Population-based analysis of arteriovenous malformation treatment

Abstract

In centers with population-based referral, AVM of the brain is predominantly a disease related to intracranial bleeding. and parenchymal clots have a profound impact on overall management outcome. The rupture of an AVM is as devastating as that of an aneurysm. Aneurysm ruptures are more lethal, whereas AVM rupture tends to result in more neurological disability due to the high occurrence of lobar intracerebral hematoma. In an attempt to quantify the need for different modalities of AVM treatment based on a population of 1,000,000 people, figures for surgeries performed range from six to 10 operations per year and embolization as well as gamma knife surgery procedures range from two to seven per year, depending on the strategy at hand. When using nonsurgical approaches to Grade 1 to 3 lesions, the number of patients requiring treatment with more than one method for obliteration increases drastically as does the potential risk for procedure-related complications.

Stereotactic radiosurgery for arteriovenous malformations, Part 2: management of pediatric patients

“…1,3,4,14,23,39 Pediatric patients with AVMs are more likely to present with hemorrhage than adults. 2,5,10,11 The annual risk of hemorrhage for untreated AVMs has been estimated to be 2%-4%, a mortality rate of 5%-10% after hemorrhage, and a 50% risk of severe morbidity associated with hemorrhage.…”

Patterns of Brain Arteriovenous Malformation Treatment

“…21 No studies describing patterns of treatment within countries, between countries, or between continents have been published before and this is, to our knowledge, the first study describing different patterns of interventional treatment within a defined population. Two other studies have described AVM treatment within a population, 22,23 but neither intended to describe regional patterns of intervention. A study of AVM management and outcome in 1989 to 1999 in a population of one million residents in a part of Sweden served by a university hospital and 10 local hospitals attempted to quantify the need for different treatment modalities for this population.…”

“…A study of AVM management and outcome in 1989 to 1999 in a population of one million residents in a part of Sweden served by a university hospital and 10 local hospitals attempted to quantify the need for different treatment modalities for this population. 23 However, international, national, and perhaps even regional differences can be inferred from the patterns of intervention in case series published in the literature. 24 -30 In North America, suitable AVMs (such as Spetzler-Martin Grades I and II) seem to be excised more often than they are embolized, 2 but endovascular treatment (with or without radiosurgery) appears to have been used more frequently in Europe.…”

Role of Embolization for Cerebral Arteriovenous Malformations

“…19 Rates of brain AVM detection determined by population-based studies range from 0.89 to 1.34 cases per 100,000 person-years. [20][21][22][23][24][25] Similarly, variable prevalence estimates ranging from less than 0.02% to 0.2% are reported. 20 The frequently cited New York Islands AVM study indicates an annual AVM detection rate of 1.34 cases per 100,000 person-years and concluded that a true prevalence may never be known due to the disease's rarity, its congenital nature, and its long asymptomatic development.…”