Safety and outcome of combined endovascular and surgical management of low grade cerebral arteriovenous malformations in children compared to surgery alone

Al-Smadi, Anas S.; Ansari, Sameer A.; Shokuhfar, Tahaamin; Malani, Aresha; Sattar, Saadia; Hurley, Michael C.; Potts, Matthew B.; Jahromi, Babak S.; Alden, Tord D.; DiPatri, Arthur J.; Shaibani, Ali

doi:10.1016/j.ejrad.2019.02.016

Cited by 16 publications

(12 citation statements)

References 37 publications

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“…It could be applied to bAVMs in low grades as well, for the specific purpose of protecting neurological functions and decreasing intraoperative risks ( 84 , 132 , 133 ). However, no extra benefit had been observed in the low-grade lesions ( 131 ). The therapeutic modes and strategies of multimodality treatments have been interpreted in relevant sections above.…”

Section: Resultsmentioning

confidence: 97%

“…As a conclusive treatment, the microsurgical resection is utilized as a salvage treatment to residual bAVMs, that has not been completely obliterated by other treatments ( 78 , 130 ). Meanwhile, the microsurgical resection can be performed systematically in some bAVMs, which have been down-graded by endovascular embolization or/and SRS from higher grades ( 76 , 131 – 133 ). Studies on staged-multimodality treatments suggested that the prior endovascular or/and radiosurgical treatments could improve the microsurgical condition with lower risks and difficulties.…”

Section: Resultsmentioning

confidence: 99%

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Chinese Cerebrovascular Neurosurgery Society and Chinese Interventional & Hybrid Operation Society, of Chinese Stroke Association Clinical Practice Guidelines for Management of Brain Arteriovenous Malformations in Eloquent Areas

et al. 2021

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Aim: The aim of this guideline is to present current and comprehensive recommendations for the management of brain arteriovenous malformations (bAVMs) located in eloquent areas.Methods: An extended literature search on MEDLINE was performed between Jan 1970 and May 2020. Eloquence-related literature was further screened and interpreted in different subcategories of this guideline. The writing group discussed narrative text and recommendations through group meetings and online video conferences. Recommendations followed the Applying Classification of Recommendations and Level of Evidence proposed by the American Heart Association/American Stroke Association. Prerelease review of the draft guideline was performed by four expert peer reviewers and by the members of Chinese Stroke Association.Results: In total, 809 out of 2,493 publications were identified to be related to eloquent structure or neurological functions of bAVMs. Three-hundred and forty-one publications were comprehensively interpreted and cited by this guideline. Evidence-based guidelines were presented for the clinical evaluation and treatment of bAVMs with eloquence involved. Topics focused on neuroanatomy of activated eloquent structure, functional neuroimaging, neurological assessment, indication, and recommendations of different therapeutic managements. Fifty-nine recommendations were summarized, including 20 in Class I, 30 in Class IIa, 9 in Class IIb, and 2 in Class III.Conclusions: The management of eloquent bAVMs remains challenging. With the evolutionary understanding of eloquent areas, the guideline highlights the assessment of eloquent bAVMs, and a strategy for decision-making in the management of eloquent bAVMs.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Chinese Cerebrovascular Neurosurgery Society and Chinese Interventional & Hybrid Operation Society, of Chinese Stroke Association Clinical Practice Guidelines for Management of Brain Arteriovenous Malformations in Eloquent Areas

et al. 2021

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“…The young population has a long-life expectancy which necessitates solid decision-making in the case of brain AVMs that carries a non-negligible risk of rupture at any point of their lives. [1][2][3][4][5]13 Our study included 57 pediatric cases, most of them with hemorrhagic AVMs, and it aimed to analyze the pattern and outcome of these cases in pediatric Egyptian population. The mean age of our study population was 12±4.5 years.…”

Section: Discussionmentioning

confidence: 99%

“…1 Most cerebral parenchymal AVMs are diagnosed between 20 and 40 years, and only around 20% of them are diagnosed before the age of 15 years. 2,3 However, a greater tendency to bleed is recognized for AVMs among young patients, with higher rates of major morbidity and mortality. In fact, pediatric AVMs represent the most common cause of spontaneous intracerebral hemorrhage (ICH) in children.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcomes after Endovascular Oblitraion of Pediatric Arteriovenous Malformation : A Multi-Center Analysis

