Surgical interventions in intracranial arteriovenous malformations: Indications and outcome analysis in a changing scenario

Thapa, Amit; Chandra, P. Sarat; Sinha, Sumit; Gupta, Aditya; Singh, Manmohan; Suri, Ashish; Sharma, Bhawani S.

doi:10.4103/0028-3886.59471

Cited by 6 publications

(2 citation statements)

References 14 publications

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“…Subtotal lesionectomy increases not only the risk of continued seizures but also the risk of intracranial hemorrhage or oncologic progression in cases of vascular malformation or brain tumor, respectively [32, 70, 79, 188]. Gross total resection may prove challenging with a lesion involving eloquent brain or located in a region that is difficult to access surgically, but various technological tools can facilitate this surgical endeavor.…”

Section: Commentarymentioning

confidence: 99%

Rates and predictors of seizure freedom in resective epilepsy surgery: an update

2014

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Epilepsy is a debilitating neurological disorder affecting approximately 1 % of the world’s population. Drug-resistant focal epilepsies are potentially surgically remediable. Although epilepsy surgery is dramatically underutilized among medically refractory patients, there is an expanding collection of evidence supporting its efficacy which may soon compel a paradigm shift. Of note is that a recent randomized controlled trial demonstrated that early resection leads to considerably better seizure outcomes than continued medical therapy in patients with pharmacoresistant temporal lobe epilepsy. In the present review, we provide a timely update of seizure freedom rates and predictors in resective epilepsy surgery, organized by the distinct pathological entities most commonly observed. Class I evidence, meta-analyses, and individual observational case series are considered, including the experiences of both our institution and others. Overall, resective epilepsy surgery leads to seizure freedom in approximately two thirds of patients with intractable temporal lobe epilepsy and about one half of individuals with focal neocortical epilepsy, although only the former observation is supported by class I evidence. Two common modifiable predictors of postoperative seizure freedom are early operative intervention and, in the case of a discrete lesion, gross total resection. Evidence-based practice guidelines recommend that epilepsy patients who continue to have seizures after trialing two or more medication regimens should be referred to a comprehensive epilepsy center for multidisciplinary evaluation, including surgical consideration.

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Section: Commentarymentioning

confidence: 99%

Rates and predictors of seizure freedom in resective epilepsy surgery: an update

2014

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“…The incidence of neurological deficits and deaths caused by AVM treatment ranges from 0 to 20% (mean 8%) [10]. Optimal therapeutic strategy should be characterised by decreasing haemorrhage risk and alleviating neurological symptoms with an acceptable mortality and morbidity rate [11]. Complete obliteration of AVM is the main goal of the treatment because subtotal therapy does not confer protection from haemorrhage [5].…”

Section: Discussionmentioning

confidence: 99%

Cerebral arteriovenous malformations – usability of Spetzler-Martin and Spetzler-Ponce scales in qualification to endovascular embolisation and neurosurgical procedure

Hofman¹,

Jamróz²,

Kołodziej³

et al. 2018

Pol J Radiol

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PurposeArteriovenous malformations (AVMs) are connected with cerebral haemorrhage, seizures, increased intracranial pressure, headaches, mass effect, and ischaemia symptoms. Selection of the best treatment method or even deciding if intervention is required can be difficult.Material and methodsThe study included 50 patients who were diagnosed with cerebral AVMs and treated in our Centre between 2008 and 2014. A total of 111 procedures were performed, including 94 endovascular embolisations and 17 neurosurgical procedures. Medical records and imaging data were reviewed for all patients. All AVMs were measured and assessed, allowing classification in Spetzler-Martin and Spetzler-Ponce scales.ResultsComplete or partial treatment was observed in 88.24% of neurosurgical procedures and in 84.00% of embolisations. Early complication rate was 21.28% for embolisation and 17.65% for neurosurgical procedures, while Glasgow Outcome Scale was 4.89 (σ = 0.38) and 5.0 (σ = 0.00), respectively. According to the Spetzler-Martin scale, cerebral haemorrhages occurred more frequently in grade 1, but no statistical significance was observed. In Spetzler-Ponce class B lower grades in Glasgow Coma Scale (GCS) were noticed (p = 0.02). Lower GCS scores were also correlated with deep location of AVM and with eloquence of adjacent brain. Patients with Spetzler-Martin grade 1 were more frequently qualified for neurosurgical procedures than other patients.ConclusionsTreating AVMs requires coordination of a multidisciplinary team. Both endovascular embolisation and neurosurgical procedure should be considered as a part of multimodal, frequently multistage treatment. Spetzler-Martin and Spetzler-Ponce scales have an influence on haemorrhage frequency and patients’ clinical condition and should be taken into consideration in selecting the treatment method.

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Clinical characteristics and outcome of patients with brain arteriovenous malformations from a university hospital in Nepal

Sharma

Sedain

Kafle³

et al. 2023

Interdisciplinary Neurosurgery

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Surgical interventions in intracranial arteriovenous malformations: Indications and outcome analysis in a changing scenario

Abstract: In our patients' cohort one in every eight patients required surgery. In intracranial AVMs, surgery still plays an important role. In developing countries like India it may be beneficial to electively excise Grade I and II AVMs if cost is a consideration.

Cited by 6 publications

References 14 publications

Rates and predictors of seizure freedom in resective epilepsy surgery: an update

Rates and predictors of seizure freedom in resective epilepsy surgery: an update

Cerebral arteriovenous malformations – usability of Spetzler-Martin and Spetzler-Ponce scales in qualification to endovascular embolisation and neurosurgical procedure

Clinical characteristics and outcome of patients with brain arteriovenous malformations from a university hospital in Nepal

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