Same day embolisation followed by microsurgical resection of brain arteriovenous malformations: a single centre early experience

Brown, Daniel J.; Graham, Christopher; Smith, Aubrey; Storey, Mathew; Robson, Craig; Maliakal, Paul; Kounin, Gueorgui; Castanho, Pedro

doi:10.1080/02688697.2020.1765972

Cited by 6 publications

(4 citation statements)

References 8 publications

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“…All studies confirmed postoperation AVM obliteration by either digital subtraction angiography or MR angiography (Table 1). Nine studies reported the interval time between the endovascular embolization and surgical resection, which were single stage (i.e., endovascular embolization followed by surgical resection on the same day with no interval) in Kocer et al, 48 Chen et al, 52 Song et al, 55 Brown et al 57 ; 1 day in Conger et al, 39 and Schramm et al 46 ; 2.5 days in Catapano et al 58 ; 1 week in Hongo et al 30 ; and 2 weeks in Hartmann et al 32 As the outcomes of surgery with and without preoperative embolization were comparable in these studies, it seems that the reported interval did not affect the outcome.…”

Section: Resultsmentioning

confidence: 99%

Microsurgery versus Microsurgery With Preoperative Embolization for Brain Arteriovenous Malformation Treatment: A Systematic Review and Meta-analysis

et al. 2022

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BACKGROUND: Preoperative embolization has traditionally been regarded as a safe and effective adjunct to microsurgical treatment of brain arteriovenous malformations (bAVM). However, there is currently no high-level evidence to ascertain this presumption. OBJECTIVE: To compare the outcomes of microsurgery (MS) vs microsurgery with preoperative embolization (E + MS) in patients with bAVM through systematic review. METHODS: We searched MEDLINE, PubMed, and Embase. The primary outcome was bAVM obliteration. Secondary outcomes were intraoperative bleeding (mL), complications, worsened modified Rankin Scale (mRS), and mortality. The pooled proportions of outcomes were calculated through the logit transformation method. The odds ratio (OR) of categorical data and mean difference of continuous data were estimated through the Mantel-Haenszel and the inverse variance methods, respectively. RESULTS: Thirty-two studies met the eligibility criteria. One thousand eight hundred twenty-eight patients were treated by microsurgery alone, and 1088 were treated by microsurgery with preoperative embolization, respectively. The meta-analysis revealed no significant difference in AVM obliteration (94.1% vs 95.6%, OR = 1.15 [0.63-2.11], P = .65), mortality (1.7% vs 2%, OR = 0.88 [0.30-2.58], P = .82), procedural complications (18.2% vs 27.2%, OR = 0.47 [0.19-1.17], P = .10), worsened mRS (21.2% vs 18.5%, OR = 1.08 [0.33-3.54], P = .9), and intraoperative blood loss (mean difference = 182.89 [À87.76, 453.55], P = .19). CONCLUSION: The meta-analysis showed no significant difference in AVM obliteration, mortality, complications, worse mRS, and intraoperative blood loss between MS and E + MS groups. For AVMs where MS alone has acceptable results, it is reasonable to bypass unnecessary preoperative embolization given higher postoperative complication risk.

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Section: Resultsmentioning

confidence: 99%

Microsurgery versus Microsurgery With Preoperative Embolization for Brain Arteriovenous Malformation Treatment: A Systematic Review and Meta-analysis

et al. 2022

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“…Most importantly, latent risks in the intervals of staged treatments were fundamentally diminished in the hybrid-modality treatment. Brown et al ( 141 ) reported their experience in 19 patients who received hybrid-modality treatment, in which neurological outcomes were similar with staged multimodality treatment without the occurrence of intracranial hemorrhage after embolization or microsurgery. Hybrid-modality treatment may be a safer method of curing eloquent bAVMs radically and effectively, but need to be further validated.…”

Section: Resultsmentioning

confidence: 97%

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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“…A recent meta-analysis of treatment for bAVMs demonstrated that complications were observed in 7.4% after microsurgery and in 6.6% after embolization [ 20 ]. Brown et al conducted the hybrid treatment in 19 bAVM cases, in which neurological outcomes were similar with staged managements without hemorrhagic events after microsurgery or embolization [ 6 ]. In our study, the clinical outcomes were similar between one-staged hybrid operation and multistaged operations ( P = 0.269 for both).…”

Section: Discussionmentioning

confidence: 99%

Multimodality Treatment of Brain Arteriovenous Malformations with One-Staged Hybrid Operation: Clinical Characteristics and Long-Term Prognosis

Jiang

Zeng

Zhang³

et al. 2022

Disease Markers

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Objective. We aimed to evaluate the clinical characteristics and long-term prognosis of brain arteriovenous malformations (bAVMs) treated with multimodality management of one-staged hybrid operation. Methods. We identified bAVM patients treated with one-staged hybrid operation from a multicenter prospective cohort study (NCT03774017) between January 2016 and June 2020. Patients were divided into unruptured and ruptured groups by the hemorrhagic presentation. Long-term (>12 months) neurological disability, postoperative complications of stroke, and nidus obliteration were evaluated and compared between groups. Prognostic predictors associated with outcomes were analyzed. Results. A total of 130 patients were identified in the study receiving one-staged hybrid operations, including 61 unruptured cases and 69 ruptured cases. Mean age was 29.1 years old, with 78 (60.0%) being male. Patients included in the study were followed up for a mean period of 37.4 (11.07) months. The annual hemorrhagic risk was 4.2% per year. Thirteen postoperative stroke events were detected in 11 patients (8.5%). Long-term disability occurred in 6.9% of cases, and 86.2% of patients experienced an unchanged or improved neurological status at the last follow-up. All patients achieved complete obliteration on follow-up angiographies. Increased AVM volume was associated with a higher risk of postoperative stroke (odds ratio (OR) 1.021, 95% confidence interval (CI) 1.006-1.037, and P = 0.006 ). Poor neurological status (OR 6.461, 95% CI 1.309-31.889, and P = 0.022 ) and infratentorial location (OR 5.618, 95% CI 1.158-27.246, and P = 0.032 ) were independent predictors for long-term disability. Conclusions. One-staged hybrid operation of embolization combined microsurgical resection can be performed as a safe and effective strategy for bAVM treatments. Long-term prognosis of complete obliteration with low rates of morbidity and mortality can be achieved. Unruptured and ruptured bAVMs acquired similar favorable outcomes after the multimodality treatment.

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Same day embolisation followed by microsurgical resection of brain arteriovenous malformations: a single centre early experience

Cited by 6 publications

References 8 publications

Microsurgery versus Microsurgery With Preoperative Embolization for Brain Arteriovenous Malformation Treatment: A Systematic Review and Meta-analysis

Microsurgery versus Microsurgery With Preoperative Embolization for Brain Arteriovenous Malformation Treatment: A Systematic Review and Meta-analysis

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

Multimodality Treatment of Brain Arteriovenous Malformations with One-Staged Hybrid Operation: Clinical Characteristics and Long-Term Prognosis

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