Advances and Innovations in Brain Arteriovenous Malformation Surgery

Bendok, Bernard R.; Tecle, Najib E. El; Ahmadieh, Tarek Y. El; Koht, Antoun; Gallagher, Thomas M.; Carroll, Timothy J.; Markl, Michael; Sabbagha, Randa; Sabbagha, Asma; Cella, David; Nowinski, Cindy J.; Dewald, Julius P. A.; Meade, Thomas J.; Samson, Duke; Batjer, H. Hunt

doi:10.1227/neu.0000000000000230

Cited by 65 publications

(45 citation statements)

References 78 publications

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“…15,20 However, the impact of LCD on surgical outcomes in patients with AVMs in eloquent areas has not been determined. 6 In recent years the feasibility of DTI in tracking fibers in AVM patients has been proven, although it has some methodological limitations. [11][12][13]19,26 Thus, it is reasonable to assume that LCD can be used in predicting the surgical outcomes in patients with eloquent motor area AVMs, and our results confirmed this hypothesis.…”

Section: Discussionmentioning

confidence: 99%

“…Case selection for surgery depends on a sophisticated understating of the angioarchitecture and relationships to surrounding eloquent brain structures. 6 Advances in imaging techniques, for example functional MRI (fMRI) and diffusion tensor imaging (DTI), may present new opportunities to select individual patients more safely. Functional MRI enables functional mapping of at-risk cortex in the vicinity of an AVM, 1,8 and DTI allows assessment of important white matter tracts.…”

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confidence: 99%

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Risk factors for worsened muscle strength after the surgical treatment of arteriovenous malformations of the eloquent motor area

Lin

Zhao

et al. 2016

JNS

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abbreviatioNs AUC = area under the ROC curve; AVM = arteriovenous malformation; BOLD = blood oxygen level-dependent; CST = corticospinal tract; DSA = digital subtraction angiography; DTI = diffusion tensor imaging; DW = diffusion weighted; EPI = echo-planar imaging; FA = fractional anisotropy; FAPA = feeding artery from perforating artery; fMRI = functional MRI; LAD = lesion-to-activation area distance; LCD = lesion-to-CST distance; MS = preoperative muscle strength; MS 1 = muscle strength 1 week postoperatively; MS 2 = muscle strength 6 months postoperatively; NPPB = normal perfusion pressure breakthrough; ROC = receiver operating characteristic; ROI = region of interest; SM = Spetzler-Martin; TOF = time-of-flight. obJective Case selection for the surgical treatment of arteriovenous malformations (AVMs) of the eloquent motor area remains challenging. The aim of this study was to determine the risk factors for worsened muscle strength after surgery in patients with this disorder. methods At their hospital the authors retrospectively studied 48 consecutive patients with AVMs involving motor cortex and/or the descending pathway. All patients had undergone preoperative functional MRI (fMRI) and diffusion tensor imaging (DTI), followed by resection. Both functional and angioarchitectural factors were analyzed with respect to the change in muscle strength. Functional factors included lesion-to-corticospinal tract distance (LCD) on DTI and lesion-toactivation area distance (LAD) and cortical reorganization on fMRI. Based on preoperative muscle strength, the changes in muscle strength at 1 week and 6 months after surgery were defined as short-term and long-term surgical outcomes, respectively. Statistical analysis was performed using the statistical package SPSS (version 20.0.0, IBM Corp.). results Twenty-one patients (43.8%) had worsened muscle strength 1 week after surgery. However, only 10 patients (20.8%) suffered from muscle strength worsening 6 months after surgery. The LCD was significantly correlated with short-term (p < 0.001) and long-term (p < 0.001) surgical outcomes. For long-term outcomes, patients in the 5 mm ≥ LCD > 0 mm (p = 0.009) and LCD > 5 mm (p < 0.001) categories were significantly associated with a lower risk of permanent motor worsening in comparison with patients in the LCD = 0 mm group. No significant difference was found between patients in the 5 mm ≥ LCD > 0 mm group and LCD > 5 mm group (p = 0.116). Nidus size was the other significant predictor of short-term (p = 0.021) and long-term (p = 0.016) outcomes. For long-term outcomes, the area under the ROC curve (AUC) was 0.728, and the cutoff point was 3.6 cm. Spetzler-Martin grade was not associated with short-term surgical outcomes (0.143), although it was correlated with long-term outcomes (0.038). coNclusioNs An AVM with a nidus in contact with tracked eloquent fibers (LCD = 0) and having a large size is more likely to be associated with worsened muscle strength after surgery in patients with eloquent motor area AVMs. Surgical treatment i...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Risk factors for worsened muscle strength after the surgical treatment of arteriovenous malformations of the eloquent motor area

