Benefits of embolization without surgery for cerebral arteriovenous malformations

Wolpert, S M; Barnett, F J; Prager, RJ

doi:10.2214/ajr.138.1.99

Cited by 19 publications

(5 citation statements)

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“…quency has been reported 22 ; the effects of embolization have been mixed [23][24][25][26][27] ; and the effects of multimodality AVM treatment have been promising. 28,29 Only 1 observational study compared the risk of de novo seizures following AVM surgery to the risk during conservative management, finding that the risk was greater following surgery, but the study was retrospective and based on clinical practice between 1941 and 1984.…”

mentioning

confidence: 99%

Seizure risk with AVM treatment or conservative management

Josephson¹,

Bhattacharya²,

Counsell³

et al. 2012

Neurology

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Methods:We used annual general practitioner follow-up, patient questionnaires, and medical records surveillance to quantify the 5-year risk of seizures and the chances of achieving 2-year seizure freedom for adults undergoing AVM treatment compared to adults managed conservatively in a prospective, population-based observational study of adults in Scotland, newly diagnosed with an AVM in 1999-2003. Results:We identified 229 adults with a new diagnosis of an AVM, of whom two-thirds received AVM treatment (154/229; 67%) during 1,862 person-years of follow-up (median completeness of follow-up 97%). There was no significant difference in the proportions with a first or recurrent seizure over 5 years following AVM treatment, compared to the first 5 years following clinical presentation in conservatively managed adults, in analyses stratified by mode of presentation (intracerebral hemorrhage, 35% vs 26%, p ϭ 0.5; seizure, 67% vs 72%, p ϭ 0.6; incidental, 21% vs 10%, p ϭ 0.4). For patients with epilepsy, the chances of achieving 2-year seizure freedom during 5-year follow-up were similar following AVM treatment (n ϭ 39; 52%, 95% confidence interval [CI] 36% to 68%) or conservative management (n ϭ 21; 57%, 95% CI 35% to 79%; p ϭ 0.7). Conclusions:In this observational study, there was no difference in the 5-year risk of seizures with AVM treatment or conservative management, irrespective of whether the AVM had presented with hemorrhage or epileptic seizures. Neurology Adults with a brain arteriovenous malformation (AVM) are at risk of epileptic seizures, especially when the AVM is supratentorial (in the temporal lobe in particular) and after intracerebral hemorrhage (ICH) has occurred.1 The main aim of AVM treatment is to reduce the risk of AVM-related ICH, but invasive procedures might also reduce the risk of seizures by obliterating epileptogenic foci. Conversely, surgical excision, endovascular embolization, and stereotactic radiosurgery could also raise the risk of seizures.Case series have reported conflicting results about seizure control following AVM treatment: surgery has been associated with better, 2-7 unchanged, or worse seizure control 8 -10 ; the effect of stereotactic radiosurgery has been promising, 11-21 although a delayed increase in seizure fre-

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mentioning

confidence: 99%

Seizure risk with AVM treatment or conservative management

Josephson¹,

Bhattacharya²,

Counsell³

et al. 2012

Neurology

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“…Due to the unclear mechanism of symptomatic headache associated with ubAVMs, obliteration of ubAVMs through single or multimodal treatment is the paramount way to relive pain and improve patients' quality of life (6,7,(9)(10)(11)19). Meanwhile, the usefulness of pharmacotherapy in treating headache associated with bAVMs was not documented by a previous study (22).…”

Section: Wwwpainphysicianjournalcommentioning

confidence: 98%

“…By contrast, multidisciplinary care of ubAVMs to improve tension-type-like headache (87.8% headache improvement, P < 0.001) or all types of headache (85.7% headache improvement, P < 0.001) is effective. Wolpert et al (6) reported that 12 (63.0%) of 19 patients had decreased headaches over 2 years following embolization. Lunsford et al (28) reported that in 104 (46%) patients presenting with headache ahead of radiosurgery, outcomes were obtained in only 73 patients due to adequate follow-up and 56 patients (75%) showed headache improvement.…”

Section: Wwwpainphysicianjournalcommentioning

confidence: 99%

Multidisciplinary Care of Unruptured Brain Arteriovenous Malformations to Improve Symptomatic Headache and the Onset, Progression, and Outcomes of Unruptured Brain Arteriovenous Malformations

Chuan-Zhi

2017

Pain Phys

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Background: Symptomatic headaches attributed to unruptured brain arteriovenous malformations (ubAVMs) are very common and affect patients’ quality life, but multidisciplinary care of ubAVMs to improve symptomatic headache remains unclear. Objective: The objective is to identify the features of symptomatic headaches, and to obtain headache outcomes following multidisciplinary care of ubAVMs, as well as provide background on the natural history of ubAVMs. Study Design: The features of symptomatic headaches and headache outcomes were analyzed in a large cohort of cases after multidisciplinary care of ubAVMs. We have also provided information on the natural history of ubAVMs Setting: This study was conducted at the Department of Neurosurgery of Zhujiang Hospital where 336 patients from 1998 to 2014 were reviewed by a multidiscipline team. Only 124 patients were eligible. Methods: The demographics, clinical features, imaging features, and headache details of eligible patients were reviewed. An 11-point pain scale score was used to assess symptomatic headaches before, during, and after treatment. The headache outcomes, death or stroke, and adverse functional outcomes (modified Rankin Scale score ≥ 2, mRS ≥ 2) were assessed following multidisciplinary care of ubAVMs. Results: Twenty-three (56.1%) of 41 patients had migraine-like headaches located in occipital lobe (P < 0.001), while forty (63.5%) of 63 patients had tension-type-like headaches located in frontotemporal lobe (P < 0.001). For patients with tension-type-like or all types of headache, headache improvement differed between the multidisciplinary group and medical group (87.8% vs. 31.8%, P < 0.001; 85.7% vs. 40.7%, P < 0.001). The risk of death or stroke did not differ between multidisciplinary group and medical group (P = 0.393), whereas the risk of adverse functional outcome (mRS ≥ 2) differed significantly by long-time follow-up (23.0% vs.10.0%, P = 0.022). Limitations: This study provides the initial experience to support multidisciplinary care for ubAVMs to improve symptomatic headaches and patients’ quality life, but based on the retrospective study with inherent limitations, larger samples and multi-center trials are needed on this interesting issue. Conclusions: Occipital ubAVM is more likely to present with migraine-like headache, while frontotemporal ubAVM tends to present with tension-type-like headache. The effectiveness of multidisciplinary care for ubAVM to improve headache has been shown, but the natural history of ubAVM patients with headache remains unclear. Key Words: Unruptured brain arteriovenous malformations, headache, headache improvement, natural history

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“…Units that deal with these lesions in large numbers are increasingly aware of the ability of patients to tolerate the lesion and of the warning symptoms and signs that signal a loss of patients' compliance. Many [4][5][6][7][8][9][10][11][12] coils are usually used (fig 3). The average overall cost of treating a patient by this method is £4500-5500.…”

Section: Technical Advancesmentioning

confidence: 99%

Interventional Neuroradiology

2013

Encyclopedia of Sciences and Religions

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Benefits of embolization without surgery for cerebral arteriovenous malformations

Cited by 19 publications

References 0 publications

Seizure risk with AVM treatment or conservative management

Seizure risk with AVM treatment or conservative management

Multidisciplinary Care of Unruptured Brain Arteriovenous Malformations to Improve Symptomatic Headache and the Onset, Progression, and Outcomes of Unruptured Brain Arteriovenous Malformations

Interventional Neuroradiology

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