Brain arteriovenous malformations in elderly patients: clinical features and treatment outcome

Tong, Xianzeng; Wu, Jun; Lin, Fuxin; Cao, Yong; Zhao, Yuanli; Niu, Bo; Zhao, Bing; Wang, Lijun; Zhang, Shuo; Wang, Shuo; Zhao, Jizong

doi:10.1007/s00701-015-2521-6

Cited by 22 publications

(19 citation statements)

References 29 publications

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“…In the study by Yang et al., small size was associated with hemorrhagic presentation, with a reduction of 0.35 in the odds ratio (OR) for hemorrhagic risk every 1 cm increase in AVM size (OR = 0.65; P < 0.01). Fok et al., Tong et al . and Sahlein et al .…”

Section: Discussionmentioning

confidence: 98%

“…The venous characteristics of AVMs have been widely evaluated and implicated in the hemorrhage of these lesions . The association between deep venous drainage and a higher incidence of hemorrhagic presentation was reported by several studies . Studies involving pediatric AVM patients found that deep venous drainage was associated with hemorrhagic presentation …”

Section: Discussionmentioning

confidence: 99%

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Grades of brain arteriovenous malformations and risk of hemorrhage and death

Stefani

Ribeiro

Mohr

2019

Ann Clin Transl Neurol

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Objective To assess the relationship of the grade of unruptured and untreated Brain Arteriovenous Malformations (AVMs), with the risk of subsequent stroke and death during follow‐up. Methods This prospective study was drawn from a cohort of adult patients with unruptured AVMs, who participated in the conservative treatment arm (medical management only for headache or seizures) of the randomized clinical trial of unruptured brain AVMs (ARUBA study). The grade of AVMs (Spetzler–Martin scale) was dichotomized into categories: AVMs of grades I and II were considered low grade; AVMs of grades III and IV were considered high grade. There were no grade V AVM patients in ARUBA. The primary outcome was symptomatic stroke (hemorrhagic or ischemic – documented by imaging) or death. Results The conservative treatment group had 123 patients (“as treated” analysis). 71 (57.7%) had lesions characterized for this analysis as low‐grade lesions and 52 (42.2%) as high grade. From the total of 10 (8.13%) primary outcomes, three occurred (4.22%) in low‐grade AVMs and seven (13.46%) in high‐grade AVMs (P = 0.0942). Interpretation Statistical analysis of the cohort of patients with unruptured and untreated AVMs from ARUBA study showed that the graduation categories (Spetzler–Martin grades) were not associated with the outcome of subsequent stroke or death.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Grades of brain arteriovenous malformations and risk of hemorrhage and death

Stefani

Ribeiro

Mohr

2019

Ann Clin Transl Neurol

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“…Though most of the patients with AVM are young when diagnosis is made there are also patients becoming symptomatic only in older age, as in our case. A multicenter study [7] showed that 65% of all AVM of patients over 60 years were treated with microsurgery, supported by preoperative embolization in 1 out of 3 cases. Radiosurgery, embolization only, or a conservative approach was each chosen as therapy regimen in 10% of all cases.…”

Section: Discussionmentioning

confidence: 99%

Massive Arteriovenous Malformation with Stroke-Like Presentation

et al. 2018

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“…Although it is uncommon for AVMs to be first diagnosed late in life, such cases are possible. [7][8][9][10] Making a decision regarding AVM treatment for elderly patients is challenging due to the limited capacity for neurological recovery and increased general risk associated with surgery among this population, compared with younger patients. Supp-SM grading incorporates patient age into the scoring system and adds 3 points to the score for every AVM patient who is older than 40 years to adjust for this risk.…”

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confidence: 99%

Surgical selection and outcomes among elderly patients with brain arteriovenous malformations

Burkhardt

Winkler

Catapano

et al. 2020

Neurosurgical Focus

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OBJECTIVEStudies of resection of brain arteriovenous malformations (AVMs) in the elderly population are scarce. This study examined factors influencing patient selection and surgical outcome among elderly patients.METHODSPatients 65 years of age and older who underwent resection of an unruptured or ruptured brain AVM treated by two surgeons at two centers were identified. Patient demographic characteristics, AVM characteristics, clinical presentation, and outcomes measured using the modified Rankin Scale (mRS) were analyzed. For subgroup analyses, patients were dichotomized into two age groups (group 1, 65–69 years old; group 2, ≥ 70 years old).RESULTSOverall, 112 patients were included in this study (group 1, n = 61; group 2, n = 51). Most of the patients presented with hemorrhage (71%), a small nidus (< 3 cm, 79%), and a low Spetzler-Martin (SM) grade (grade I or II, 63%) and were favorable surgical candidates according to the supplemented SM grade (supplemented SM grade < 7, 79%). A smaller AVM nidus was statistically significantly more likely to be present in patients with infratentorial AVMs (p = 0.006) and with a compact AVM nidus structure (p = 0.02). A larger AVM nidus was more likely to be treated with preoperative embolization (p < 0.001). Overall outcome was favorable (mRS scores 0–3) in 71% of the patients and was statistically independent from age group or AVM grading. Patients with ruptured AVMs at presentation had significantly better preoperative mRS scores (p < 0.001) and more favorable mRS scores at the last follow-up (p = 0.04) than patients with unruptured AVMs.CONCLUSIONSOutcomes were favorable after AVM resection in both groups of patients. Elderly patients with brain AVMs treated microsurgically were notable for small nidus size, AVM rupture, and low SM grades. Microsurgical resection is an important treatment modality for elderly patients with AVMs, and supplemented SM grading is a useful tool for the selection of patients who are most likely to achieve good neurological outcomes after resection.

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Brain arteriovenous malformations in elderly patients: clinical features and treatment outcome

Cited by 22 publications

References 29 publications

Grades of brain arteriovenous malformations and risk of hemorrhage and death

Grades of brain arteriovenous malformations and risk of hemorrhage and death

Massive Arteriovenous Malformation with Stroke-Like Presentation

Surgical selection and outcomes among elderly patients with brain arteriovenous malformations

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