Benefits of Exclusion Treatments of Unruptured Brain Arteriovenous Malformations on Epilepsy in Adults

2020 ◽  
Author(s):  
Romain Capocci ◽  
Mihaela Bustuchina Vlaicu ◽  
Eimad Shotar ◽  
Bertrand Mathon ◽  
Mariette Delaitre ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Brain Arteriovenous Malformations

scholarly journals Multimodal Treatment of Pediatric Ruptured Brain Arteriovenous Malformations: A Single-Center Study

Children ◽  
2021 ◽  
Vol 8 (3) ◽  
pp. 215
Author(s):  
Lukasz Antkowiak ◽  
Monika Putz ◽  
Marta Rogalska ◽  
Marek Mandera
Keyword(s):  
Medical Records ◽  
Arteriovenous Malformations ◽  
Pediatric Patients ◽  
Interventional Treatment ◽  
Digital Subtraction ◽  
Brain Arteriovenous Malformations ◽  
Single Center Study ◽  
Complete Obliteration ◽  
Multimodality Approach ◽  
Related Mortality

Bleeding from ruptured brain arteriovenous malformations (bAVMs) represents the most prevalent cause of pediatric intracranial hemorrhage, being also the most common initial bAVM manifestation. A therapeutic approach in these patients should aim at preventing rebleeding and associated significant morbidity and mortality. The purpose of this study was to determine the clinical outcomes of pediatric patients who initially presented at our institution with ruptured bAVMs and to review our experience with a multimodality approach in the management of pediatric ruptured bAVMs. We retrospectively reviewed pediatric patients’ medical records with ruptured bAVMs who underwent interventional treatment (microsurgery, embolization, or radiosurgery; solely or in combination) at our institution between 2011 and 2020. We identified 22 patients. There was no intraoperative and postoperative intervention-related mortality. Neither procedure-related complications nor rebleeding were observed after interventional treatment. Modified Rankin Scale (mRS) assessment at discharge revealed 19 patients (86.4%) with favorable outcomes (mRS 0–2) and 3 patients (13.6%) classified as disabled (mRS 3). Microsurgery ensured the complete obliteration in all patients whose postoperative digital subtraction angiography (DSA) was available. Management of high-grade bAVMs with radiosurgery or embolization can provide satisfactory outcomes without a high disability risk.

The Epidemiology of Brain Arteriovenous Malformations

Neurosurgery ◽  
2000 ◽  
Vol 47 (2) ◽  
pp. 389-397 ◽  
Author(s):  
Mitchell F. Berman ◽  
Robert R. Sciacca ◽  
John Pile-Spellman ◽  
Christian Stapf ◽  
E. Sander Connolly ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Brain Arteriovenous Malformations

scholarly journals Impaired peri-nidal cerebrovascular reserve in seizure patients with brain arteriovenous malformations

Brain ◽  
2010 ◽  
Vol 134 (1) ◽  
pp. 100-109 ◽  
Author(s):  
Jorn Fierstra ◽  
John Conklin ◽  
Timo Krings ◽  
Marat Slessarev ◽  
Jay S. Han ◽  
...  
Keyword(s):  
Arteriovenous Malformations ◽  
Cerebrovascular Reserve ◽  
Brain Arteriovenous Malformations

The Diagnosis and Management of Brain Arteriovenous Malformations

2013 ◽  
Vol 31 (3) ◽  
pp. 749-763 ◽  
Author(s):  
Roberta L. Novakovic ◽  
Marc A. Lazzaro ◽  
Alicia C. Castonguay ◽  
Osama O. Zaidat
Keyword(s):  
Arteriovenous Malformations ◽  
Diagnosis And Management ◽  
Brain Arteriovenous Malformations

scholarly journals Current surgical results with low-grade brain arteriovenous malformations

2015 ◽  
Vol 122 (4) ◽  
pp. 912-920 ◽  
Author(s):  
Matthew B. Potts ◽  
Darryl Lau ◽  
Adib A. Abla ◽  
Helen Kim ◽  
William L. Young ◽  
...  
Keyword(s):  
Randomized Trial ◽  
Functional Outcomes ◽  
Arteriovenous Malformations ◽  
Preoperative Embolization ◽  
Low Grade ◽  
Cure Rate ◽  
Brain Arteriovenous Malformations ◽  
First Line Therapy ◽  
Delayed Hemorrhage ◽  
Martin Grade

OBJECT Resection is an appealing therapy for brain arteriovenous malformations (AVMs) because of its high cure rate, low complication rate, and immediacy, and has become the first-line therapy for many AVMs. To clarify safety, efficacy, and outcomes associated with AVM resection in the aftermath of A Randomized Trial of Unruptured Brain AVMs (ARUBA), the authors reviewed their experience with low-grade AVMs—the most favorable AVMs for surgery and the ones most likely to have been selected for treatment outside of ARUBA's randomization process. METHODS A prospective AVM registry was searched to identify patients with Spetzler-Martin Grade I and II AVMs treated using resection during a 16-year period. RESULTS Of the 232 surgical patients included, 120 (52%) presented with hemorrhage, 33% had Spetzler-Martin Grade I, and 67% had Grade II AVMs. Overall, 99 patients (43%) underwent preoperative embolization, with unruptured AVMs embolized more often than ruptured AVMs. AVM resection was accomplished in all patients and confirmed angiographically in 218 patients (94%). There were no deaths among patients with unruptured AVMs. Good outcomes (modified Rankin Scale [mRS] score 0–1) were found in 78% of patients, with 97% improved or unchanged from their preoperative mRS scores. Patients with unruptured AVMs had better functional outcomes (91% good outcome vs 65% in the ruptured group, p = 0.0008), while relative outcomes were equivalent (98% improved/unchanged in patients with ruptured AVMs vs 96% in patients with unruptured AVMs). CONCLUSIONS Surgery should be regarded as the “gold standard” therapy for the majority of low-grade AVMs, utilizing conservative embolization as a preoperative adjunct. High surgical cure rates and excellent functional outcomes in patients with both ruptured and unruptured AVMs support a dominant surgical posture for low-grade AVMS, with radiosurgery reserved for risky AVMs in deep, inaccessible, and highly eloquent locations. Despite the technological advances in endovascular and radiosurgical therapy, surgery still offers the best cure rate, lowest risk profile, and greatest protection against hemorrhage for low-grade AVMs. ARUBA results are influenced by a low randomization rate, bias toward nonsurgical therapies, a shortage of surgical expertise, a lower rate of complete AVM obliteration, a higher rate of delayed hemorrhage, and short study duration. Another randomized trial is needed to reestablish the role of surgery in unruptured AVM management.

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