81; 95% CI: 1.07–21.53; p = 0.040). Following multivariate analysis, the only factor independently associated with poor prognosis in the surgically treated subgroup was a poor clinical status (mRS 3–5) at admission (OR: 96.14; 95% CI: 5.15–1793.9; p = 0.002). Conclusions Management of posterior fossa AVMs is challenging, and patients who present with ruptured AVMs often have a poor clinical status at admission leading to a poor prognosis. Therefore, proper and timely management of these patients is essential.

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Section: Discussionmentioning

confidence: 99%

Clinical outcomes of posterior fossa arteriovenous malformations: a single center experience

Miron,

Prună,

Visarion

et al. 2024

Acta Neurochir

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Characterization of Pediatric Infratentorial Arteriovenous Malformations: A Retrospective, Multicenter Cohort Study

Calafiore,

Burke,

Becerril-Gaitan

et al. 2024

Neurosurgery

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BACKGROUND AND OBJECTIVES: Infratentorial arteriovenous malformations (AVMs) harbor different characteristics compared with supratentorial AVMs. This study aims to explore the unique characteristics of pediatric infratentorial AVMs and their response to single session stereotactic radiosurgery (SRS). METHODS: The International Radiosurgery Research Foundation database of pediatric patients with AVM (age <18 years) who underwent SRS was retrospectively reviewed. Baseline demographics, AVM characteristics, outcomes, and complications post-SRS were compared between infratentorial and supratentorial pediatric AVMs. Unfavorable outcome was defined as the absence of AVM obliteration, post-SRS hemorrhage, or permanent radiation-induced changes at last follow-up. RESULTS: A total of 535 pediatric AVMs managed with SRS with a median follow-up of 67 months (IQR 29.0-130.6) were included, with 69 being infratentorial and 466 supratentorial. The infratentorial group had a higher proportion of deep location (58.4% vs 30.3%, P = <.001), deep venous drainage (79.8% vs 61.8%, P = .004), and prior embolization (26.1% vs 15.7%, P = .032). There was a higher proportion of hemorrhagic presentation in the infratentorial group (79.7% vs 71.3%, P = .146). There was no statistically significant difference in the odds of an unfavorable outcome (odds ratio [OR] = 1.36 [0.82-2.28]), AVM obliteration (OR = 0.85 [0.5-1.43]), post-SRS hemorrhage (OR = 0.83 [0.31-2.18]), or radiologic radiation-induced changes (OR = 1.08 [0.63-1.84]) between both cohorts. No statistically significant difference on the rates of outcomes of interest and complications were found in the adjusted model. CONCLUSION: Despite baseline differences between infratentorial and supratentorial pediatric AVMs, SRS outcomes, including AVM obliteration and post-SRS hemorrhage rates, were comparable amongst both groups. SRS appears to have a similar risk profile and therapeutic benefit to infratentorial pediatric AVMs as it does for those with a supratentorial location.

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Interventional outcomes for patients eligible for entry into the ARUBA clinical trial: a systematic review and meta-analysis

Snyder¹,

Chen²,

Farzad³

et al. 2022

Journal of Neurosurgery

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OBJECTIVE A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA) suggested that medical management afforded outcomes superior to those following intervention for unruptured arteriovenous malformations (AVMs), but its findings have been controversial. Subsequent studies of AVMs that would have met the eligibility requirements of ARUBA have supported intervention for the management of some cases. The present meta-analysis was conducted with the object of summarizing interventional outcomes for ARUBA-eligible patients reported in the literature. METHODS A systematic literature search (PubMed, Web of Science, Google Scholar) for AVM intervention studies that used inclusion criteria identical to those of ARUBA (age ≥ 18 years, no history of AVM hemorrhage, no prior intervention) was performed. The primary outcome was death or symptomatic stroke. Secondary outcomes included AVM obliteration, hemorrhage, death, and poor outcome (modified Rankin Scale score ≥ 2 at final follow-up). Bias assessment was performed with the Newcastle-Ottawa Scale, and the results were synthesized as pooled proportions. RESULTS Of the 343 articles identified through database searches, 13 studies met the inclusion criteria, yielding an overall study cohort of 1909 patients. The primary outcome occurred in 11.2% of patients (pooled = 11%, 95% CI 8%–13%). The rates of AVM obliteration, hemorrhage, poor outcome, and death were 72.7% (pooled = 78%, 95% CI 70%–85%), 8.4% (pooled = 8%, 95% CI 6%–11%), 9.9% (pooled = 10%, 95% CI 7%–13%), and 3.5% (pooled = 2%, 95% CI 1%–4%), respectively. Annualized primary outcome and hemorrhage risks were 1.85 (pooled = 2.05, 95% CI 1.31–2.94) and 1.34 (pooled = 1.41, 95% CI 0.83–2.13) per 100 patient-years, respectively. CONCLUSIONS Intervention for unruptured AVMs affords acceptable outcomes for appropriately selected patients. The risk of hemorrhage following intervention compared favorably to the natural history of unruptured AVMs. The included studies were retrospective and varied in treatment and AVM characteristics, thereby limiting the generalizability of their data. Future studies from prospective registries may clarify patient, nidus, and intervention selection criteria that will refine the challenging management of patients with unruptured AVMs.

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Posterior Fossa Arteriovenous Malformations: Experience with 14 Patients and a Systematic Review of the Literature

Cited by 3 publications

References 53 publications

Clinical outcomes of posterior fossa arteriovenous malformations: a single center experience

Clinical outcomes of posterior fossa arteriovenous malformations: a single center experience

Characterization of Pediatric Infratentorial Arteriovenous Malformations: A Retrospective, Multicenter Cohort Study

Interventional outcomes for patients eligible for entry into the ARUBA clinical trial: a systematic review and meta-analysis

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