Sultan

Abouzeid²,

Shadad³

2022

Pan Arab Journal of Neurosurgery

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BACKGROUND:Although pediatric arteriovenous malformations (AVMs) are relatively rare, they carry a higher rate of rupture than in adults. Pediatric AVMs could also present with recurrent seizures or headaches. Endovascular embolization is usually achievable in pediatric AVMs with increasing complete obliteration rates, especially in cases with small AVMs. It also serves as adjuvant therapy with microsurgery or radiosurgery in larger AVMs. Long-term follow-up is required to confirm the efficiency of endovascular AVM obliteration, especially in young populations with the longest life expectancy. OBJECTIVE:The aim of the study was to perform a multicenter analysis of embolized pediatric cerebral AVMs regarding the clinical and radiological outcomes with a long term follow up. METHODS:A retrospective study of 57 pediatric patients diagnosed with cerebral AVMs and admitted to departments of neurosurgery at Alexandria, Sohag and Tanta University hospitals was conducted. All patients were subjected to clinical and radiological assessments. Endovascular embolization was done for all cases in one or two sessions. Complementary treatment included microsurgery and radiosurgery. Clinical and radiological follow-ups were done for all patients for at least one year. The outcome measures were angiographic disappearance of the AVM nidus and neurological improvement on clinical followup. RESULTS:The study included 57 pediatric patients with age range between 4-18 years. Fifty-four patients (94.73%) presented with intracranial hemorrhage and 3 patients (5.26%) presented with seizures. All patients were treated with endovascular embolization as a primary modality of treatment. Total obliteration of the AVM was achieved in one session in 30 patients (52.63%) and in 2 sessions in 8 patients (14.03%). After endovascular embolization, 7 patients (12.28%) underwent microsurgical excision, and another 12 patients (21.05%) were referred to radiosurgery. All patients had no permanent morbidity or mortality related to the embolization technique. Five patients (8.77%) had transient neurological deficits. One patient had minimal subarachnoid hemorrhage (SAH) due to microwire perforation and another patient had temporary pulmonary edema due to the effect of dimethyl sulfoxide on lung; both patients improved with medical treatment. One patient had a retained tip of a microcatheter which was removed with surgery.CONCLUSION: Endovascular embolization is a safe and effective technique as a single modality in the management of pediatric AVMs. It has extended the role of microsurgery and radiosurgery to treat previously non-curable high-grade lesions. Long-term follow-up over 3 years confirms stable occlusion. A longer follow-up is still needed due to the long life expectancy.

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“…The treatment for AVMs aimed to minimize the risk of blood vessel rupture and resect lesions. Currently, treatment approaches mainly include microsurgical resection, endovascular embolization, and stereotactic radiosurgery [1,2,26].…”

Section: Discussionmentioning

confidence: 99%

Single-center Retrospective Analysis of One-stop Hybrid Surgery for Brain Arteriovenous Malformations

Wang

Shi

et al. 2021

Preprint

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Objectives To evaluate the safety and effectiveness of one-stop hybrid surgery of microsurgical resection combined with preoperative embolization or intraoperative angiography for brain arteriovenous malformations (bAVMs) and compare the efficacy of one-stop hybrid surgery with nonhybrid surgery (endovascular embolization alone) in the treatment of bAVMs. Methods A single-center retrospective study was performed to recruit 70 patients with bAVMs at our hospital between July 2017 and April 2020. Patients were divided into 2 groups depending on the mode of surgery: hybrid group (i.e., microsurgical resection combined with preoperative endovascular embolization or intraoperative angiography in the hybrid operating room), and nonhybrid group (i.e., endovascular embolization, stereotactic radiosurgery, or microsurgical resection alone). The hybrid group was divided into two subgroups: the microsurgical resection combined with preoperative embolization, and the microsurgical resection combined with intraoperative angiography subgroups. All patients’ demographic variables, clinical manifestations, and imaging features, postoperative complications, and long-term clinical prognosis were recorded and analyzed. Results Among 70 patients, 48 (68.6%) of whom presented cerebral hemorrhage due to bAVMs rupture. 36 (51.4%) patients in the hybrid group were treated with the combination of pre-operative embolization or intraoperative angiography combined with microsurgical resection, whereas 34 (48.6%) in the nonhybrid group underwent embolization alone. There was no statistical difference in gender, age, ruptured bAVM rate, Spetzler-Martin grades between the 2 groups. Regular clinical and radiological follow-up examinations cure rates were 94.4% in the hybrid group compared to 38.3% in the nonhybrid group (P<0.01). The percentage of patients with favorable outcomes was 94.1% in the hybrid group and 90.6% in the nonhybrid group, although this difference was not statistically significant. Conclusions One-stop hybrid surgery could be a safe and effective intervention to treat bAVMs clinically, whereas further follow-up is needed to determine the long-term effects after operation.

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Safety and outcome of combined endovascular and surgical management of low grade cerebral arteriovenous malformations in children compared to surgery alone

Cited by 16 publications

References 37 publications

Chinese Cerebrovascular Neurosurgery Society and Chinese Interventional & Hybrid Operation Society, of Chinese Stroke Association Clinical Practice Guidelines for Management of Brain Arteriovenous Malformations in Eloquent Areas

Chinese Cerebrovascular Neurosurgery Society and Chinese Interventional & Hybrid Operation Society, of Chinese Stroke Association Clinical Practice Guidelines for Management of Brain Arteriovenous Malformations in Eloquent Areas

Long-Term Outcomes after Endovascular Oblitraion of Pediatric Arteriovenous Malformation : A Multi-Center Analysis

Single-center Retrospective Analysis of One-stop Hybrid Surgery for Brain Arteriovenous Malformations

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