Recommendations for the Management of Intracranial Arteriovenous Malformations

Ogilvy, Christopher S.; Stieg, Philip E.; Awad, Issam A.; Brown, Robert D.; Kondziolka, Douglas; Rosenwasser, Robert H.; Young, William L.; Hádemenos, George J.

doi:10.1161/01.cir.103.21.2644

Cited by 193 publications

(151 citation statements)

References 151 publications

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“…[1][2][3][4][5][6][7] Management of these lesions is complicated by the fact that bAVMs form a very heterogeneous group of lesions. The variable arteriovenous malformation (AVM) locations, morphologies, and angioarchitectural characteristics may impart a different risk of hemorrhage for each patient, 8 -15 requiring individualized treatment decisions.…”

mentioning

confidence: 99%

“…[2][3][4][5]7,22,23 The appropriate management of patients with AVMs can therefore vary from simple observation to aggressive multimodality treatment aimed at total AVM obliteration. 6 Because risks of treatment must be weighed against those of conservative management of bAVMs, we sought to obtain a better understanding of the natural history and factors predictive of hemorrhage in bAVM patients.…”

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confidence: 99%

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The Natural History and Predictive Features of Hemorrhage From Brain Arteriovenous Malformations

Costa

Wallace

Brugge

et al. 2009

Stroke

389

264

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Background and Purpose-Patients harboring brain arteriovenous malformations (bAVMs) are at a lifelong risk for hemorrhagic strokes, but the natural history is poorly understood. We examined the impact of demographic and angiographic features on the likelihood of future hemorrhage. Methods-A prospectively accrued database of bAVM patients maintained at the Toronto Western Hospital was analyzed; 678 consecutive, prospectively enrolled bAVM patients were followed for 1931.7 patient-years. The rate of hemorrhage over long-term follow-up was recorded. The impact of baseline clinical and radiographic features and partial treatment on time to hemorrhage were analyzed using survival analysis. Neurological outcome after hemorrhage was assessed using the Glasgow Outcome Score. Results-Hemorrhage rates were 4.61% per year for the entire cohort (nϭ678), 7.48% per year for bAVMs with initial hemorrhagic presentation (nϭ258), 4.16% per year for initial seizure presentation (nϭ260)

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confidence: 99%

mentioning

confidence: 99%

The Natural History and Predictive Features of Hemorrhage From Brain Arteriovenous Malformations

Costa

Wallace

Brugge

et al. 2009

Stroke

389

264

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“…An annual hemorrhage risk of 2% to 4% is typically quoted and is associated with a 5% to 25% risk of death and 10% to 50% risk of neurological disability. 4,8,10 Originally conceived as a surgical risk assessment tool, the Spetzler-Martin grading system that assigns points for AVM size, location, and venous drainage pattern is commonly used to describe AVMs in the clinical setting (Table 1). 11 Current treatment modalities for cerebral AVMs include microsurgical resection, endovascular embolization, and stereotactic radiosurgery.…”

Section: Introductionmentioning

confidence: 99%

“…If endovascular intervention is elected, possible therapeutic strategies include premicrosurgical embolization, preradiosurgical embolization, curative embolization, or palliative embolization. 10,[16][17][18] …”

Section: Introductionmentioning

confidence: 99%

Role of Embolization for Cerebral Arteriovenous Malformations

Ellis

Lavine

2014

Methodist DeBakey Cardiovascular Journal

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“…Brain arteriovenous malformations (AVM) typically appear between the age of 25 and 45 years, with a peak incidence in the 4 th decade [1][2][3][4] . Despite its congenital origin, only 18-20% are diagnosed in childhood 5 .…”

Section: Introductionmentioning

confidence: 99%

Abordagem anestésica de grávida com malformação arteriovenosa cerebral e hemorragia subaracnoidea durante a gravidez: relato de caso

Carvalho¹,

Resende²,

Centeno³

et al. 2013

Rev. Bras. Anestesiol.

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Background and objectives: Subarachnoid hemorrhage (SAH) during pregnancy is a rare event, and about half the cases are due to arteriovenous malformations (AVM). The authors describe the anesthetic approach of a 39 week pregnant patient scheduled for cesarean section, with a history of SAH due to AVM at 22 week gestation. Case report: 39 week pregnant patient, healthy prior to pregnancy, with a history of SAH at 22 week gestation, manifested by headache, vomiting, and dizziness without loss of consciousness or other defi cits on admission to the emergency room. Magnetic resonance imaging (MRI) revealed a left frontal AVM. After a short hospital stay for stabilization and diagnosis, the fi nal medical decision was to maintain the pregnancy and a multidisciplinary follow-up by neurosurgery and high-risk obstetric consultation. An elective cesarean section was performed at 39 weeks under epidural anesthesia. During the intraoperative period, an episode of hypotension rapidly reversed with phenylephrine occurred. The newborn Apgar score was 10/10. An epidural catheter was used for postoperative analgesia, also uneventful. Conclusions: There are very few published cases of anesthetic approach for pregnant women with symptomatic AVM. All decisions made by the multidisciplinary team, from choosing to continue the pregnancy to the ideal time for AVM intervention and type of anesthesia and analgesia, were weighted according to the risk of brain damage. Regarding the anesthetic procedure, the authors emphasize the need for hemodynamic stability.

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Recommendations for the Management of Intracranial Arteriovenous Malformations

Cited by 193 publications

References 151 publications

The Natural History and Predictive Features of Hemorrhage From Brain Arteriovenous Malformations

The Natural History and Predictive Features of Hemorrhage From Brain Arteriovenous Malformations

Role of Embolization for Cerebral Arteriovenous Malformations

Abordagem anestésica de grávida com malformação arteriovenosa cerebral e hemorragia subaracnoidea durante a gravidez: relato de caso

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