Chinese Cerebrovascular Neurosurgery Society and Chinese Interventional & Hybrid Operation Society, of Chinese Stroke Association Clinical Practice Guidelines for Management of Brain Arteriovenous Malformations in Eloquent Areas

Abstract

Aim: The aim of this guideline is to present current and comprehensive recommendations for the management of brain arteriovenous malformations (bAVMs) located in eloquent areas.Methods: An extended literature search on MEDLINE was performed between Jan 1970 and May 2020. Eloquence-related literature was further screened and interpreted in different subcategories of this guideline. The writing group discussed narrative text and recommendations through group meetings and online video conferences. Recommendations followed the Applying Classification of Recommendations and Level of Evidence proposed by the American Heart Association/American Stroke Association. Prerelease review of the draft guideline was performed by four expert peer reviewers and by the members of Chinese Stroke Association.Results: In total, 809 out of 2,493 publications were identified to be related to eloquent structure or neurological functions of bAVMs. Three-hundred and forty-one publications were comprehensively interpreted and cited by this guideline. Evidence-based guidelines were presented for the clinical evaluation and treatment of bAVMs with eloquence involved. Topics focused on neuroanatomy of activated eloquent structure, functional neuroimaging, neurological assessment, indication, and recommendations of different therapeutic managements. Fifty-nine recommendations were summarized, including 20 in Class I, 30 in Class IIa, 9 in Class IIb, and 2 in Class III.Conclusions: The management of eloquent bAVMs remains challenging. With the evolutionary understanding of eloquent areas, the guideline highlights the assessment of eloquent bAVMs, and a strategy for decision-making in the management of eloquent bAVMs.

Multimodal treatments of brain arteriovenous malformations: a comparison of microsurgical timings after endovascular embolization

“…There were differences in patient selection between multimodal treatments and microsurgery. The former approach provided the potential of total resection for complex bAVMs, while the microsurgical resection is appropriate for lesions with SM grade I–III ( 20 ). In this study, the average diameter of bAVMs treated with MO/HO is >3 cm.…”

“…Besides, singlestaged HO showed its potential in decreasing the volume of intraoperative blood loss, incidences of postoperative complications and residue. Multimodality treatment consisting of endovascular embolization and microsurgical resection has been routinely utilized in the treatment of bAVMs (20). Compared to the traditional multi-stage approach, HO with embolization and microsurgical resection in one single setting has unique advantages in regard to treatment workflow and patient convenience.…”

Grading scale based on arcuate fasciculus segmentation to predict postoperative language outcomes of brain arteriovenous malformations

“…Additionally, cautious assessment and adequate communication with patients and their families are necessary to select treatment strategies. Multimodality treatments with microsurgery performed as a definitive treatment might be recommended for their potential in decreasing operative risks and protecting neurological functions 25. Further studies are needed to evaluate the clinical benefits of this treatment strategy.…”

Exosomal miR‐3131 derived from endothelial cells with KRAS mutation promotes EndMT by targeting PICK1 in brain arteriovenous malformations

“…Brain arteriovenous malformations (bAVMs) are abnormal enlargements of vessels, wherein arterial blood flows directly into draining veins without the normal interposed capillary beds, while no brain parenchyma is contained within the nidus 1 . bAVMs usually occur in young people, presenting as seizures, neurological deficits, headaches, or devastating spontaneous intracranial hemorrhage 2,3 .…”