Recurrent Brain Arteriovenous Malformations (AVMs): A Systematic Review

Sorenson, Thomas J.; Brinjikji, Waleed; Bortolotti, Carlo; Kaufmann, Gabriel; Lanzino, Giuseppe

doi:10.1016/j.wneu.2018.05.117

Cited by 49 publications

(52 citation statements)

References 55 publications

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“…In vascular malformations, BBB damage could be an underlying cause of the pathology (CCMs) or the BBB may be a site of secondary damage (AVMs and HHT). In AVMs and HHT, lesions form due to a redirection of blood flow from arteries/arterioles to veins/venules, bypassing downstream capillary beds and reducing the proper brain oxygenation [8]. One predominant complication is blood vessel rupture and brain hemorrhage.…”

Section: Vascular Malformation and Bbb Models Systemmentioning

confidence: 99%

“…Several genetic factors (polymorphism of EPHB4, IL-6, TNFα, IL-1β, APOE, genes) are indicated as risk factors for hemorrhage of AVM lesions [8]. AVM is also a component of several hereditary disorders, like hereditary hemorrhagic telangiectasia (HHT, also known as Osler-Weber-Rendu disease), Wyburn-Mason syndrome, and Sturge-Weber syndrome characterized by mutations of endoglin (ENG) or Alk1 (ACVRL1) [7,8]. Some pathogenic processes in AVM lesions are abnormal angiogenesis, blood flow alterations and cellular remodeling of the BBB/NVU.…”

Section: Vascular Malformation and Bbb Models Systemmentioning

confidence: 99%

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Modeling blood–brain barrier pathology in cerebrovascular disease in vitro: current and future paradigms

Andjelkovic

Stamatovic

Phillips

et al. 2020

Fluids Barriers CNS

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The complexity of the blood-brain barrier (BBB) and neurovascular unit (NVU) was and still is a challenge to bridge. A highly selective, restrictive and dynamic barrier, formed at the interface of blood and brain, the BBB is a "gatekeeper" and guardian of brain homeostasis and it also acts as a "sensor" of pathological events in blood and brain. The majority of brain and cerebrovascular pathologies are associated with BBB dysfunction, where changes at the BBB can lead to or support disease development. Thus, an ultimate goal of BBB research is to develop competent and highly translational models to understand mechanisms of BBB/NVU pathology and enable discovery and development of therapeutic strategies to improve vascular health and for the efficient delivery of drugs. This review article focuses on the progress being made to model BBB injury in cerebrovascular diseases in vitro.

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Section: Vascular Malformation and Bbb Models Systemmentioning

confidence: 99%

Section: Vascular Malformation and Bbb Models Systemmentioning

confidence: 99%

Modeling blood–brain barrier pathology in cerebrovascular disease in vitro: current and future paradigms

Andjelkovic

Stamatovic

Phillips

et al. 2020

Fluids Barriers CNS

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“…A recent systematic review of 14 case reports and 16 case series examined the risk factors and timing for recurrence of resected brain AVMs, finding a 2.7% rate of recurrence in adult cases and a 9.5%-14% rate of recurrence in pediatric cases, with an average time to recurrence of 4.2 years. 26 Lang et al assessed 28 pediatric patients treated with AVM resection and noted a recurrence in 14.3% of them, occurring 50-60 weeks after the initial resection, with the recurrence risk identified as 0.07 per person-year. 15 Interestingly, these authors also correlated a lower compactness score with AVM recurrence.…”

Section: Avm Recurrence: When How and Why?mentioning

confidence: 99%

“…The literature on AVMs in adults reports a recurrence rate of approximately 2%-4%. 13,26 The reason for the higher rate of recurrence among the pediatric AVM population is not fully understood, although multiple theories have been postulated. The concept of early postoperative changes hiding residual AVM which later presents as a recurrence is one such theory.…”

Section: Avm Recurrence: When How and Why?mentioning

confidence: 99%

“…graphic resolution of low-grade intracranial AVMs, many high-grade lesions are not amenable to this therapeutic modality because of their high-risk features or eloquent location. 7,9,26 Endovascular therapy via embolization can be used to treat or reduce the flow of large AVMs in multiple stages, aiming for cure or rendering the lesion more amenable to surgery or radiosurgery. Complete radiographic resolution following embolization therapy alone has been estimated to occur in 10%-40% of AVMs treated endovascularly.…”

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confidence: 99%

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Pediatric intracranial arteriovenous malformations: a single-center experience

LoPresti

Ravindra

Pyarali

et al. 2020

Journal of Neurosurgery: Pediatrics

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OBJECTIVEIntracranial arteriovenous malformations (AVMs) are a common cause of intracranial hemorrhage in children. Exploring outcomes of treatment and factors that predict recurrence may help guide the management of pediatric AVMs. In this study, the authors review a single-center experience with pediatric AVMs, aiming to identify factors contributing to recurrence and areas for improvement in treatment.METHODSA single-center retrospective review of patients ages 0–18 years with AVMs in the period from 2005 to 2018 was conducted. Demographic, clinical, and radiographic data were collected and examined to compare the clinical and functional outcomes of patients managed with and those managed without open microsurgical resection.RESULTSOne hundred five patients were diagnosed and treated during the study period. Fifty (47.6%) had been treated surgically and 35 (33.3%) nonsurgically, and 20 (19%) had been treated primarily at an outside institution and thus were excluded from further analysis. Of the 50 treated surgically, 92% had complete obliteration on postoperative imaging, with the remaining patients having residual AVM and undergoing re-resection or SRS, ultimately resulting in a 96% radiographic cure rate. The surgically treated patients were followed up for an average of 3.34 years. Eighty-two percent had a modified Rankin Scale (mRS) score of 0–2. There was a recurrence rate of 12%, with the time to recurrence averaging 327.86 days (range 85–596 days). Of the 35 patients managed without open surgery, 77% underwent serial imaging surveillance, 20% underwent endovascular embolization, and 3% underwent stereotactic radiosurgery. Radiographic cure was seen in 6% of those treated nonsurgically, and all had undergone endovascular treatment alone. The nonsurgically treated patients were followed up for an average of 2.14 years. Eighty percent had an mRS score of 0–2.CONCLUSIONSThe data revealed that patients with lower-grade AVMs treated surgically and those with higher-grade AVMs managed without surgery have good functional and clinical outcomes. A high rate of recurrence was noted, and the possible contributing factors were explored. The authors encourage further study into mechanisms to reduce AVM recurrence in pediatric patients and look forward to advances in the medical management of lesions that are considered unresectable.

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