Lin

Zhao

et al. 2016

JNS

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“…1,5,31,32 Treatment of AVMs includes microsurgical resection, radiosurgery, endovascular embolization, or a combination of these strategies. 3,6,24,28 Accumulating evidence has demonstrated that AVMs recur in children. 1,2,14,16 The rate of hemorrhage associated with recurrent AVMs is not well defined, largely due to relatively small numbers of patients available for study.…”

Section: Discussionmentioning

confidence: 99%

Postoperative imaging for detection of recurrent arteriovenous malformations in children

Morgenstern

Hoffman

Kocharian

et al. 2016

PED

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OBJECT The optimal method for detecting recurrent arteriovenous malformations (AVMs) in children is unknown. An inherent preference exists for MR angiography (MRA) surveillance rather than arteriography. The validity of this strategy is uncertain. METHODS A retrospective chart review was performed on pediatric patients treated for cerebral AVMs at a single institution from 1998 to 2012. Patients with complete obliteration of the AVM nidus after treatment and more than 12 months of follow-up were included in the analysis. Data collection focused on recurrence rates, associated risk factors, and surveillance methods. RESULTS A total of 45 patients with a mean age of 11.7 years (range 0.5–18 years) were treated for AVMs via surgical, endovascular, radiosurgical, or combined approaches. Total AVM obliteration on posttreatment digital subtraction angiography (DSA) was confirmed in 27 patients, of whom the 20 with more than 12 months of follow-up were included in subsequent analysis. The mean follow-up duration in this cohort was 5.75 years (median 5.53 years, range 1.11–10.64 years). Recurrence occurred in 3 of 20 patients (15%). Two recurrences were detected by surveillance DSA and 1 at the time of rehemorrhage. No recurrences were detected by MRA. Median time to recurrence was 33.6 months (range 19–71 months). Two patients (10%) underwent follow-up DSA, 5 (25%) had DSA and MRI/MRA, 9 (45%) had MRI/MRA only, 1 (5%) had CT angiography only, and 3 (15%) had no imaging within the first 3 years of follow-up. After 5 years posttreatment, 2 patients (10%) were followed with MRI/MRA only, 2 (10%) with DSA only, and 10 (50%) with continued DSA and MRI/MRA. CONCLUSIONS AVM recurrence in children occurred at a median of 33.6 months, when MRA was more commonly used for surveillance, but failed to detect any recurrences. A recurrence rate of 15% may be an underestimate given the reliance on surveillance MRA over angiography. A new surveillance strategy is proposed, taking into account exposure to diagnostic radiation and the potential for catastrophic rehemorrhage.

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“…Considerable progress has been made in the treatment of bAVMs, be it microsurgery, radiotherapy, or endovascular treatments [1,5,17]. However, no treatment modality is without inherent risks, and in 2014, the ARUBA study concluded that the risk of any form of neurosurgical treatment was inferior to the natural history of unruptured bAVMs [13].…”

Section: Treatmentmentioning

confidence: 99%

To treat or not to treat brain AVMs—that’s still the question

Meling

2017

Acta Neurochir

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Advances and Innovations in Brain Arteriovenous Malformation Surgery

Cited by 65 publications

References 78 publications

Risk factors for worsened muscle strength after the surgical treatment of arteriovenous malformations of the eloquent motor area

Risk factors for worsened muscle strength after the surgical treatment of arteriovenous malformations of the eloquent motor area

Postoperative imaging for detection of recurrent arteriovenous malformations in children

To treat or not to treat brain AVMs—that’s still the question

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