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      Embolization and radiosurgery for arteriovenous malformations

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          Abstract

          The treatment of arteriovenous malformations (AVMs) requires a multidisciplinary management including microsurgery, endovascular embolization, and stereotactic radiosurgery (SRS). This article reviews the recent advancements in the multimodality treatment of patients with AVMs using endovascular neurosurgery and SRS. We describe the natural history of AVMs and the role of endovascular and radiosurgical treatment as well as their interplay in the management of these complex vascular lesions. Also, we present some representative cases treated at our institution.

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          The stereotaxic method and radiosurgery of the brain.

          L Leksell (1951)
          Article 0 comments Cited 135 times – based on 0 reviews     Review now
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            Predictors of hemorrhage in patients with untreated brain arteriovenous malformation.

            H Mast, J. Mohr, B Khaw … (2006)
            Intracranial hemorrhage is a serious possible complication in patients with brain arteriovenous malformation (AVM). Several morphologic factors associated with hemorrhagic AVM presentation have been established, but their relevance for the risk of subsequent AVM hemorrhage remains unclear. The authors analyzed follow-up data on 622 consecutive patients from the prospective Columbia AVM database, limited to the period between initial AVM diagnosis and the start of treatment (i.e., any endovascular, surgical, or radiation therapy). Univariate and multivariate logistic regression and Cox proportional hazard models were applied to analyze the effect of patient age, gender, AVM size, anatomic location, venous drainage pattern, and associated arterial aneurysms on the risk of intracranial hemorrhage at initial presentation and during follow-up. The mean pretreatment follow-up was 829 days (median: 102 days), during which 39 (6%) patients experienced AVM hemorrhage. Increasing age (hazard ratio [HR] 1.05, 95% CI 1.03 to 1.08), initial hemorrhagic AVM presentation (HR 5.38, 95% CI 2.64 to 10.96), deep brain location (HR 3.25, 95% CI 1.30 to 8.16), and exclusive deep venous drainage (HR 3.25, 95% CI 1.01 to 5.67) were independent predictors of subsequent hemorrhage. Annual hemorrhage rates on follow-up ranged from 0.9% for patients without hemorrhagic AVM presentation, deep AVM location, or deep venous drainage to as high as 34.4% for those harboring all three risk factors. Hemorrhagic arteriovenous malformation (AVM) presentation, increasing age, deep brain location, and exclusive deep venous drainage appear to be independent predictors for AVM hemorrhage during natural history follow-up. The risk of spontaneous hemorrhage may be low in AVMs without these risk factors.
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              The natural history of symptomatic arteriovenous malformations of the brain: a 24-year follow-up assessment.

              Rani George, Stephen L Ondra, H Troupp … (1990)
              The authors have updated a series of 166 prospectively followed unoperated symptomatic patients with arteriovenous malformations (AVM's) of the brain. Follow-up data were obtained for 160 (96%) of the original population, with a mean follow-up period of 23.7 years. The rate of major rebleeding was 4.0% per year, and the mortality rate was 1.0% per year. At follow-up review, 23% of the series were dead from AVM hemorrhage. The combined rate of major morbidity and mortality was 2.7% per year. These annual rates remained essentially constant over the entire period of the study. There was no difference in the incidence of rebleeding or death regardless of presentation with or without evidence of hemorrhage. The mean interval between initial presentation and subsequent hemorrhage was 7.7 years.
              Article 0 comments Cited 114 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Surg Neurol Int
                Journal ID (iso-abbrev): Surg Neurol Int
                Journal ID (publisher-id): SNI
                Title: Surgical Neurology International
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 2229-5097
                ISSN (Electronic): 2152-7806
                Publication date Collection: 2012
                Publication date (Electronic): 26 April 2012
                Volume: 3
                Issue: Suppl 2
                Pages: S90-S104
                Affiliations
                [1]Interventional Neuroradiology Service, Clinica Tezza e Internacional, Lima, Peru
                [1 ]Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, NY, USA
                Author notes
                [* ]Corresponding author
                Article
                Publisher ID: SNI-3-90
                DOI: 10.4103/2152-7806.95420
                PMC ID: 3400489
                PubMed ID: 22826821
                SO-VID: 8ef5b1aa-784f-43c8-a6c1-a65fe8170bf2
                Copyright © Copyright: © 2012 Plasencia AR.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 27 February 2012
                Date accepted : 28 March 2012
                Categories
                Subject: Surgical Neurology International: Stereotactic

                ScienceOpen disciplines: Surgery
                Keywords: embolization,stereotactic radiosurgery,arteriovenous malformation
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: embolization, stereotactic radiosurgery, arteriovenous malformation

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