Natural history of cerebral arteriovenous malformations: a meta-analysis

Gross, Bradley A.; Du, Rose

doi:10.3171/2012.10.jns121280

Cited by 464 publications

(348 citation statements)

References 30 publications

Supporting

Mentioning

308

Contrasting

Unclassified

Order By: Relevance

“…32 For conservatively treated patients, although the overall annual hemorrhage rate is 3.0% (95% CI 2.7%-3.4%), AVM hemorrhage has been associated with longterm neurological morbidity and mortality as high as 35% and 29%, respectively. 16 The results of published series describing stereotactic radiosurgery in larger AVMs are no more promising than those from surgical series, with a low obliteration rate, bleeding during the latent period, and an increasing risk of radiation-induced complications. 9 Recently, advanced functional imaging techniques have significantly contributed to reducing perioperative morbidity.…”

Section: Discussionmentioning

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

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionmentioning

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

View full text Add to dashboard Cite

show abstract

“…The incidence of AVMs is 0.94 to 1.34 per 100,000 person-years with a mean age of presentation at 30 to 35 years. [1][2][3] The prevailing theory of AVM rupture risk is the lack of intervening capillaries leading to an abnormally high-pressure blood flow through the AVM nidus. This high pressure is then transmitted to the venous vasculature, resulting in venous hypertension by impaired outflow, eventually resulting in rupture.…”

Section: Introductionmentioning

confidence: 99%

“…The ICH risk for untreated AVMs is 2% to 6% per year. 2,[6][7][8] However, the annual hemorrhage risk may be as high as 34% if any additional risk factors are present. 9 History of hemorrhage, high blood pressure, intranidal aneurysm, venous stenosis, and deep venous drainage are the main factors that increase the likelihood of AVM rupture.…”

Section: Introductionmentioning

confidence: 99%

Biology of Cerebral Arteriovenous Malformations with a Focus on Inflammation

Mouchtouris

Jabbour

Starke

et al. 2014

J Cereb Blood Flow Metab

124

View full text Add to dashboard Cite

Cerebral arteriovenous malformations (AVMs) entail a significant risk of intracerebral hemorrhage owing to the direct shunting of arterial blood into the venous vasculature without the dissipation of the arterial blood pressure. The mechanisms involved in the growth, progression and rupture of AVMs are not clearly understood, but a number of studies point to inflammation as a major contributor to their pathogenesis. The upregulation of proinflammatory cytokines induces the overexpression of cell adhesion molecules in AVM endothelial cells, resulting in enhanced recruitment of leukocytes. The increased leukocyte-derived release of metalloproteinase-9 is known to damage AVM walls and lead to rupture. Inflammation is also involved in altering the AVM angioarchitecture via the upregulation of angiogenic factors that affect endothelial cell proliferation, migration and apoptosis. The effects of inflammation on AVM pathogenesis are potentiated by certain single-nucleotide polymorphisms in the genes of proinflammatory cytokines, increasing their protein levels in the AVM tissue. Furthermore, studies on metalloproteinase-9 inhibitors and on the involvement of Notch signaling in AVMs provide promising data for a potential basis for pharmacological treatment of AVMs. Potential therapeutic targets and areas requiring further investigation are highlighted.

show abstract

“…A recent meta-analysis 8 revealed an overall annual hemorrhage rate of 3.0% per year, with an initial annual rupture rate of 2.2% and rerupture rate of 4.5%. Prior hemorrhage, a deep AVM location, exclusively deep venous drainage, and associated aneurysms are significant risk factors for AVM hemorrhage.…”

Section: Outcomes Based On Literature Review and Institutional Experimentioning

confidence: 99%

Management of perisylvian arteriovenous malformations: a retrospective institutional case series and review of the literature

Pabaney

Reinard

Massie

et al. 2014

FOC

View full text Add to dashboard Cite

Object Sylvian arteriovenous malformations (sAVMs) are challenging lesions of the central nervous system. The natural history of these unique lesions as well as clinical outcomes following treatment of sAVMs has been limited to case series owing to the rarity of these lesions. The authors present their experience with sAVMs and review the literature. Methods In accordance with the Henry Ford Institutional Review Board, medical records of patients with sAVMs treated from 2000 to 2012 were reviewed. Clinical data were retrospectively collected to calculate pre- and posttreatment modified Rankin Scale scores for all patients. Results The authors identified 15 patients with sAVMs who received treatment. Of these, 12 were female and 3 were male, and the average age at presentation was 39.6 ± 12.94 years (± SD). Two patients (13.3%) had Spetzler-Martin Grade I lesions, 6 patients (40%) had Grade II lesions, 5 patients (33.3%) had Grade III lesions, and another 2 (13.3%) harbored Grade IV arteriovenous malformations (AVMs). According to the Sugita classification, 6 patients (40%) had medial lesions, 6 (40%) had lateral lesions, 2 (13.3%) had deep lesions, and 1 patient (6.67%) had a pure sAVM. Eight patients (53.3%) underwent stereotactic radiosurgery while 7 patients (46.7%) had microsurgical resection; 1 patient underwent surgical extirpation after incomplete response following radiosurgery. After treatment, 9 patients were unchanged from pretreatment (60%), 3 patients worsened, and 2 patients had improved functional outcome (20% and 13.3%, respectively). The authors’ literature search yielded 348 patients with sAVMs, most of them harboring Spetzler-Martin Grade II and III lesions. Approximately 98% of the patients underwent resection with excellent outcomes. Conclusions While the ideal choice of therapeutic modality for cerebral AVMs remains controversial in light of the recent publication of the ARUBA (A Randomized trial of Unruptured Brain AVMs) trial, a multidisciplinary treatment approach for the management of sAVMs can lead to acceptable neurological outcome.

show abstract

Natural history of cerebral arteriovenous malformations: a meta-analysis

Abstract: Arteriovenous malformations with prior hemorrhage, deep location, exclusively deep venous drainage, and associated aneurysms have greater annual hemorrhage rates than their counterparts, influencing surgical decision making and the selection of radiosurgery for these lesions.

Cited by 464 publications

References 30 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

Biology of Cerebral Arteriovenous Malformations with a Focus on Inflammation

Management of perisylvian arteriovenous malformations: a retrospective institutional case series and review of the literature

Contact Info

Product

Resources

About