Posterior fossa AVMs: Increased risk of bleeding and worse outcome compared to supratentorial AVMs

Dinc, Nazife; Platz, Johannes; Tritt, Stephanie; Quick-Weller, Johanna; Eibach, Michael; Wolff, Robert; Berkefeld, Joachim; Seifert, Volker; Marquardt, Gerhard

doi:10.1016/j.jocn.2018.04.010

Cited by 22 publications

(12 citation statements)

References 46 publications

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“…One other study found that due to the anatomical vicinity to delicate brain structures and the relatively narrower surgical corridors employed during posterior fossa surgery, arteriovenous malformations in the infratentorial region are more hazardous and prone to rupture leading to worse neurological outcome compared to those that were supratentorial. [24] We did not separate our findings by type of surgery; however, it is clear that further research is needed to elucidate whether location of the lesion is associated with new neurologic deficit.…”

Section: Discussionmentioning

confidence: 96%

Clinical impact of intraoperative hyperlactatemia during craniotomy

et al. 2019

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ObjectPatients often develop markedly elevated serum lactate levels during craniotomy although the reason for this is not entirely understood. Elevated lactate levels have been associated with poor outcomes in critically ill septic shock patients, as well as patients undergoing abdominal and cardiac surgeries. We investigated whether elevated lactate in craniotomy patients is associated with neurologic complications (new neurological deficits) as well as systemic complications.MethodsWe performed a cohort study of elective craniotomy patients. Demographic and intraoperative data were collected, as well as three timed intraoperative arterial lactate values. Additional lactate, creatinine and troponin values were collected immediately postoperatively as well as 12 and 24 hours postoperatively. Assessment for neurologic deficit was performed at 6 hours and 2 weeks postoperatively. Hospital length-of-stay and 30-day mortality were collected.ResultsInterim analysis of 81 patients showed that no patient had postoperative myocardial infarction, renal failure, or mortality within 30 days of surgery. There was no difference in the incidence of new neurologic deficit in patients with or without elevated lactate (10/26, 38.5% vs. 15/55 27.3%, p = 0.31). Median length of stay was significantly longer in patients with elevated lactate (6.5 vs. 3 days, p = 0.003). Study enrollment was terminated early due to futility (futility index 0.16).ConclusionElevated intraoperative serum lactate was not associated with new postoperative neurologic deficits, other end organ events, or 30 day mortality. Serum lactate was related to longer hospital stay.

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Section: Discussionmentioning

confidence: 96%

Clinical impact of intraoperative hyperlactatemia during craniotomy

et al. 2019

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“…Compared with supratentorial AVMs, these lesions carry a higher risk of morbidity and mortality: the high-rate of rupture with compromise of vital structures and hydrocephalus must be a cause of concern. 5 The standard classification system for AVMs is the Spetzler--Martin classification, which predicts the complication rate when surgery is performed, but not when endovascular approach is chosen. The Spetzler-Martin classification is the most widely used in all types of AVMs, 6 especially supratentorial AVMs, but is not suitable for posterior fossa lesions.…”

Section: Discussionmentioning

confidence: 99%

“…10 Posterior fossa AVMs should be treated promptly because of the high-rate of rupture compared with supratentorial AVMs. 5 The association with aneurysms occurs in 20% of all AVMs and ranges from 5 to 20%. 11,12 If the aneurysms are located in the infratentorial space, the risk of rupture rises to 60%.…”

Section: Discussionmentioning

confidence: 99%

Single-session Curative Embolization of Unruptured Cerebellar Arteriovenous Malformation with Precipitating Hydrophobic Injectable Liquid

Saal‐Zapata

Valer

Rodríguez

2020

Indian Journal of Neurosurgery

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Microsurgery is the treatment of choice for cerebellar arteriovenous malformations (AVMs). Nevertheless, endovascular therapy aims to be an effective treatment since the introduction of new embolic agents. Cerebellar AVMs represent a subgroup of vascular lesions with a high rate of hemorrhagic presentation compared with their cerebral counterpart. Moreover, they have a higher incidence of flow-related aneurysms when diagnosed. With this in mind, prompt treatment must be performed to avoid rebleeding with devastating consequences. Herein, we present the case of an unruptured cerebellar AVM treated with precipitating hydrophobic injectable liquid (PHIL) with complete obliteration.

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“…Nevertheless, we must emphasize, that a considerable number of patients at our centre were treated by neurologists and were not eligible for this study, as mentioned in the Methods section. The risk of AVM hemorrhage depends on special AVM features, including AVM location and angioarchitecture [22,23] and the annual bleeding risk amounts approximately 1 to 4%. [10,24] While AVM rupture may lead to severe neurologic dysfunction or result in death,[25,26] many studies described differences in outcome after AVM hemorrhage and spontaneous hemorrhage and confirm a better outcome after AVM hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

Differences in bleeding patterns and outcome after intracerebral hemorrhage due to vascular malformations

et al. 2019

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Background Atypical intracerebral hemorrhage is a common form of primary manifestation of vascular malformations. Objective The aim of the present study is to determine clues to the cause of bleeding according to hemorrhage pattern (lobar, basal ganglia, infratentorial). Methods We retrospectively evaluated 343 consecutive neurosurgical patients with intracerebral hemorrhage (ICH), who were admitted to our neurosurgical department between 2006 and 2016. The study cohort includes only neurosurgical patients. Patients who underwent treatment by neurologists are not represented in this study. We assessed location of hemorrhage, hematoma volumes to rule out differences and predicitve variables for final outcome. Results In 171 cases (49.9%) vascular malformations, such as arteriovenous malformations (AVMs), cavernomas, dural fistulas and aneurysms were the cause of bleeding. 172 (50.1%) patients suffered from an intracerebral hemorrhage due to amyloid angiopathy or long standing hypertension. In patients with infratentorial hemorrhage a malformation was more frequently detected as in patients with supratentorial hemorrhage (36% vs. 16%, OR 2.9 [1.8;4.9], p<0.001). Among the malformations AVMs were most common (81%). Hematoma expansion was smaller in vascular malformation than non-malformation caused bleeding (24.1 cm 3 vs. 64.8 cm 3 , OR 0.5 [0.4;0.7], p < 0.001,). In 6 (2.1%) cases diagnosis remained unclear. Final outcome was more favorable in patients with vascular malformations (63% vs. 12%, OR 12.8 [4.5;36.2], p<0.001). Conclusion Localization and bleeding patterns are predictive factors for origin of the hemorrhage. These predictive factors should quickly lead to appropriate vascular diagnostic measures. However, due to the inclusion criteria the validity of the study is limited and multicentre studies with further testing in general ICH patients are required.

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Posterior fossa AVMs: Increased risk of bleeding and worse outcome compared to supratentorial AVMs

Cited by 22 publications

References 46 publications

Clinical impact of intraoperative hyperlactatemia during craniotomy

Clinical impact of intraoperative hyperlactatemia during craniotomy

Single-session Curative Embolization of Unruptured Cerebellar Arteriovenous Malformation with Precipitating Hydrophobic Injectable Liquid

Differences in bleeding patterns and outcome after intracerebral hemorrhage due to vascular malformations

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