Surgical strategies for management of pediatric arteriovenous malformation rupture: the role of initial decompressive craniectomy

LoPresti, Melissa A.; Goethe, Eric A.; Lam, Sandi

doi:10.1007/s00381-020-04501-0

Cited by 14 publications

(9 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our literature review revealed that a commonly referenced recommendation was delaying resection for approximately 4 weeks. 14,16-18 Preliminary analysis demonstrated that most ruptured AVMs in our series were treated on or before the 20-day mark. To accentuate the difference between the “early” and “delayed” groups, we selected the earliest time point within a 3- to 4-week window.…”

Section: Methodsmentioning

confidence: 84%

“…6 Despite advances in microsurgical techniques, microscope visualization, and preoperative imaging modalities, many modern reports still recommended delayed and even staged resections for ruptured AVMs. 14,[16][17][18] However, even among those advocating for a delayed treatment strategy, marked variability exists in the length of delay recommended between rupture and surgery, further highlighting the ongoing controversy surrounding this topic. Beecher et al 16 supported delaying surgical AVM resection for 4 weeks to allow for hematoma reabsorption and better radiological visualization of the AVM.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, earlier studies have failed to demonstrate that improved outcomes are associated with delaying surgical treatment for ruptured AVMs. 6,14 Therefore, we analyzed the clinical outcomes and hospital costs associated with early and delayed treatment of ruptured cerebral AVMs to determine whether early surgery is justified.…”

mentioning

confidence: 99%

“…2,5,13 Therefore, after the initial intracranial hemorrhage, the standard treatment for ruptured AVMs consists of surgical resection with or without endovascular embolization. 14,15 However, the timing of surgical resection remains controversial, with considerable variability among centers. 6,14,16…”

mentioning

confidence: 99%

“…14,15 However, the timing of surgical resection remains controversial, with considerable variability among centers. 6,14,16…”

mentioning

confidence: 99%

See 4 more Smart Citations

Early Treatment of Ruptured Cerebral Arteriovenous Malformations: Analysis of Neurological Outcomes and Health Care Costs

Baranoski,

Koester,

Catapano

et al. 2023

Neurosurgery

View full text Add to dashboard Cite

BACKGROUND: The timing of surgical resection is controversial when managing ruptured arteriovenous malformations (AVMs) and varies considerably among centers. OBJECTIVE: To retrospectively analyze clinical outcomes and hospital costs associated with delayed treatment in a ruptured cerebral AVM patient cohort. METHODS: Patients undergoing surgical treatment for a ruptured cerebral AVM (January 1, 2015–December 31, 2020) were retrospectively analyzed. Patients who underwent emergent treatment of a ruptured AVM because of acute herniation were excluded, as were those treated >180 days after rupture. Patients were stratified by the timing of surgical intervention relative to AVM rupture into early (postbleed days 1-20) and delayed (postbleed days 21-180) treatment cohorts. RESULTS: Eighty-seven patients were identified. The early treatment cohort comprised 75 (86%) patients. The mean (SD) length of time between AVM rupture and surgical resection was 5 (5) days in the early cohort and 73 (60) days in the delayed cohort (P < .001). The cohorts did not differ with respect to patient demographics, AVM size, Spetzler-Martin grade, frequency of preoperative embolization, or severity of clinical presentation (P ≥ .15). Follow-up neurological status was equivalent between the cohorts (P = .65). The associated mean health care costs were higher in the delayed treatment cohort ($241 597 [$99 363]) than in the early treatment cohort ($133 989 [$110 947]) (P = .02). After adjustment for length of stay, each day of delayed treatment increased cost by a mean of $2465 (95% CI = $967–$3964, P = .002). CONCLUSION: Early treatment of ruptured AVMs was associated with significantly lower health care costs than delayed treatment, but surgical and neurological outcomes were equivalent.

show abstract

Section: Methodsmentioning

confidence: 84%