Contemporary management of brain arteriovenous malformations in mainland China: a web-based nationwide questionnaire survey

Abstract

Background: In the benefit of the large population and rapid economic growth, the interventional techniques and equipment for brain arteriovenous malformations (bAVMs) in mainland China have been rapidly improved. Chinese neurosurgical cerebrovascular physicians have accumulated rich experience and made pioneering explorations. This study aims to summarize the experience and treatment progress of bAVMs in mainland China. Methods: We performed a web-based nationwide questionnaire survey among 67 tertiary neurosurgical institutions that had acknowledged treating bAVMs in the primary survey. Our questionnaire included clinical characteristics, radiological findings, intervention indications/contraindications, intervention timing, and intraoperative management of different treatment modalities. Results: A total of 63 participants from 49 (73.1%) tertiary neurosurgical institutions responded to our questionnaire. Forty-two (66.7%) were neurosurgeons, 13 (20.6%) were neurointerventionists, and 8 (12.7%) were radiosurgeons. Approximately 3500 to 4000 cases of bAVMs were treated annually in these 49 departments. All participants agreed that the conclusions of ARUBA are debatable. Flow-related aneurysms, deep venous drainage, and arteriovenous fistula were considered as common hemorrhagic risk factors. Unruptured SM IV-V bAVMs, giant bAVMs, pediatric bAVMs, elderly bAVMs, and eloquent bAVMs were not absolute contraindications to intervention. Maximum lesion occlusion and minimal functional impairment were the principles of intervention management. Most of the neurosurgeons and neurointerventionists recommended early intervention (< 30 days) for ruptured bAVMs, and the radiosurgeons suggested intervention in the chronic phase or recovery phase (P < 0.01) and preferably 3 months after bleeding. Multi-modality strategies were thought effective for complex bAVMs, and more exploration of individualized intraoperative management was necessary.

Association of nidus size and rupture in brain arteriovenous malformations: Insight from angioarchitecture and hemodynamics

“…proposed the R 2 eD AVM Score system to predict the rupture risk, and the nidus size < 3 cm was a crucial positive indicator 28 . Even in a previous web-based nationwide questionnaire study in Mainland China conducted by the author of this study, small size was considered a risk factor for AVM hemorrhage 29 .…”

Pre-operative imaging and post-operative appearance of standard paediatric neurosurgical approaches: a training guide for neuroradiologists

“…The advances achieved over the years in neurosurgical techniques and neuroanaesthesia have driven a parallel expansion in the array of conditions, which are potentially treatable with surgery (37,38). As such, the range of surgical options is now wider than ever, and includes minimally invasive procedures amenable for service improvement projects focused around the concepts of early recovery after surgery and prompt discharge from neurosurgical centres (39)(40)(41). An awareness of the surgical thinking and planning of neurosurgical interventions in children, and the practical knowledge of the operative steps involved, can truly lead to enhance accuracy in radiology reporting of the postoperative scan (37).…”

Multimodality treatment for brain arteriovenous malformation in Mainland China: design, rationale, and baseline patient characteristics of a nationwide multicenter prospective registry

“…However, the finding have not been confirmed in the predominantly yellow Asian population, and some scholars have expressed concerns about it [ 5 ]. Therefore, clarifying the natural history of AVMs among Asian populations is of distinct practical significance [ 6 ].…”